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Everything posted by medic25

  1. The thought is that we can reduce the need for patients physically returning for things like wound checks and hopefully cut down on bounce backs and re-admissions if we can check in on some higher-risk patients. Not sure how the billing will work; above my pay grade I'm afraid...
  2. Anyone who has experience with seeing patients virtually in a telemedicine setting have tips or advice? Our ED is running a pilot project doing follow-up visits with ED patients using video visits. I can definitely see challenges to the loss of hands on examination, access to vital signs, etc.; love to get some advice on how to get the most benefit from the trial.
  3. I've had to do the same education with topical lidocaine jelly for NG tubes with our nurses. They'll use it as the lubricant for inserting the tube and think that the local is ineffective; once I told them to have the patient snort the jelly then wait 20 minutes, all of a sudden NG tubes are amazingly much more comfortable!
  4. The article did mention he was enrolled in the ZMapp trial, but was randomized to the control arm so didn't receive the medication.
  5. We had a physician from Liberia present grand rounds for us a couple of years ago who shared his story of surviving Ebola. He credited the PA who cared for him as the one who saved him; Liberia has a large number of PAs in their health system, and several died during the last large outbreak. Sent from my iPhone using Tapatalk
  6. The 1998 Aviation Medical Assistance Act is supposed to provide coverage that is even stronger than most Good Samaritan laws. Here's a quote from the law: An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.
  7. No, went old school and whipped him over to CT right away. Sent from my iPhone using Tapatalk
  8. Recently had an elderly patient with "abdominal bloating" after eating a burger, triaged as an ESI Level 4. Markedly hypertensive at triage, past surgical hx of a AAA repair. I'll let you guess what his diagnosis was....
  9. Nah, it always matters what you think I definitely don't want to downplay the importance of serial exams, especially in abdominal complaints; just saying that they may not always change much of the care plan. In the patient with appendicitis on CT, they'll be getting antibiotics and a surgical consult regardless of what my repeat exam shows, then the surgeon will again push on their abdomen when they see them. If I don't have a specific clinical question to address, it's not unreasonable to defer the repeat exam at times and spare the patient some additional discomfort.
  10. Pretty common in our department as well. We all carry hospital-issued iPhone's, so if the consultant is quick with their callback you are often in the room with the patient giving them an update. I don't think it's always a guaranteed that at patient will need another abdominal exam 90 minutes after the initial exam. If the patient the patient had RLQ tenderness and has CT-documented appendicitis, they will still need to see the surgeon regardless of the repeat exam; in some situations it's just more likely to inflict more discomfort without adding much to the clinical management.
  11. Is it a possibility to stay on as a casual employee while in PA school? We've have several ER techs go back to school and come back to be hired as PAs; by staying with the hospital while in school they maintained their seniority within the health system.
  12. Paramedic practitioners have already been a part of the health system of other countries for several years, including the UK and Australia. They are to the best of my knowledge prepared at the Masters level, and primarily work in ED's, EMS and some primary care settings. Here in the US we have no structure set up yet for educational requirements, and importantly billing reimbursement (not really an issue in the NHS). It is an uphill battle nationally getting American EMS agencies to pay traditional paramedics a living wage; without a mechanism to improve reimbursement for paramedic practitioners I wouldn't anticipate a huge rush to adopt this level of training if the medic will get a Masters degree and still be lucky to make $20/hour. I don't know if community paramedicine is driving the Missouri efforts or if there is someone else leading it; just sharing some info about how other countries are structured. Here's a video highlighting a paramedic practitioner in the UK: https://www.emsworld.com/video/12106357/u-k-reporter-spends-24-hours-with-nhs-paramedic-practitioner
  13. FYI, they just did the first field ECMO cannulation in North America earlier this month in Albuquerque; I've got a couple of buddies in EMS leadership down there and they have a very progressive system from the sounds of things. https://www.abqjournal.com/1375453/unm-debuts-new-response-to-cardiac-arrest.html
  14. I didn't actually see a rotation breakdown on the APP fellowship website. They list rotations for a 1 year physician EM fellowship designed to prepare IM/FP physicians to work in an ED (I won't even open that can of worms). Odd that in 12 months they don't list any actual rotations in the ED as part of the fellowship; I'm not sure if a month in OB or a month in ophtho are a substitute for actual time in the ED.
  15. My daughter has had her median sternotomy scar since her first birthday. I’m pretty sure her big brother would disagree that the knee he injured when deployed in Iraq is more “worthy” than her heart condition. Sent from my iPhone using Tapatalk
  16. Check with the program you are looking to teach at. As already stated, many states have their own state certification, and in many cases it is only required if you are the program head or core faculty. If you are just coming in from time to time giving PRN lectures you may not require any specific EMS instruction certification.
  17. The beauty of living in a beach town; no need for a vacation to enjoy views like this every day...
  18. Sounds like a winner! Unless you are going to a top-tier MBA there isn’t much point in spending a ton. With my hospital tuition reimbursement I was able to have the cost of my whole program covered; can’t beat that for ROI! Sent from my iPhone using Tapatalk
  19. I just completed my MBA in Healthcare Management last week, so it's too early to say what impact it might have on my future career. It definitely has been noticed by some of our senior hospital leadership who reached out to congratulate me; I don't think it's a free pass into an administrative role, but it should help to set you apart from other candidates for a position that don't have an MBA or MHA.
  20. For some perspective, you're getting paid as a PA what our ED techs get paid. Are you having these conversations with the surgeon or with an office manager? might be worth going directly to the surgeon, and include in the discussion the estimated $100-200k it costs to lose, recruit and train a new APP.
  21. Agreed, I think Heady gets more press than it deserves. Hill Farmstead however brews the best beers on the planet; never had such consistently amazing brews. Sent from my iPhone using Tapatalk
  22. We developed our clinical ladder, but still haven't implemented it (waiting for final finance approval, since it could affect salary for over 1300 PAs, NPs, CRNAs and CNMs in our system). Look at the AAPA Distinguished Fellow application for inspiration; we award points for various achievements such as precepting students, committee leadership, publications, etc. We also built in a big emphasis on mentorship, with those higher up on the ladder being expected to provide guidance to junior APPs.
  23. If you’re still looking for reasonable proximity to NYC, look at Connecticut. We aren’t Midwest cheap, but once you get past Fairfield county the cost of living is much more affordable. My town calculates out to being 72% cheaper than Queens (never mind Manhattan). I live on the shoreline, 5 minutes from the beach in one direction and a state park in the other, but I can still hop in the train and head into NYC for a Yankee game or a broadway show (going with my wife to see Harry Potter next month...). Our state practice act hits all six elements of the AAPA, and in general PAs are treated relatively well. If you aren’t quite ready for the cosmic jump to Alaska or Nebraska, we are a nice alternative to NYC (I left an ED job in Queens 16 years ago and would never go back). Sent from my iPhone using Tapatalk
  24. Excellent; you'll have a blast having the chance to advocate for your fellow PAs.
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