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rev ronin

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rev ronin last won the day on December 2

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About rev ronin

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    Physician Assistant

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  1. rev ronin

    Student case

    I didn't post them, but I did look at her previous labs--significant proteinuria with preserved eGFR as of two months ago, probably Stage 2 CKD.
  2. I thought K2 was a brand name of synthetic "Bath Salts"? Could definitely lead to confusion... (I mean, people could just want to get high and not fail a drug screen, and instead they end up on this ginormous mountain...)
  3. rev ronin

    Candy Man Situation

    Interesting. When I worked at Group Health, I had delegation agreements with my primary SP and an alternate, but would see patients empaneled with any of the 20+ MD/DO PCPs in the clinic if needed, even though most of my work was for one "pod" I can't imagine the hassle of naming all physicians as alternates...
  4. Outcome-focused. If you want to talk politics, beliefs/preferences take a bigtime back seat to outcomes.
  5. This is exactly what I had in mind when I said there were plenty of great other perspectives out there.
  6. rev ronin

    BA degree at WGU

    My original undergraduate career was far from distinguished, but the good bit is that I needed so much undergraduate leveling before PA school that I got another associates: made president's list 3x, graduated with highest honors... after I already had two other masters degrees. I still put that on my full CV
  7. Sounds like a weed-out class to me. Not at all uncommon in universities with primarily traditional undergrad-age students who decide to invest their efforts in major students who can swim in a sink-or-swim environment.
  8. rev ronin

    Candy Man Situation

    Ugh. Sorry to hear you're in this situation. You LIKED the job, unfortunately, because with a new SP, everything changes.
  9. rev ronin

    Quarter Hours

    Typically, they'll do a course-to-course equivalent, so accept 5 quarter hours (3.33 semester equivalent) for e.g. a biology course that nominally requires 4 semester hours, but you'll really have to ask individual programs. I had a mixed bag of semester and quarter hour science courses, but it all calculated fine in CASPA.
  10. rev ronin

    BA degree at WGU

    That's wrong. Well, at least, atypical. Normally, transcripts are broken up into "quality hours" as a subset of total hours earned, and GPA is total quality points per quality hour. Pass/Fail, AP, credit by exam, etc. are typically given as non-quality credits that don't factor into the GPA unless you fail, and then they're F's. If your school MEANT to do that, that's stupid. I doubt it would be worth going back and challenging it now, but any system that holds a 'pass' in a 'pass/fail' system against a student is dumb and wrong.
  11. rev ronin

    BA degree at WGU

    Typically, pass/fail courses are not included in a GPA. Pacific's PA program is all pass/fail, 80% being a pass. We had an option to take a one credit medical Spanish course as an elective, but since that wasn't part of the program, it was graded, so anyone who took it would have been 1) the only one(s) in our program with a GPA, and 2) their entire PA school GPA would be based on that one, 1 credit course. Pretty sure no one in my class took that option.
  12. rev ronin

    Student case

    I considered lactate, but the patient appeared hemodynamically stable, PVCs being the sole concern. Had I been treating her inpatient or ED and I could have gotten it stat, I would have. Had she actually met sepsis criteria, I would have called the FD and let her sign AMA with the EMTs.
  13. rev ronin

    Student case

    Good on the labs. I ordered all of those, plus a TSH and an A1c because those were done 2 months ago and problematic, and I wanted to see how they had changed since. I also ordered blood cultures, just in case, but in retrospect that was probably overly cautious. I agree that IV antibiotics are indicated in this case, but my gut made the call that I wasn't going to be able to get her to go and get admitted that night, and I don't have IV support. Based on the Sanford guide, (p. 17, 2018 edition) I went with Augmentin and Doxycycline. I seem to recall she was Sulfa-allergic, but don't have the chart in front of me. We DO have Rocephin (Ceftriaxone) available so I had her given 1 gm IM before she left. Keflex is one of the other options, and would have been reasonable given no history of MRSA. I went with Augmentin in part because of the less frequent dosing--bid for Augmentin, qid for Keflex. When in doubt, go with the easier med for patient compliance. OK, that pretty much wraps up what I wanted students to comment on. Practicing PAs, feel free to pick it apart.
  14. rev ronin

    Student case

    Checking lower extremity vascular sufficiency with an ankle/brachial index would have been one option. I didn't end up doing that, but it's one of the things I found myself wishing I had taken the time to do. As far as the tachycardia and arrythmia goes, the first thing I did was order an EKG, which showed frequent PVCs on top of NSR. Since she was asymptomatic, I placed a cardiology consult, figuring that she would need one before any eventual surgery even if it wasn't her most pressing problem. OK, the open/remaining questions are lab work (what & why) and outpatient antibiotics.
  15. rev ronin

    Student case

    Yep. Plain films showed suspicions in at least 4 separate bones, so MRI was ordered for follow-up. I'd really rather a few others answered my questions before all of us practitioners dissect things.
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