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rcdavis last won the day on February 22 2014

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  1. So go to the state board medical examiners web site, find the " look up a licensee" section, and you will find your answers
  2. The patient went missing and turned up dead. Makes it an unexplained death, requiring reporting and investigation.. Either by coroner or local police or both. The police have jurisdiction in all homicide cases unless a higher agency ( FBI) takes over claiming federal priority. They may want to be looking at the facility for ensuring patient safety.. Was patient sober and mentally competent? If not, the facility has an obligation to act in the patient's behalf.. Including restraining him from leaving if indicated. If the patient was competent, then he is able to leave without "permissi
  3. I agree with Andersen. Many many years ago, I did it for couple years until life circumstance pulled me back into EM setting. I found that rounds started at 0500 with whole team rounding on all day 1-3 post ops, all sicu and step down patients. With some floor rounding as time dictated. Surgeries started between 6 and 7 am and went on through the afternoon stopping anywhere between 3 and 7 pm depending on demand, surgeons, and complexity of cases. PA s were extremely well regarded, and ruled the floors and units. Docs and pas were integral and interchangeable .. The pa would often take
  4. No experience with national guard. Loads experience in nc, sc, and apollomd. First off, unequivocally can state that apollomd will do their level best to treat you right, to protect you and, should you get Ill or injured, stay behind you for a period of time that is entirely unreasonable to get you back on your feet. Personal experience speaking here. North Carolina in many ways is best pa state.. If you have what it takes to be a good pa, you will be respected, and will not have as much administrative "mid level belittling" as in other states ( sc, ga, ky). Your scope of practice is
  5. Dunno.. I recently had a chest wall pain with 3 ribs fractured. Did not want to take oxy or hydro or t3.. And found the best thing for me, especially at night, was combo ultracet and zanaflex.. Allowed me to sleep and not awaken with every rapid rib cage movement due to coughing, rolling over, etc. For someone like me, who does not take much pain meds, is a pretty effective analgesic.
  6. Thanks for the reviews.. Very informative, and seem to support the use of lido w epi if desired. The wound repair time frame is again helpful... Though unless the wound is cosmetically egregious I will not do closure after 24 hours unless is a delayed primary closure.
  7. Agree with ventana... Too many times I have seen an otherwise normal patient ( eg not drunk, high, no distracting inj) WALKING AT THE SCENE, taken down by EMS, c-collared and the strapped on the backboard. My feeling is, if you put 'em on the board, you take it off ASAP you arrive at the ED. Putting an unstable or burst vertebral burst fracture or a fractured pelvis on the backboard ( in a sober patient who can protect his corpus and airway) is an unnecessary form of torture. Unless you have a bivalved back board ( one which separates into two halves), rolling such a patient off the boar
  8. Physassist, I remember your lectures/ comments to us on the glories and wonder of the ACA, and how it was gonna save us individually and by family thousands of dollars, and how there would be no disruption in the caregivers we all had, and how the roles of the uninsured would over time disappear. How is that program workin out for ya? Multiple presidential executive exemptions to political cronies and the insurance companies, millions of people losing the insurance they were perfectly happy with, supplanting the minority of the previously uninsured to the point that we now have the sam
  9. Only way to treat pt #1, short of taking to the OR would seem to be load with ffp and, I would assume platlets as she probably is thrombocytopenia plus coagulopathic.. What did you do? #2 is more interesting.. Did the cp improve with improved hemoglobin? How did you address the GIB. UPPER OR LOWER? I am assuming LGIB. As an upper that severe would have required endoscopic bleeding control and I doubt you could have gotten ahead of the loss with PRBCs. Sometimes, as you we'll know, patients die. #2 sounds like she came close. No disaster for me.. Closest was 6 year old with florid
  10. When lido w epi was first introduced the strength of the epi was 1:200, hence the admonition " no lido in the nose, toes, fingers nor penis" due to protracted arterial spasming. Since the use of 1:1000 epi and 1:10,000 in dental epi, the above observations and case reviews are correct. Infact Most hand surgeons frequently use lido with epi. However, why use it on fingers? A good digital block with a tourniquet applied during the procedure should be all you need. In multiple generations of doing both simple and complex hand and finger repairs, I cannot recall the need for epi... V/r
  11. Think about this: employer provider malpractice has, as it's primary client, the employer. If it comes down to settling a claim by paying off, your input is not requested, it is a decision between the insurance company and the employer. Happened to me and the FIRST. I knew of it was a quick note from the national practitioner data bank.... Malpractice self insurance has one client: you. Nothing is done without your permission, within the restrictions of the policy. It is portable, providing you stay in the same classification of practice (eg emergency medicine, urgent care, family practice a
  12. Nah, I think is too short. I wouldn't strenuously object to doing both years 1 and two, with 3rd year optional if you can pass all 3 steps of the nmle... I think this would shore up academic short fallings and the holes in the PA education ( both in class and in practical experience) which make in separation between medical students and PAs. I wonder if, not having at least ms3 would negatively affect your ability to match. I do not see ms2 as a lot of free time to explore residencies..or to interview for them...
  13. Is not a standard unless stipulated in the basic employment contract. Most places that pay for these things consider it a cost of doing business and understand that each practitioner may leave during the license active period. Sorta chintzy on the employers part.
  14. you are getting good advise here. check state laws (what is minimum required). check hospital bylaws (as empa said, they are usually more restrictive), and see what the staff requires. then go to the senior partner. if the new guy doesn't want to play ball, drop him as a supervisor, and exclujde him from partaking in any profit sharing of monies you generate. my suspicion, however, is that he has the same reaction as many of our patients: "what's this? a PA? what is a PA? can they practice without a doctor? I'll see a doctor, right? " and he is a little sketchy about co-signing
  15. problem solving in clinical medicine by Paul Cutler. I read this book (last edition available is 1998, I think), in the mid-70s.. and couldn't put it down.. he presents maybe 70-100 patients, one at a time, and as each patients history was presented, I remember thinking "hey!, I have seen that patient!". he then goes on and explains the data gathering THINKING (not merely the collecting), and the genesis of a focused differential. Is sorta a classic. you will not regret reading it.
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