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just_nelle

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About just_nelle

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  1. just_nelle

    OB/GYN PA in NC?

    We have a couple OB/Gyn PAs at UNC-Chapel Hill and UNC-Hillsborough. It is sort of an NP-dominated and CNM-dominated specialty in NC but there are some opportunities for sure!
  2. just_nelle

    question for EM u/s gurus

    Looks like I was beat to the punch, but LOTS of GEL is your friend in this instance.
  3. just_nelle

    quoting "rules" in your note

    Great list! Don't forget Alvarado score when you're consulting the surgeon in the middle of the night for an acute appy...not really a rule, but a helpful decision tool.
  4. just_nelle

    2 Acceptances: Rutgers v. PCOM

    I'd vote for PCOM...but I'm an alum :)
  5. just_nelle

    "it's probably nothing"-fast track disasters

    Here's a gem from this week. Working in fast track for the first time in months. First patient of the day, triaged with CC: "rib pain" Triage note: 68 healthy male. Left sided lateral rib pain x4 days after bumping into door hinge. Afebrile P: 90 RR: 20 O2: 95% RA Easy enough I thought, until I saw the patient. Turns out he has no past medical history *other than* glioblastoma, last chemo 6 days ago (minor details, right?). He did bump his left ribs against the door hinge 4 days ago and he thought he might have broken a rib. Pain worse with deep breath, mild dyspnea. No extremity pain/swelling. No cardiac or VTE history. My exam: Speaks in full sentences, splinting due to pain, borderline tachy reg rhythm, decreased but clear breath sounds throughout, tender to left lateral chest wall without ecchymosis/crepitus, no LE edema/tenderness. Popped the oximeter on him during my evaluation, HR ranging from 90-105, O2 ranging from 90-96%. I thought to myself, this guy very well might have rib fractures or some atelectasis/PNA from shallow breathing; maybe even small PTX…but I'm more worried about PE. Got him moved to a monitored bed (after some head to head combat with ED resource nurse who didn't want to "waste" the valuable real estate on a "guy with rib fractures"), ordered labs, EKG, CXR, PE CT, passed off to colleague working in monitored area, and got back to tending to my lacs and FOOSHes in fast track. Checked in on the guy at end of shift. Sure enough…saddle embolus. No heart strain on bedside cardiac u/s, bnp and trop nonelevated. Anticoag was initiated, and patient was admitted. One left sided, non displaced rib fx.
  6. just_nelle

    California to Boston relocation

    Hi Chica - I just sent you a PM. Haven't been on the forum for awhile!!
  7. just_nelle

    AAPA Conference Boston

    I'll be attending and I live in Boston. I'd love a PA Forum meet up!! Let me know if you'd like me to scout out venues....
  8. just_nelle

    Update on the new law......

    I echo your irritation with the inability to sign the Section 12, just because it is something we deal with multiple times daily in the ED. Same as you said, ventana, sometimes I (and other PA colleagues) don't even bother seeing the patients who need to be sectioned and just let the docs see them...unless they need some sort of other medical workup other than just their psych c/o. Or, it just ends up being me filling out the pink paper and then handing it over to the doc for a signature. But...we can write the order to d/c the Section 12...
  9. just_nelle

    Migraine prophylaxis

    Topic related, but not specific to the OP's patient... What do you know/feel about riboflavin (B2) for migraine prophylaxis? I had a patient in the ED the other day very resistant to initiate any sort of migraine prophylaxis. (The classic "I just don't don't like to take medications because they're unnatural"). After episodic symptomatic treatment, I got a neuro consult in the ED (one of the perks of working in a large teaching hospital...specialists at your fingertips woohoo) mostly because this patient had been lost to follow up to neuro despite many ED visits for her migraines. The neuro's rec for this patient with resistance to start a prophylactic med (but not necessarily against a "vitamin supplementation"? Riboflavin 400mg daily. I don't ever really recall learning about this utilization, but I've since stumbled upon a few papers suggesting it is good at decreasing frequency, but not severity of migraines. Minimal side effects, too. Thoughts? Anyone else use this? JMJ??
  10. Also, thanks for taking the time to attend the meeting in Worcester. Represent us well and give us an update, please!
  11. Just sent an email! Fired up about this issue, especially after a long day of hearing from all many of my patients that they were in the ER on a Saturday night for a chronic issue because "I can't get into my PCP for 2 weeks..." clearly we need more recognized PCPs! Thanks for bumping, ventana.
  12. I'm going to one-up you on this one... Patient on my fast track shift tonight. Same as you wrote, but trade the 2 weeks for SIX MONTHS. It's feeling pretty much better. But, I just wanted to make sure nothing was broken, you know.
  13. EMEDPA - I wholeheartedly agree with you re: BTLs and vasectomies...I've felt that way for some time now. As a PA who had previously moonlighted (out of passion for reproductive medicine) at a reproductive health clinic in California where my duties occasionally included prepping, assisting during procedures, and providing follow up for AB/vasectomy/BTL patients, I feel that if provided proper additional training, each of these procedures could be safely performed by a non-physician provider in order to increase access (and hopefully eventually decrease the need for terminations). I'm just curious how California would go about ensuring standardization and quality assurance of this additional training, given the fact that it would affect ACPs that fall under different governing bodies (PA, NP, CNM). Also, what does ACOG think about this?
  14. just_nelle

    California to Boston relocation

    Just a follow up on this post...we have settled in Boston in June and I ended up sticking with EM and taking a position at MGH. I'm enjoying it so far! I definitely miss CA, however, Jeff, you were right...MA is a great place to be a PA! Thanks for the guidance, all!
  15. just_nelle

    PA's in CA, no jobs and working three jobs?

    A few years ago, someone wise on the PA Forum told me something that has really stuck with me. You can expect to get 2 of your 3 "ideals" with a PA job: 1) pay 2) location 3) specialty As long as you use this as your standard of expectation, you should be able to find something (even in Coastal SoCal). This is coming from someone who is not necessarily working in her desired specialty, but has the location (Santa Barbara) and pay (100k+ working 3 days/week) she desires. That is...until I have to move back to the East Coast this year. Who knows, maybe I'll find something even better? My advice if you're having difficulty finding work: be aggressive and creative with potential employers, recruiters, networkers; yet willing to budge on a few of your employment "requirements." A longer commute or non-ideal specialty or even having to tighten your household budget because of a lower (or part time) salary is much better than a half a year gap on your resume. (IMHO). YOU CAN DO IT! PS: I echo all of you who want to live in SLO...it would be the ideal place to live/work. Small-city coastal living, but without the outrageous SB prices. Maybe I'll make it back west at the end of the career...
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