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About JustinPA

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  1. I don't really think there is a benefit to administering clonidine or doing an EKG for asymptomatic hypertension. There's nothing wrong with refilling her meds for 7-10 days and giving her information for a local PCP. "In ED patients with asymptomatic markedly elevated blood pressure, routine screening for acute target organ injury (eg, serum creatinine, urinalysis, ECG) is not required. (2) In select patient populations (eg, poor follow-up), screening for an elevated serum creatinine level may identify kidney injury that affects disposition (eg, hospital admission)." "(1) In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required. (2) In select patient populations (eg, poor follow-up), emergency physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control." https://www.acep.org/patient-care/clinical-policies/asymptomatic-elevated-blood-pressure/#sm.000r7hbwf19sffdj106hb7uklsfu6
  2. It is not necessary to pass the EM CAQ. I did not take the course and I passed the EM CAQ test. I don't recall any specific questions that you would have had to have taken that course to answer.
  3. So I posted this in response to the Huddle thread on this topic: "I believe James Anderson did something very unethical in writing this article and using his government position to distribute it. I'm sure that will set any progress on PA legislation back quite a bit in that state, and maybe even in other states. Perhaps he should have considered consulting some of his fellow PAs before publishing an article like that. Ironically, didn't he just have a post questioning one of the candidates about their ethics? I think he owes his fellow PAs an explanation about his "ethics." On another note, the censorship is absolutely ridiculous. I certainly think if someone has resorted to insults or name calling that it is okay for a post to be deleted, but not the entire discussion. If someone does something that is highly unethical and someone expresses their strong disagreement for it, that is not an appropriate reason to censor that. This situation is a big deal in my opinion, and the AAPA censoring the discussion does not look good at all." They deleted my comment with the explanation being that the underlined sections violate the Code of Conduct. This is blatant censorship. You aren't even allowed to state your disagreement with someones actions using words like "unethical" without it being censored? The AAPA moderators are a joke.
  4. Keflex for barefoot? Cipro alone, or cipro plus keflex for through a rubber soled shoe? What are you guys using and what is your rationale? Thanks.
  5. Oh I missed that part, I apologize. I agree with that.
  6. The link from Ikth487 suggests that people in general with influenza do worse when given steroids, but unfortunately doesn't answer the question of if asthmatics with current exacerbation and influenza infection do better with vs without steroids. I still think in this situation where the patient has known asthma and influenza with wheezing that I would probably still treat them like an asthma exacerbation with the steroids but also give them the Tamiflu, regardless how many days out from the onset of flu symptoms they were, to help mitigate the effects of the steroids on their ability to fight off the flu.
  7. This study is kind of similar to what we are discussing: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0032280
  8. In this situation aren't we using the steroids for the asthma exacerbation that is secondary to the influenza infection though? I agree that the steroids shouldn't be used for routine influenza. A good amount of asthma exacerbations are triggered by viral URIs, and those asthma exacerbations are still treated with PO steroids. In this situation I'm assuming the issue is that they have a positive influenza test, and there is concern that the steroids will decrease the patient's ability to fight off the influenza or increase their chances of getting a secondary bacterial pneumonia. I brought up the use of steroids for viral croup and tonsillitis because in those situations it doesn't seem to inhibit the patient's ability to fight off the viral infection or increase their chances for secondary infection, at least that I have ever heard of.
