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Everything posted by medic25

  1. Nothing on the books these days. I rarely do refills, and never on controlled substances, but if someone has a rational explanation (e.g. visiting the area and forgot meds at home) I'll do a short supply of maintenance meds.
  2. Refill her meds and if possible help her get primary care access. Absolutely no reason to send an asymptomatic hypertension patient to the ED; this is a huge frustration for us when these patients are sent in by UC or PCP. Sent from my iPhone using Tapatalk
  3. Weird; never had that happen with any of our Epic upgrades. Same health system?
  4. Separate fund. Our hospital pays separately for licensures/certifications that are required to practice (e.g. state license, DEA, NCCPA).
  5. Nobody has given the correct emergency medicine treatment plan yet? -Stabilize, then admit to medicine
  6. I'm still not grasping why you didn't buy the Samoa; clearly the superior cookie...
  7. Any way to pull our logs from your billing department? I needed to generate a procedure log a few years ago when applying for a promotion, and at that point hadn't kept track of my procedures. Our billers were able to give me a list of every LP, arthrocentesis, etc. that had been billed in my name; not perfect, but it might get you enough to finish credentialing.
  8. medic25

    cool derm case

    Was she incredibly short? Did you ask if her house was a toadstool, or if she lived in a village surrounded by lots of other blue people? Ever been attacked by a wizard named Gargamel?
  9. medic25

    Quick Case

    Dry CT head? We have moved to CTA head/neck as standard initial imaging for possible stroke patients.
  10. Agree with E about citing decision rules. I'll always try and document the patients ability to ambulate for things like back pain, hip pain, etc. e.g. "patient able to ambulate without assistance and no visible limp, doubt occult hip fracture..."
  11. Our department has an APP Manager who oversees 50+ PAs/NPs that staff our 3 ED's. It's a full-time administrative position, and we are currently working on making it a Director-level position with APP managers that report to the director (they'll be half clinical, half admin). However you structure your proposal, I'd strongly argue for building in guaranteed protected time. Trying to do all of the administrative work while still pulling a full clinical load is a recipe for disaster, now matter how much extra they pay you. I currently do 50% admin and 50% clinical and it's definitely contributed to my sanity. The main things to focus on in the role would be things like hiring/firing, onboarding/orientation (hugely important and usually ignored), ongoing education, CQI, etc. It all depends on how big the group is and how much they'll let you do, but it doesn't hurt to ask for more than what you expect. In the big hospital system, definitely shoot for a title of either Director (best) or Manager; even if it seems like fluff it makes a difference within big shops. Feel free to DM me if there's anything else I can answer.
  12. We use MModal dictation software with Philips SpeechMike microphones. It works pretty well with Epic; one nice feature is that if you don't have a mike handy you can use the MModal dictation app to connect your iPhone to your desktop and use your phone as a dictation mike.
  13. Ouch; I'd start looking elsewhere. I'm at an academic center in the Northeast; even as a new hire our PAs accrue over 300 hours of PTO per year (over 7 weeks). This isn't including the 40 hours of paid CME days, the CME budget, or the 7 or 8 recognized holidays (still have to work since I'm EM, but 1.5x pay).
  14. Love having PTO cash-in. I can elect to cash in up to 180 hours/year; it's like working overtime without actually working. Paid CME time is also nice; 40 hours/year for CME, in addition to standard PTO.
  15. Typically you shouldn't require much pressure with your probe to perform a FAST, with the exception of the subcostal view. You might try lightening up your contact (combined with some judicious use of fentanyl). If they can't tolerate the subcostal view you can always try a different cardiac window like a PSLA so that you're visualizing the heart without applying abdominal pressure. FAST it typically pretty poor for retroperitoneal bleed (much, much better for intraperitoneal), so if it makes you feel better there is likely a good chance you wouldn't have seen much even with a good FAST.
  16. 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.
  17. 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.
  18. 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!
  19. 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.
  20. Same here; I'll be at Quiz Bowl
  21. Anyone up for a meet tonight? If not, could do it over the weekend Sent from my iPhone using Tapatalk
  22. Sorry, have committed meetings until 5pm. Maybe later tonight? Sent from my iPhone using Tapatalk
  23. Cool; I'll have to root for you to come in 2nd since our residents will be there competing as well!
  24. Buying the beers for a bunch of EM PAs might get expensive! Will you be taking part in the resident Quiz Bowl?
  25. I'll be there; looking forward to it!
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