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MTOPAC last won the day on June 29 2016

MTOPAC had the most liked content!

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  1. As someone who is, as of today, 1 year out from graduating PA school - do a fellowship. I really don't think there is another way to get into EM. Also, as someone who excelled in PA school and had no difficulty with the PANCE, I can't have imagined stepping into the ED as a provider without a fellowship. I was apprehensive about doing a fellowship, but hindsight is 20/20
  2. There is about 1 month left of access on my rosh question bank access, however there are still several boost EOR exams that have a later expiration date. The boost pance power pack has even longer. I am also selling my PANCEmaster question bank access. This does not expire (it expires when you submit your passing PANCE score, which I just have neglected to do). Shoot me a message if interested.
  3. To start off, I considered posting this in the TN state specific discussion, however it is a very slow sub and figured I may get more responses here. Move if appropriate, thanks. I'm a soon to be graduate in May and have a PANCE date of May 15. A potential employer is asking how soon I would have licensure in the state of TN after graduation. I have no idea how long it takes to get licensure in the state after passing the PANCE, and i'm hoping there were a few Tennessee PAs here that could provide a time frame of how long it took them to receive licensure after passing the PANCE. Any help is greatly appreciated! Thanks
  4. Fair, I got a little excited and posted up quick before I had to leave. 69 year old AA female. I didn't list the meds because I personally did not right them down and I don't have access to the records at home. Ones I remember were lyrica 300, lisinopril 10, clonidine 0.1 and gabapentin 300. We didn't have PMH as this was the first time she was in our ER and there were no collateral to get any medical information from.
  5. 0 signs of fluid overload. Mucous membranes looked a little dry, tbh.
  6. Doing a CK was brought up, however not initially. I'm not sure if it was discussed during the consult between my preceptor and Internal, but after the consult my preceptor brought up to me that sometimes we would check a CK in these cases but there were more important things to worry about right now and it wouldn't change treatment plan (as you stated). We were never able to get any urine while she was in our care. She literally had 0 urine to run. Nothing came out of catheter, she was then US'd, nothing in bladder. She wasn't producing a drop of urine. As far as tachycardia - i brought your point up to my preceptor. I personally went through all her meds that came with her. There were no rate control meds in the grocery bag of ~8 scripts. It is possible that a blocker was left at home, however beta blockade as cause of her rate was on the radar. Thanks for your points. Again, the case itself was a great learning experience as well as the stuff y'all are bringing up.
  7. Again, I can't remember specific values, but I do remember everything on her ABGs being (L) or normal. I believe she was compensating. Her airway was fine, we did not think it needed to be protected. TBH, i'm not sure it even crossed our mind as she had good O2 sats, no labored breathing etc. However, we do think she was lying on floor for much longer than 2 hours. Her condition did not occur suddenly. Also, take it as you may - for the entire time she was in our ER (~3 hours) the son who called EMS (or any other family for that matter) showed up the the ER. It was our belief that she had been there for quite some time and was not cared after adequately.
  8. Patient was also placed in Bair Hugger warming system and still did not bring her temp up. However, seeing as we were continually intervening with her i'm not sure she was given much opportunity to warm up.
  9. Norepi was the pressor we were about to use. I guess the only reason we hadn't was because internal showed up and she had been admitted, even though still in ER. I appreciate the replies everyone. This case, while stressful, has taught me a lot. Thanks to my preceptor as well for reinforcing my decision making. Great learning case.
  10. Most of your questions I just addressed in Emed in my reply. If i didnt state it in my original post, one of the last things we did was place IJ central line to get access for Vanc and CVP. As we were doing central line clinical pharms were setting up 2 amps of Bicarb. Also, should be noted her EKG was normal. This case blew my mind. It seems the cases my preceptor is handing off to me are the crazy ones.
