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kargiver

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kargiver last won the day on February 2 2018

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About kargiver

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    Just an old school EM guy...

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    Physician Associate

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  1. I'd like to see the DPH policy on this... as it makes absolutely no sense, epidemiologically, immunologically, or clinically. G
  2. Lots of good advice here... Ill add my 0.02 Can you give a 2 week notice? Mine is 90 days and every contract I've signed has had this clause. Pandemic possibilities do not mitigate the contractual requirement if it exists. FMLA - sounds like you have an out if you want to take it. This is a personal choice - only you can do what is right for you. There is no allegiance to the hospital as if the tables were turned, and they had to furlough you - there wouldn't be a second thought. G
  3. It perplexes me that people who are anti-vax (and even many among us as medical providers) don't really know the history of how vaccination came about, the role of Jenner, how people were re-infected with smallpox to prove that cowpox vaccination was actually protective, and the role of ethics in all of this. Semantics are just that - semantics - to try to dissuade one from an overwhelming argument. This is what my 5 yo son used to try to do. Vaccination at its core is all about cause and effect - eliminate the cause and there can be no effect. But to try and use "Koch's" postulates against anyone as a means to disprove the efficacy of vaccination is, well, absurd. Rev - thanks for blocking JMPA; strikes me as one who thinks Zenos Paradoxes are the only way to see the world around them... G
  4. The responses to this thread are certainly interesting... and run the gambit of what one would expect. It is not unreasonable to think of oneself in times like this when those who are supposed to provide for us have failed to do so, and in doing so, have made it impossible in some places to do our jobs - not without severe risk to ourselves. This is not a reasonable standard to which anyone can be legally held - you may have to fight with your medical boards but in the end, you are not obligated to expose yourself to harm without protective equipment as part of your job. The ED is our scene. The first principle is scene safety. If you are not safe, you just don't go in. Me being dead does no one any good. G
  5. There are exceptions to the science that have not been identified yet. The early mortality curve is "high," but this is an artificial construct of both case definition and lack of testing on a large scale. One only need look at South Korea for a better epidemiological presentation of what this novel virus actually does. Additionally, this virus will mutate to being less virulent over time otherwise it WILL burn itself out. This is going to happen much quicker than most people appreciate. There are already 2 strains circulating (suggesting a strong mutation has already occurred). That's just the calculus of its virology. That strain which mutates "best" will propagate itself best. Just how natural selection works. Further, the influenza vaccination rate is estimated at being 10% effective this year - dismal by any standard - and it too spreads before someone is acutely ill and can sit on furniture, counters, etc and infect others when inadvertently touched. We tend not to fret about it though because we are used to seeing it. It will be no different with this virus as well. The South Korean model is doing quite well at identifying who is infected, who is really sick, and treating them early. This is contributing to their lower mortality rate. Of course, it requires a paradigm shift in thought and response, one that has not been embraced thus far, but one hopes that WHO advocates for this approach and it is adopted by CDC. Thus far their response has been less than stellar. This is scientific criticism, not a political one. Finally, I do agree, our current resources CANNOT handle it, not in the manner we are going about it, and it will not get better before it spreads much, much further into the community at large and we start weeding out "sick from not sick," and focus on the ones who actually need aggressive treatment (similar to the South Korean approach). This i think we can handle, as this surge is coming late in the winter months and into early spring (even though there is a second wave of Influenza A currently making the rounds as well). Hopefully we get it into gear... G
  6. Its an interesting question... but why now? Have we never considered this with other infectious diseases OTJ, the real risk of violence from patients, offended co-workers, etc, or any other unforeseen risks that we inherently encounter practicing medicine? Worked as a medic for a long, long time and been a PA for quite some time now as well. I considered this when I was 18-19, reassessed it in my early 20s when I got married, again in grad school, and again when I had a kid - but the answer is always the same: If I wanted a safe job I'd be a police department accountant. G
  7. I don't know the exact numbers - they aren't published anywhere and last I knew was 2013-14 numbers. ACEP was bigger then - I suspect its bigger now. Certainly been around much longer. There is a lot of in-fighting between AAEM and ACEP - I consider ACEP real world and AAEM the academy. Like most in the academy, they are out of touch with reality... and so it goes. ACEP has at least accepted the reality that working with APPs is the future and that the idea that a board certified ED physician can and will staff every ED in the country isn't realistic. There is a lot of angst behind the scenes politically about APP encroachment but as time has shown, it just isn't warranted. When dealing with groups around the country, I came to the conclusion that most APPs self-select to lower acuity positions (they actually buy into what is taught to them that they don't know it all and aren't expected to) and it's the rare breed that steps into the role of "independent level" practice in any ED setting and is able to flourish. G
  8. AAEM has been, and continues to be, difficult in dealing with regarding relations with other providers and getting along in the sandbox. When dealing with them politically in the past, they have always maintained the sanctimonious position that docs are the "be all, end all" of healthcare and everything revolves around them. When presented with real issues, their parroted line has always been "a board certified MD/DO has to be in charge." Of course, this is completely devoid of reality, just as their various position statements are, but they sure are good at fanning the flames... Their collective approach has always struck me as that of a spoiled child not getting their way and throwing a tantrum about it. and so it continues... G
  9. Have to be familiar with all of these procedures as many times, when landing at critical access or other small facilities, you are performing the procedures before moving a patient. I have run many side by side resuscitations with myself leading one and a member of a flight crew leading another. Nature of the beast. G
  10. I practice to the best of my abilities, have good medical malpractice insurance, and try to be nice to people. Its all you can do. Medicine is the only profession where you are held to a 100% correct standard every time. Its a hard pill to swallow. But frankly, I don't give a sh*t. I love what I do. I don't let others control that joy for me. G
  11. Giving some to a CVC patient as I review and answer this thread. It has become by first line medication for CVC. I don't bother with anything else anymore - Haven't had a need for it. Takes about 15-25 min to kick in (a touch longer if I give it IM, which I generally prefer). Haven't really encountered the need for IV tylenol - suspect its a difference of practice approach. G
  12. This is overkill IMHO. Have worked across the gambit of ER types (academic, rural, suburban, etc) and what I have consistently encountered (if other services available at hospital) was 1 provider for sedation, 1 for procedure, RT for airway and nurse for nursing. In facilities that do not have all these capabilities (where I currently work for example) I do the sedation and procedure with RN at bedside managing rest. If third set of hands available, great. If not, meh. Of course, if complication occurs - procedure aborted. Most limitations I have come across for sedation policies and procedures have been anesthesia department driven and/or larger facility bylaw-based. All nonsense IMHO... G
  13. Sure does. in a vacuum. Nothing exists there though. Going after a SNF with an APS complaint will open floodgates hereto not considered. The point is - watch your back with issues like this. G
  14. Yes you can bill. See patients all day long from the FP clinic downstairs that require more extensive work-up or admission. 2 separate services, 2 separate bills.
  15. One can easily make the case this is tantamount to, at least, elder neglect, and requires reporting to Michigan Adult Protective Services for investigation. Just understand, ethics aside, you are opening a can of hurt for a lot of people with something like this and if the shit ever hits the fan, you will be the one hung out to dry. https://www.michigan.gov/mdhhs/0,5885,7-339-73971_7119_50647---,00.html Good luck, G
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