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medic25

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Everything posted by medic25

  1. I am on the hospital committee currently building a clinical ladder for all APPs in the hospital (PA, NP, CNM, CRNA). Nothing ironed out yet, but I'd be happy to share once we get something up and running.
  2. I would ask to see what regulation specifically disallows you to have that title. It's a different category, but I have a title of Associate Medical Director for our local EMS system. Shoot me a PM if you think this is helpful and I'll send you my LinkedIn info.
  3. One of docs I was working with this weekend and I were talking about this (from the recent ACEP Now article) and she ended up using it with one of her patients later that shift. Said that the patient went for 10/10 pain to feeling great with just the MAD atomizer of 2% followed by the cotton swab up the nose. Looking forward to trying it myself!
  4. Level 1 trauma center; we have 4 resuscitation bays, with two teams of PAs/residents/attendings/RNs alternating which R room gets the next resuscitation patient. The bays are part of a critical care pod/unit with 19 or so other beds, so the two teams cover the beds in that unit, not just the resuscitation rooms.
  5. Same here; I'll be at Quiz Bowl
  6. Anyone up for a meet tonight? If not, could do it over the weekend Sent from my iPhone using Tapatalk
  7. Sorry, have committed meetings until 5pm. Maybe later tonight? Sent from my iPhone using Tapatalk
  8. Cool; I'll have to root for you to come in 2nd since our residents will be there competing as well!
  9. Buying the beers for a bunch of EM PAs might get expensive! Will you be taking part in the resident Quiz Bowl?
  10. I'll be there; looking forward to it!
  11. Yale’s PA residents have flight time as a component of their EMS rotation. In addition to ground EMS they have the option to fly with either Skyhealth (Yale’s own flight program) or Boston MedFlight. Sent from my iPhone using Tapatalk
  12. Congrats on passing! Just wondering, are you issued a paramedic card from NREMT at the end of this, or just your state PHPE licence? If you receive certification as a Nationally Registered paramedic, then this might create a mechanism for PAs from other states to get their NREMT-P and then use that to obtain state paramedic certification in their home state.
  13. This is one of the greatest things about my hospital; we don't call medicine for admissions (except ICU), period. It's our call whether they stay or not. If we decide that we want to admit a patient, I just put the order into Epic and bed management starts working on their bed. The admitting team can read the note and come do their own H&P, but there is no such thing as stalling or blocking an admission. Makes life so much less stressful....
  14. That sounds about right. I've searched high and low for literature or guidelines on this and have never found a published guideline.
  15. Working in a beach town, a big chunk of my plantar wounds are saltwater contaminated (lots of people walking barefoot and stepping on clam and oyster shells). We end us using a lot of doxycycline for Vibrio coverage.
  16. https://www.journals.elsevier.com/physician-assistant-clinics/ Rev, here is a link to the journal with past issues. I wrote an article for them last year; it's a nice opportunity for PAs to get more involved with academics and get exposure to what goes into the publication process.
  17. Patient I had a couple of years ago: Older male presented with acute onset shortness of breath and pleuritic chest pain. HR 110-120's, actively being treated for cancer and had been discharged from the hospital the week before after an extended admission. Triage nurse decided to try and be helpful and sent a d-dimer before the patient was seen by a provider, which is negative. The patient with the negative d-dimer had multiple segmental PE's on the CTA. Takeaway point for new grads especially; d-dimer is only useful when used in conjunction with proper risk stratification. If your pre-test suspicion is high enough, the dimer result is irrelevant.
  18. The Ultrasound Podcast with Matt & Mike is a nice one; video podcast and shows you some nice ultrasound techniques.
  19. Always important to remember that nitrofurantoin should never be used if pyelonephritis is suspected. It has very poor penetration into the renal parenchyma; you'll never reach therapeutic levels if it's anything more than a simple cystitis.
  20. Back when I was a new PA, my kid brother called me after he'd done a few days of a hand-to-hand combat class at the NYPD academy. Told me that he could barely move his arms or legs, and his urine looked like iced tea. Proving why you should never diagnose family members over the phone, I told him to drink a ton of gatorade, take some motrin and suck it up. I'm on a night shift in the ED that night, and he calls and tells me that he's being admitted to the ICU in his local hospital. CK's in the 100,000's, ALT/AST in the 1000's; says "I've got something called rhabdo-something"....
  21. Agree with the EM folks above; I'll refer people for emergent follow-up (e.g. splinted fracture that'll need surgery in a few days), but beyond there you get a name and a phone number to call for the most part. I wouldn't know the first thing about filling out paperwork, managing insurance rules, etc. One nice thing that we've started doing at my hospital is having our patient follow-up nurses help to facilitate referrals to specialists. We can click a button in EPIC doing our discharge papers and send a message to these nurses to either help the patient get a PCP, or help them get scheduled with a specialist. It's not uncommon to hear from patients "I called XYZ specialist and I can't be seen for 2 months"; our nurses can help to pull some strings and help to get them in to see someone sooner.
  22. We had this happen last month in town. Runner in a half-marathon got to the finish line and collapsed in cardiac arrest. A couple of our ED docs who had also ran the race started resuscitation along with the EMS crew on standby. Got ROSC back in the field, and the patient eventually went home with no ill-effects!
  23. Took it a few years back; I've also taken the EMS version and found the EM one more relevant to ED practice. We send our PA residents to the Levitan cadaver-based airway course in Baltimore; I'm looking forward to trying it someday to see how it compares to the sim-based Difficult Airway Course.
  24. We are using them for an EMS research study and they are great; our medics are being trained to perform lung ultrasounds in respiratory distress patients. Have you seen the new Butterfly iQ ultrasound? Connects to your IPhone for under $2k, and uses one probe for multiple different indications (uses a chip instead of crystals so you don't need to change probes). Looks pretty fantastic as well. https://www.butterflynetwork.com/
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