  11. TSH honestly never occured to me. I haven't seen it ordered on any chart i've been in while in the ER (granted, i've been there for 4 days). I'm going to keep that in mind. We were about to start her on pressors, but that is when Internal med came to ER bc patient was being admitted. I'm not sure if she ever got them, but it was certainly our next step as I had discussed it with my preceptor. She was not critical anemic, I remember her HGB being low 11's. Cant remember her electrolytes, however I remember sodium being mid 120's. It should be noted that the only *critical* labs, as noted by ER lab, were the BUN, Cr and blood pH. I was thinking distributive shock, however her extremities were cold as well. IIRC, characteristic sign of DS is warm extremities d/t vasodilation. Unfortunately, follow up will be tough. My preceptor is on vacay for a week, i'm not scheduled to be back in ER for 9 days. However i'm trying to pick up shifts w/ other docs because i love it so much. I'll update as I can.
  12. Heads up, long post. I'm in my 8th rotation which happens to be EM. This was a patient that came through the ER with altered mental status, and my preceptor told me it'd be a good one to work up. Turns out this would be the most ill patient coming through the doors on my first week there. My most pressing question (I didn't have a chance to ask my preceptor as things got crazy quick with this patient and the ER in general) is, was this patient in shock and if so what kind? She was in a stupor, but could be aroused to her name and painful stimuli. She would also tell you her name if you asked. Important to note. She was found lying on floor covered in feces by son who called EMS. EMS first BP reading was 62/40, they give 400cc of fluid. Second BP reading after bolus 70/44. We gave her 1L bolus in ER, BP now 74/50. Her heart rate this entire time stays in a narrow range between 70-76. This does not change during the entire course of ambulance ride, and her stay in ER before internal med takes over. We try multiple times to get a temp, but after 4 attempts on 2 different thermometers, (2 oral, 1 axillary, 1 rectal) they all error out. Patient also keeps screaming she is cold. We eventually place an indwelling rectal thermometer, which gave a reading of 34.0 celsius. Immediately started warming the patient. Minus the heart rate and body temp, it's eerily similar to the septic shock patient we had 24 hours previous, I want to work her up for septic shock. Preceptor agrees. I order CBC, BMP, Lactic acid, Procalcitonin, ABGs, Blood cultures and Chest xray. Order abx Zosyn 4g-0.5g with vanc to follow Now i'll jump to the good stuff. While waiting for stat labs patient continues to decomp, BP now 65/40. Specific labs I remember. Lactic acid and procalcitonin were completely WNL. WBCs 22.3. BUN 140!!. Cr 11.8! The real kicker was her blood pH...6.9 She was in a state of complete anuresis. So it was clear she was in a state of uremic encephalopathy, acute on chronic kidney disease and all that good stuff. But I just cant figure out why we couldn't get her blood pressure up. We eventually placed a central line which gave a central venous pressure of 2. At this point internal med docs came down and started taking over. They asked for another 2L of fluid to be pushed, yet that BP never came up. What was going on here?
  13. Hey guys, do any of you recent grads have any advice for preparing for the surgery PAEA end of rotation exam? I have done well on previous PAEA EOR's, using Rosh Review boost exams. I find the Rosh Review exams difficult, but doable and will score roughly 65-70% on them, and will subsequently earn a high B on PAEA exams. However, i'm 70% through the Rosh Surgery boost exam, and have roughly a 90% score. I feel like it is not going to correlate well with the actual PAEA surg exam, given that surgery is the second lowest scoring average of all the PAEA EORs. Any tips, or anyone have experience using the Rosh Boost exams and have taken all the PAEA EORs? Thanks
  14. Hey everyone! I'm supposed to be starting my clinical year in January with 2 family medicine rotations, however my program has not been able to produce any in the area. They *think* they can get me one that is an hour and a half drive away. That would be tough to do every day for 10 weeks, in an already stressful time. I'm hoping somebody here is willing to take me as a student, or can produce a lead for a provider who may be willing to accept me as a student for 5 weeks (but preferably 10 weeks). ANYTHING helps! I'm happy to provide a CV of my performance as well as my background in the medical field prior to entering into my PA program. Thanks so much -Michael
  15. Don't come with scripted answers. We change things asked between interview dates, and even individual interviewees. You might get asked what Ramyaziz said, you may not. I can guarantee you that if you sit in with me, I won't be asking you that. ;) Just be yourself. We know all that stuff about you anyway - through your CASPA application and personal statement. You received the interview invite because the faculty liked that much, now they want to get to know you as a person.
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