karebear12892

Does TeamHealth still offer this course? Did a quick Google search and wasn't able to find it.

I appreciate everyone's input! It sounds like I'll need to discuss this with the AZ state medical board. If they say I need an AZ state license, then that's what I'll do. To be clear, I'm not expecting to have the same scope as a PA in primary care while volunteering in this capacity. The physicians that volunteer their time are not always on site - they are present perhaps 1/3 of the time. In fact, most of them are not licensed to practice in AZ. The infirmary is staffed by volunteer RN's 24/7. I understand I am obligated to act if (knock on wood) something disastrous happens (and yes, I will make sure I have liability insurance in place should this occur), but barring extraordinary circumstances, my role would essentially be the same as the camp nurses. Just want to go about this through the proper channels. Thanks, y'all!

In high school and college, I used to volunteer as a camp counselor at a non-profit overnight summer camp for economically disadvantaged children. I am about to finish PA school and I'd like to return this summer to volunteer my time and skills in the infirmary. The camp director knows me well and wants my help. However, up until now, only physicians and nurses have volunteered. Has anyone here done something similar? Any ideas on what I would need to do in terms of having a supervising physician (on site vs. phone call away), scope of practice, etc.? I wasn't planning to get licensed in the state where the camp is located (AZ) - is that something I'll need to have in order to volunteer there? I'm quite sure my duties would not extend beyond basic first aid and dispensing Tylenol/Motrin/previously prescribed medications as scheduled. I'm guessing anything more involved would probably mean a trip into the town's urgent care office for the camper. Any input on how to go about this would be greatly appreciated!

You don't have to love it. You don't even have to like it. You just have to get through it. I majored in business in undergrad because I found it a whole lot more interesting and easier than biology, chemistry, etc. I really struggled with undergrad science and barely got the grades I needed to gain acceptance to PA school. But now that I've "jumped through all of the hoops" I needed in order to get to where I wanted to be, my classes in PA school are far easier and more enjoyable than any science course I took in undergrad. Try not to get discouraged!

"True indepent practice = go to med school. Not PA or NP school" Well yeah, obviously. No one goes to PA school with the intent of practicing 100% independently. Were you really not aware of this when you applied?

I remember seeing one of your prior threads - looks like that extensive scope of practice as an MA really paid off. Congratulations!!

Great case! Please share more of them in this format. Great way for us to learn. Thanks so much!

Bottoms are true to size/length but I would get a size smaller than what you normally wear in tops. I am 5'3", 130 lbs, 34DD and normally wear medium sized T-shirts/tops, but I wear a small in FIGS scrub tops and could probably fit into an XS if I wanted a more fitted look. I really like the Catarina tops and Livingston bottoms.

Great advice! I'm not planning on a career in IR, but I might still purchase a used copy of one of the books you recommended and sell it back to Amazon at the end of the rotation, just to have a solid reference available. I am familiar with the Seldinger technique from central line placement in the ER but will definitely read up on it more. Thank you so much!

For those of you who have done an elective rotation in IR or currently work in IR - any recommendations for study materials to help me prepare? Generally prefer print over online content but open to all suggestions. I don't have a strong radiology background outside of the ER so I want to start studying for this rotation ahead of time. Thanks in advance!

Another vote for FIGS scrubs. I refuse to wear any other brand now! They're awesome!

All right, I'll give it a go: 1. Reassess ABC's. Given this patient's neurological status, I'm concerned about his ability to protect his airway and prevent aspiration. I would have a low threshold for intubating this patient while keeping his head elevated as much as possible due to likely increased ICP. Recheck cardiac monitor - does he need BP control at this point? 2. Reassess GCS. Is he still able to answer questions? Any seizure activity? Posturing? Change in his pupils? 3. Need to control his vomiting so that we can obtain stat head CT. If his vomiting is indeed due to increased ICP, then IV steroids should help, as well as IV Zofran or Reglan (not sure if one over the other would be preferred in this scenario). Based on the abrupt change in his condition, I would consider obtaining a non-contrast CT of his head instead of the CTA for now since it can be done more quickly. 4. Do we have any labs back? Depending on his sodium level/hydration status, he may be a candidate for Mannitol.

