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ohiovolffemtp last won the day on December 5 2021

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  1. Some random tips from an EM nocturnist who covers the floor overnight in a rural critical access hospital: learn how to sedate "just enough" the elderly confused and agitated patients that are exhausting the nurses and techs: find out what meds your attending likes teach the nurses & techs to call you early for this problem so the meds will be worn off by the time the day attendings and specialists round (23:00 is WAY better than 03:00). The day docs (and the family that's visiting in the morning) won't be happy if the patient can't talk to them learn what meds you should give in 1/2 normal doses to the elderly and frail, esp. the sedating meds, which includes many anti-emetics learn to always review the patient's meds and baseline vitals before ordering anything. The older you get, the more variation there is in baselines. Afib with RVR with a rate of 115 - can wait, as long as the pt's pressure is good enough. learn to expect BP, pulse, and O2 sat to decline when the patient is asleep. Maybe all they need is a NC @ 2 lpm while they sleep vs a workup learn what labs can change in hours vs days. when 1 doc complains about what you ordered when you ordered exactly what another doc would, just accept it. It's hard to realize that there are many "right" answers, i.e. preferences as much as you can, place PRN orders for anti-pyretics, anti-emetics, lower level pain meds, nebs, etc so that the nurses can just get things done. You'll be pestered less, and the nurses will love you for it. if the patient has poor peripheral vasculature but isn't bad enough to need a central line, get a PICC line ordered for the next day if you have time, walk through the floor and ask the nurses and techs if they need anything for everybody. Learn their names. on any overnight admit, make sure the patient's key morning meds are ordered so they get them. The day doc who's doing the full med rec might not get to it 1st thing in the morning and the pain, hypertension, hyperglycemia, etc. that the patient has could have been avoided.
  2. Best choices: doccafe.com indeed.com monster.com (seems to have less) state PA organizations web sites PA specialty group web sites, e.g. SEMPA AAPA web site Oddly enough, I found my dream job on craigslist.org.
  3. Also, the PA job market is still very much 2 tier: new grad + < 3-5 years experience vs 5+ years experience in a particular area of medicine. At the height of COVID in early 2020, there were almost no jobs for the experienced PA's and none for the new grads. New grads were going 12+ months before they found anything, and then it was primarily lower paying lower quality positions. Now there are some jobs for new grads and the market for experienced PA's is good, at least in the areas I follow: EM and hospitalist.
  4. I would ask this question of your target PA schools. See how they feel about online courses and whether they require these science courses to include a lab.
  5. It totally depends upon the school. I took cell biology hoping it would satisfy a school's requirements for biochemistry but it did not. It seems like they looked primarily at the course title. So, I took a course named biochemistry to meet their requirements. This was the school I ultimately attended. So, if your target schools don't list it as a prereq, there's no harm in dropping the class. It really won't be that relevant to your PA school classwork. A&P, micro, and pathophysiology are the prereqs that are really relevant.
  6. Miserable situation. Following patient's wishes when we know they won't give them their desired outcome is tormenting, but we have to. Part of EM is to make the situation less bad for the in-patient providers. This is where we can help move towards a less painful process. The conversations we have with patients, families, POA's, etc. about futility and the brutality and cost of resuscitation can help position the patient, family, etc. to be more accepting of a move to palliative care. This is another part of us in EM having to live with the fact that we have only limited ability to make things better or even different.
  7. COVID is a huge risk factor for PE and new onset A-fib, especially with RVR. I've seen it multiple times. If I have any clinical findings that suggest PE I pretty much go straight to the CTA. Dimers aren't valuable, because with COVID they're pretty much always positive, even with age adjustment.
  8. I go by "first name, last name - the night guy" as I do solo overnight coverage in an ED in a rural critical access hospital. Sometimes I add "taking over for the younger and better looking Dr. XYZ" if they were signed out to me.
  9. Some thoughts: look at a number of PA schools' web sites to get a feel for what the pre-reqs are. There are some variations, but in general they include: Chemistry: 1 year of majors/premed level with lab Biology: 1 year of majors/premed level with lab Anatomy & Physiology: 1 year of majors/premed level with lab Organic Chemistry (though not all):1 year of majors/premed level with lab Microbiology: 1 semester Psychology: 1 year Sociology: 1 year Statistics: 1 semester Physics: 1 year of majors/premed level with lab Genetics: 1 semester Biochemistry: 1 semester Other useful courses: Pathophysiolgy Cell biology Nutrition The above is about 3 years worth of work if done full time Local community colleges can be a great way to get better instruction at lower cost than large campuses. Some are even branches of large universities so your transcript will show the large university's name. (this was my method). It's doable - my undergrad degree is Computer Science and I did corporate IT for 29 years.
  10. Come visit me. I've gotten 3 deer over the years - all in car season. That's what happens on the way home when you're a nocturnist.
  11. If your key concerns are the need to present every patient and seeing only low acuity patients, talk to the PA's and NP's that currently work there and see if there is a progression in their autonomy based on the working relationships with the docs. There is the policy and there is the actual practice. I had a relationship with my primary supervising doc at my prior FT job where my "presentations" was the answer to "Do I need to see any of your patients?"
  12. Sounds like they need a referral to a opiate pill mill.
  13. I'll defer to the members of the forum who are on admissions committees, but I think that spending the 18 months or so to get a LPN education would be better spent re-taking science classes and working as a tech in an ED. An EMT class would be the path to getting that ED tech job. The sciences you'd take for LPN aren't the same (much softer) than the pre-med level ones needed for applying to PA school.
  14. Never done one. Have done hematoma blocks for hip fx and had good success reducing but not eliminating pain. @EMEDPA: did they do it under U/S guidance?
  15. I've seen several of my ED nurses go to travel nursing vs completing their NP's/working as an NP. It's easy to get $125/hour as a travel ED RN, well above what an EM PA or NP makes. I've asked only partially in jest what's in the nursing scope of practice that's not in a PA's scope of practice. In my ED where there's me and 2 RN's or a RN and a paramedic, helping lift, clean, etc. is part of what I do to keep people moving through the department. I think the only thing I've not done is foley's on females.
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