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Everything posted by rcdavis

  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 "permission" anytime he desires.. He assumes the consequences of his actions. This is opposed to the local police asking the facility to retain the patient or to call them when treatment is completed so the police can pick him up... Most hospital's try to comply, but in fact the hospital is not a police agency and cannot restrain or hold up any patient whom they have discharged... We medics are not a surrogate police force. So, I think the answer is, if the police are investigating the death, any facility in their "precinct " is subject to their investigation, federal or otherwise.
  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 an unstable floor patient back to the or, get all set up and open the chest before the surgeon arrived. Lines, tubes, pressors, wires, pumps, etc, were all purview of the floor PA. If you are on top of your game ( or want to be), find a Cts Which utilizes their PAs to do more than harvest vein/artery, and become studly. Lesser beings are found in the trenches of EM, trauma, cardiology, etc. Studs, however, are in the CTS suites and teams.
  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 what you and sp agree upon.. BME tells your what they expect, and will hold you to that. Previous president of BME was a PA. Lots of PA In Wilmington area.. Go figure.. But jobs can be had. You can make good cash if you are willing to work hard.. Or make reasonable cash working a less strenuous tempo, but better quality of life. Also, consider the Shumacher group for eastern nc EM jobs.. Another pretty good group, but not as good as apollo .
  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 board is extremely painful, and in fractured pelvis, potentially vascularily dangerous. Depending again on level of consciousness and sobriety, if significant trauma I would still like spine until I can clear the spine.. But the back board in a non extricated patient should become yesterday's tool.
  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 same number of medically uninsured/underinsured as we had before, 6-7 million of the newly insured are "on shakey grounds" when it comes to having told the truth and are falsely claiming eligibility for subsidies we taxpayers need to pay, etc, etc etc. What a disaster. Thanks a lot. You should have known better, but you have drunk the progressive kool aid and used your position here to buttress a flawed program supported by 2 essential lies ( "can keep my doctor", "can keep my insurance") which now is beginning to be appreciated as the sham it is. Review your postings circa 2010 . You might want your 1000 back. I'd like to see the grief this program has wrought immediately fixed by abandoning it.
  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 PSGN, edema, hypertension 200/115, 4 plus protein urial.sent to Peds nephro for Dmission and bx for crescent bodies ... (To see if steroids would help). Nothing c.w. Y'all in the wild Wild West Rc
  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 Davis
  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 all can be clumped together ... Surgery or surgical sub specialities probably will need individual policies - orthopedics vs obstetrics, general surgery vs ophthalmology.. Etc). It is ALWAYS better to have your own policy.. Especially if the employer provided insurance wants to settle and your insurance company doesn't. Well worth the money.
  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 charts of patients he has not seen ("hey, in residency, as a pgy 3 I still had to present patients to my attending") la good compromise would be for him to not cosign any charts (and not get paid for those patients), until he sees the quality of work you all do..and gets a chance to review 'from a distance' what you see, how you think, etc. this happens a lot with docs either from overseas or from training institutions that do not use PAs. trust me, his attitude will pass.
  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.
  16. Yeah..hey, contrarian.. As nat said, I was sorry to see you pop smoke and vamanos. Glad as hell you are back
  17. Yeah but you may not be legislatively able to.. You probably out to mask the metal in justin bieber clothes
  18. Review the pa legislation ( is a state statute), which will enumerate what legislative okay and no-no s there are a-la " the PAs may not prescribe heavy metal therapy, for example. Read this and see if there are legislative prohibitions. Then review the enabling legislation from the medical board ( which can be more restrictive). Again look for specific prohibitions. Then review the institutional PA credentials... Many times it is this, the institutional requirements ( driven a lot of times by insurance reimbursement) that have created the problem. If it is not insurance but departmental ( eg radiology doesn't want the PA to be independently ordering invasive, expensive or high exposure tests without MD involvement).. Then you have an opportunity to change things.. Education, politics, and interdepartmental meetings to change the status quo. Same for drugs. Georgia is terrible for PAs. It will take a multidisciplinary task force to get the legislature to enable the PAs to write for CNII... Emory, GAPA, GaBoardMedical Examiners, Ga board pharmacy, etc...
  19. Nope. In patient medicine is like riding a bike. Once you have learned the fine art of chart combing and data collection, and once you have brought yourself up to speed on national, regional and institutional regimens for the various infections you will see, pneumonia, bacteremia, sepsis, etc, and once you've learned what resources your institution has to help you ( discharge planning, social work, placement assistance, etc), it is all gravely, one week on the job and it will all comeback to you. What family medicine or internal medicine will give you, that inpatient medicine will not, is perspective. And a more thorough understanding of pathophysiology If you apply yourself diligently to those clinics for 3 years, study, study and study some more, the subsequent 10 years will be easier and infinitely more enjoyable. You will know enough to begin a career in the ED, needing only to expand your clinical interventional skills and to understand the peculiar ED priority and disposition mindset... .
  20. Just as an aside, Jeff, what is the proper tx? The PICC associated clot is not due to an inherent congenital coagulopathy, I consider it akin the a DVT of immobility.. 3-6 mos anticoag ( I like xaralto or any of the factor xa inhibitors in young otherwise healthy patients who are not going to be playing sports or subjecting themselves to head trauma over Coumadin), then stop. But, once it occurs there still is the risk of clot fragment.. And, IMHO, the PICC Must come out. Which means either another PICC or a portacath. I am excluding any extrinsic hyper coagulate state: eg cancer from this conversation. Comments?
  21. How important? Very. Think of your first job as the time you take to solidify the mush and muck of data you have been swimming it.. You need to use the data and watch its application in real patient scenarios so that you actually come to trust it, and yourself, as it gels into a solid wall of experience. This becomes your fundamental base core, onto which everything else is built. This job is so important, I would recommend a 30,000 dollar a year pay cut sacrifice to get an opportunity to work anywhere where they will teach you and give you extra training. The lost bucks will easily be replaced later. Cannot express this jobs importance.
  22. Here it is, again. ASSISTANT Denegating what we do, for and to whom. Until the NPs finagled themselves into an approved provider status, I really didn't care. But hearing now how insurers make the, to them, obvious conclusion that the work "assistant" is a the noun and physician is the adjective, we will forever be classified as medical assistants, office help, etc. Thanks AAPA. Thanks a lot.
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