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surgblumm

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surgblumm last won the day on August 18 2019

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  1. Dead, but it's been one hell of a run. Filled with adventures, mainly victories and a few lousy patients or nurses who had a chip on their shoulder but otherwise strive to have fun and to make a difference.
  2. I read this three days ago and thought it was just trash written by a lousy author from Medscape.
  3. The horror of keeping a loved one alive at all costs He was in his ICU bed without movement or brain stem involvement. His weight was down to 90 pounds. His six-foot frame and skeletal body made me gasp. ADVERTISEMENT After countless sessions with the patient’s daughter to make her 92-year-old dad “comfort care,” the intensivist sadly hung his head down low. The daughter insisted on doing everything for her daddy. It was my night shift, and I knew what was to be expected. Another endless code. A futile event to please a family member. I’ll never understand this. He coded twice on this day. The ICU doctors called in the ethics committee. But that was a process, and we had run out of time. He coded on me this night — his third code blue in 24 hours. We pushed the code blue button. The nurses, an intensivist, a virtual ICU MD, respiratory therapists, and CNAs to assist in CPR showed up promptly. We all had our roles. He was already on the ventilator. Unresponsive. Central line. Levophed, vasopressin, and bicarbonate drips infusing. His heart stood still. Asystole. The daughter and her husband insisted on watching the code. They wanted to make sure that everything that could be done was done. They said they would have their lawyer “after us” if we did not do everything. They watched us do CPR. They listened to his frail body as we cracked his ribs. They watched me push epinephrine, and we announced each medication we gave IV push — epinephrine every three to five minutes. The doctors begged the daughter to let us stop. He said that this treatment, this code was futile. It was brutal. Yet, she refused. After 15 minutes of CPR and never regained a pulse, asystole was his only rhythm. He essentially had “died” 15 minutes earlier. And the ICU doctor said: “Stop CPR.” The doctor addressed the daughter. “After 15 minutes of vigorous CPR, epinephrine IV push, your father has not responded. He is without a pulse. He died. There’s nothing more we can do.” I watched the daughter as she shook her head. “Daddy, you almost made it to 100 years. We tried daddy. We tried.” I was in disbelief. I could not comprehend the brutality in this, how this was so inhumane. How sad that we can end our own pets’ lives when they are suffering and dying, but we can’t accept humans to die peacefully. This scene tormented me for months. That song, “How could you be so heartless,” rang in my head over and over again. Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.
  4. Why did they not choose to get a Doctorate in Psychology?
  5. Surgblumm@gmail.com A PA by law in many states cannot supervise an NP and signing paperwork may be categorized as that. I was on the national board of Minute Clinic and started the first MC in NYS only to discover a few months later that I could only hire NPs because of the supervisory cost of an SP and a couple of months later discovered I could no longer be the Manager of operations because I could not supervise an NP in NY
  6. We recently passed legislation in the HOD that advocates for a name change and the Academy is going to endorse it, but what are we doing to advocate for ourselves with this new piece of PR? When you graduate you proclaim it to the world. When you become married you are filled with happiness and announce it to everyone. when you have a new baby you create excitement for your family and friends. When NPs started getting FPA they shared it with each other, with all of the medical boards and with institutions that hire them They were proud, excited and fearless and we see the result from their TV advertisements. President Kennedy thrilled the nation with his determination to put an American on the moon. “We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.” We need to have the same determination to use our accomplishment to notify all of the people at the table. We do not need to let the voices of physician organizations to shout louder than ourselves. Contact your state PA society and your AAPA BOD and encourage them to use this as a tool for OTP.
  7. AS I have surfed the social network PA sites, I have seen a number of people who do not understand that this is not our name yet. I don't need to preach to the choir as to what must be done between now and the official title change. I don't know what the Academy or any other leader can do but what has already been done. I would warn PAs not to use the title on their lab coats where they are giving patients the idea that they are more than a assistant until their state ratifies the change. I know I must be redundant.
  8. I think you have a nice deal and M-F eight hours a day is a gift to someone like me who normally worked 80 hours a week or more. You will need to bone up on your hepatology while you give your current practice notice. Their expectations should not be high for a transition but your previous work as a hospitalist , will be invaluable. Go for it!
  9. Looking at your four specialties, I would advise with one reservation on all but emergency medicine. I think your employer will need to know that you are a novice and be willing to give you OJT and a bit more supervision. For UC you need to be able to suture wounds well, read fracture radiographs and chest films at the least. EM is a tough nut unless they are willing to place you in Fast Track with another PA for a few months. I always ask this question when answering about the ER;" would you want someone with your experience to be making decisions on your children or loved ones? Simple things can be life threatening.
  10. Between SAS and Ventana, you filled in the information needed. I fail to accept the fact that so many of our colleagues are totally ignorant of the legislative aspects of medicine, particularly when it comes to NPS and PAs. I can praise the legislative savvy of many NPs all day but unfortunately we have too many ostriches with the credentials but not the understanding. That my friends is how physicians and administrators take the game ball.
  11. In reference to Scott's last post----Remember Samson. And the pillars did fall!
  12. Online courses are superb and can be watched or read at your speed and with interruption if you wish. SEMPA is the best conference for those in ER medicine as is Emergency Medicine Boot Camp. The APACVS is the best conference for Cardiac PAs and the preparation for PANRE courses is plentiful, I started Steve's course and do not need to pass PANRE because I am retired. Forget the cost of a program, add food, travel and hotel and you could be on a beach with your spouse drinking Pinacoladas and soaking up rays with a good sunscreen. IMHO.
  13. If this were our marriages, we would be giving our histories a toss to the wind too quickly. I have been at odds with many of the AAPA's opinions for decades but still maintain my voice in this marriage. I am a founder of PAFT and would not divorce this group so quickly. Do we pull the plug on sepsis or do we do our best to resuscitate? I call for some patience as we need to see how it plays out and what a new PAFT BOD can add to the mix. It changes from when it was created and will continue to be in a metamorphosis.
  14. Unless I am wrong, and I think I am correct, regardless of the HOD vote, it will still remain the vote of the AAPA BOD to make this a reality. All of the other arguments have been made over the past twenty five years and are, in my opinion, invalid. And to add to others, who gives a damn what the physicians of AMA think? We need to stand up as a profession like most of the girlie NPs who accomplished their goals.
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