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About chiaroscuro27

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    Physician Assistant

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  1. Thank you, EMEDPA! I have great respect for you, so that means more than you know. It's forum members like you and others that make this platform so valuable. Many of us have become PAs and have achieved success in our respective specialties because of the guidance and insight you all have provided over the years. I'm just doing my part to pay it forward. I hope to shake your hand someday soon, sir!
  2. I started out in a rural ED straight out of PA school. I had to drive 1 1/2 hours one way to get there and I was scared to death during every shift, but it was the best decision I made coming out of school. I was there for almost three years before we moved, and then I took a job in a larger ED and found out quickly that I had been spoiled. In the rural ED I had a lot of independence but a lot of support. I had great docs and great guidance. In larger facilities I felt like a cog in a wheel, relegated to fast track to move bodies in and out as fast as possible and I knew my skill set was m
  3. It sounds like you have your mind made up, and if you truly want to be a physician I say go for it! I agree, there are loopholes in our training when compared to that of our physician colleagues. The good news is you can fill those loopholes...but it will take some time! Just because you've graduated from PA school doesn't mean you stop reading, learning and training. There are PAs I work with that outperform our physician colleagues. It's not necessarily the degree that gives you the knowledge. It's a voracious appetite for information and a desire to perform at the highest level possible
  4. This is my plan. I'm starting the DMSc program this fall. I'll start the DrPH program afterwards. There is an online program that requires a few campus visits within driving distance from my home. I hear you on the money part; I couldn't pursue the DrPH without the benefit of in-state tuition.
  5. 58 yo male presented yesterday to my ED. My attending was on the floor, so I pulled the chart and read the triage note: "facial twitching for three days." The nurse told me it was likely bell's palsy. I went in to see and interview the patient. Very pleasant man with no obvious deformities or twitching at first glance, but the more he spoke the more it became apparent. His story: 3 day history of left-sided facial twitching. It began with his eye, then moved down to the corner of his mouth. Much better since yesterday, but he notices he has trouble chewing on the left side and when
  6. Yes browndog, so true. I am getting a lot more comfortable each day, but the fear factor is still there. One part of the job that I struggle with, especially in a rural town where everyone knows everyone, is allowing the nursing staff to sway my clinical decision-making because they have a history with my patient. There have been a lot of close calls because I considered not calling in ultrasound late at night for that suspected gallbladder issue, or not getting the stone study on a known drug seeker who really looked like they were in pain. So yes, I realize more every day the huge a
  7. PA for the win indeed! Great article. Pertussis was on my Ddx after the first few paragraphs.
  8. There's nothing to do but move on and hope for the best. I'm sure you did much better than you think. Best of luck to you, and don't be so hard on yourself!
  9. Yeah...let's not. I'd hate to see someone's feelings get hurt. I am currently precepting an NP student. I cannot put into words how floored I am at the lack of knowledge this student has. Clinical year is all about building upon a medical foundation, getting your hands dirty and applying the medicine you've learned. With this student, there is no medical foundation to build upon. Classes of drugs, how they work, building differentials, suturing, etc. How can you build a differential list if you don't know the clinical findings of common diseases? I don't expect the student to know e
  10. Never heard of that method, Emed. Thanks. We don't have MRI available 24/7 but that's something to keep in the back pocket.
  11. I've come across four or five studies totaling 1000 participants -adults and children alike- that demonstrate both oral and iv contrast are not necessary. Sure, it's helpful to use it to rule out other intra-abdominal pathology. In the ED with true emergency cases, I would question the need for oral contrast altogether given transit time. I'm inclined to agree with you TruAnomaly that radiologists are not seeing this literature. Perhaps this is just one of those things that will take some time to catch on. Contrast is indeed helpful, but why use it if the literature says otherwise? Aren'
  12. Had an 18 yo female come in with periumbilical pain, positive McBurney's point, nausea and anorexia last night. She didn't look ill, but everything was pointing to appendicitis. Ultrasound was gone for the day (isn't that always the way it works out), so I played with the idea of a CT scan of the belly and pelvis. Got her labs back...nada. Discussed it briefly with the attending and told the nurse to order a non-contrasted CT of the abdomen and pelvis. The attending looked puzzled and asked why I wasn't giving IV contrast for an appendicitis rule out. Good question. I know this is
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