2nd year PA student here. I'll procrastinate my OB/GYN studying by adding in my two cents. History: -Was this incident witnessed by anyone at the facility? Anyone know how long he was down? Last known well time? -Medication list? History of MI/HTN = good chance he's on a beta blocker, in which case a HR of 98 may be falsely reassuring. Would also be curious to know if he is on anticoagulants given his history. Probably not on anticonvulsants w/ no PMHx of seizures but I'd double check. Also make sure he isn't on anything else that would warrant measuring a serum level (ex: Digoxin). -Any family, friends, neighbors, staff, etc. present to provide additional history? Similar episodes in the past? Complaints of anything earlier in the day, prior to the incident? Any new medications or changes in his medications? Recent surgery? History of alcohol/substance abuse? PE: ABC's intact as described above. Some things I'd be looking for on secondary survey along w/ differentials, specifically based on what we know so far: -HEENT: pupil size/reactivity/nystagmus (toxic ingestion? bleed?), Battle's sign/raccoon eyes/hemotympanum (ICH?), other head trauma, tongue laceration (if present, midline or lateral? Helpful in distinguishing syncope vs. seizure...if he has teeth). Oral mucosa = dry or moist? -Neck: Posterior midline tenderness (C-spine injury from fall?), nuchal rigidity (meningitis?), carotid bruits (stroke?) -Cardiac: NSR on the monitor is reassuring but cardiac arrhythmia is always on the differential in syncope (if that's what occurred). -Lungs: You mentioned lungs sounded clear, SpO2 94%....always a concern for pneumonia/influenza in elderly patient w/ AMS...would risk stratify for PE with Wells. Recent literature suggests PE causes syncope more than we realize. He cannot be PERC'd. -GI/GU: Check bowel sounds, hepatosplenomegaly (could he be encephalopathic?), tenderness (looking for non-verbal pain cues....specifically CVA/suprapubic tenderness; always consider UTI in elderly patient w/ AMS), evidence of bladder/bowel incontinence (also helpful in distinguishing seizure vs. syncope), check hemoccult (could be anemic from GI bleed, would also get a rectal temp) -Skin/Extremities: Looking for rash, capillary refill/skin tenting (hydration status?), assess ROM (trauma from fall?), asterixis (again looking for encephalopathy), track marks (unlikely in this patient but hey you never know), jaundice, assess calf circumference/lower extremity edema. -Neuro: GCS? Posturing? CN function? Reflexes? Gaze/EOM? Facial droop? Drift/focal extremity weakness? Hemiparesis? He may be nonverbal but his ability to follow simple commands and shake/nod his head yes or no dictates a large part of how the rest of the neuro exam will go. Plan: There's a good deal of overlap in terms of what I'd order for AMS/syncope/seizure in an elderly patient - as you mentioned, this would not be the time to be shy with ordering tests. My top priority in this patient following ABC's is obtaining a non-contrast head CT. My index of suspicion for ICH at this point is high. I agree with the above suggestions of EKG (electrolyte abnormality could cause a seizure, arrhythmia could cause syncope). Would obtain old EKG for comparison if available - with his history, it will almost certainly be abnormal. I also agree that we should not precipitously lower his BP and risk cerebral hypoperfusion in the event that he is having an ischemic stroke. He could be postictal but in this patient, I'd consider that to be a diagnosis of exclusion. May suggest additional diagnostics based on PE findings but I'd probably start with (in addition to the above) CBC, magnesium/phosphate (low levels may cause seizure), troponin, CPK (we don't know how long he was down....rhabdo?), lactic acid, D-Dimer, blood/urine cultures, influenza, urinalysis, chest x-ray, UDS, EtOH level, coags, type & screen, and CT neck (he cannot be cleared via NEXUS criteria). Gonna hold off on suggesting interventions for now, pending PE findings....but I would elevate the head of the bed to reduce ICP and keep him on a cardiac monitor. Great case. Thanks for sharing!

Just spoke yesterday with an emergency medicine PA in coastal South Carolina making $70/hr + hourly productivity bonus (some combination of patients per hour + RVU's) and he is averaging a total of $90/hr. He's only about 3 years out of school.

I was thinking the same thing. And if you don't stay four years, do you still get your loans repaid? "If I stay for 4 years, tail is 100% covered, if I stay for less I have to pay a portion myself".... be careful, this might mean a small portion or a very large portion. I'd want tail coverage provided, especially with a salary that low.