  9. I would probably do a single dose of PO Decadron and a prescription for Tamiflu in that situation. I can't imagine a few days worth of steroid activity in a healthy individual is enough to cause significant immunosuppression. Steroids are routinely used in viral croup and tonsillitis without any issues. On a side note, if you are giving PO Decadron IV/IM solution remember to increase the dose because it only has a 75 percent bioavailability compared to normal PO Decadron. I was unaware of this until a couple weeks ago when a pharmacist mentioned it to me. I had always assumed they were equivalent. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418677/
  10. https://www.ncbi.nlm.nih.gov/pubmed/14985664 "Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial. Abstract STUDY OBJECTIVE:Although sterile technique for laceration management continues to be recommended, studies supporting this practice are lacking. Using clean nonsterile gloves rather than individually packaged sterile gloves for uncomplicated wound repair in the emergency department may result in cost and time savings. This study is designed to determine whether the rate of infection after repair of uncomplicated lacerations in immunocompetent patients is comparable using clean nonsterile gloves versus sterile gloves. METHODS:A prospective multicenter trial enrolled 816 individuals who were randomized to have their wounds repaired by using sterile or clean nonsterile gloves. The attending physician or resident completed a checklist describing patient, wound, and management characteristics. The patients were provided with a questionnaire to be completed by the physician who removed their sutures at the prescribed time and indicated the presence or absence of infection. When follow-up forms were not returned, a telephone call was made to the patient to determine whether he or she had experienced any wound complications. RESULTS:Follow-up was obtained for 98% of the sterile gloves group and 96.6% of the clean gloves group. There was no statistically significant difference in the incidence of infection between the 2 groups. The infection rate in the sterile gloves group was 6.1% (95% confidence interval [CI] 3.8% to 8.4%) and was 4.4% in the clean gloves group (95% CI 2.4% to 6.4%). The relative risk of infection was 1.37 (95% CI 0.75 to 2.52). CONCLUSION:This study demonstrated that there is no clinically important difference in infection rates between using clean nonsterile gloves and sterile gloves during the repair of uncomplicated traumatic lacerations." I use nonsterile gloves for simple laceration repairs.
  11. When assessing for rectal tone with the digital rectal exam, are you simply assessing the amount of resistance when your finger enters or are you having the patient attempt to squeeze your finger? I was taught the first way, however I've read in some references that you are supposed to have the patient attempt to squeeze for assessment of tone. I feel like it's highly subjective and as far as I know I've never felt anyone with decreased tone on exam. Is it something you'll just know if you come across it? I came across this study which suggests even among experienced doctors it wasn't all that accurate, it also mentioned the squeeze test. http://www.ncbi.nlm.nih.gov/pubmed/25811266 If you are doing the squeeze test how are you instructing the patient to do it? Thanks.
  12. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial. http://www.ncbi.nlm.nih.gov/pubmed/14985664
  13. So a follow up, I've been given a a copy of the malpractice policy. The malpractice policy is in the name of the urgent care facility and does not mention covering physician assistants or employees anywhere as far as I can see. Is it common for a malpractice policy to be in the clinic's name with no mention of the providers?
  14. I've worked at an urgent care facility for a little over a year. I have a contract that states I'm to be provided with $1,000,000/$3,000,000 claims-made professional liability insurance. I filled out some paperwork when I was first hired and never really thought much else about it. When I got a contingent job at another urgent care facility, part of the hiring process was them requesting information about my current malpractice coverage for credentialing. This was about 4 months ago. They were unable to provide me with any documentation of my malpractice policy. I would ask my employer and he'd say he asked the agent and the agent wasn't sure exactly what kind of forms I wanted. Since then I have requested it multiple times from my employer without any evidence produced. I requested a contact person and the insurance carriers name. He gave me an email address, which turned out to be an insurance broker. She referred me back to the insurance agent. I have contacted the insurance agent 3 times by email and twice by telephone over the past 2 1/2 months, with each time him saying he will get some proof of insurance for me but then never contacting me again. I have contacted the broker again, and again she referred me back to the agent who isn't responding to my emails. I've asked multiple times if they can at a minimum confirm that I am not covered under my works malpractice policy and no one will give me a direct answer. They state that I should be covered, but are unable to provide me with any documentation. The insurance agent is the sole insurance agent at his business and is also the owner so there is no one else there I can ask for the information from. I'm very suspicious that I may not have malpractice coverage given the circumstances. I was wondering if anyone has had a similar situation to this in the past, and if it is unreasonable of me to request proof of malpractice insurance? Does anyone have any advice as to what I should do next in this situation?
  15. Do you guys use the 100mg or 200mg TID PRN dosing most commonly?
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