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dsta

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About dsta

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  1. Thanks for the response. I'm going to shadow the department head who will also be my SP and the one training me, so that should give me a pretty good idea of what it will be like. It's an area of medicine I'm really interested in, so I'm hopeful it will be a good fit.
  2. Basically just curious what the the biggest challenges were from your experience. I don't have experience in sleep medicine, so would be interested in hearing what it was like for you starting off and what the learning curve was like.
  3. I'm interviewing for a position in sleep medicine, and I'm wondering if anyone who has worked in or is currenlty working in sleep medicine could tell me a little bit about what you do and what your experience has been like.
  4. I don't work in EM, but thought that EM PAs would probably be best at answering this. Is IM Toradol contraindicated for patients who take baby aspirin? The interaction checks I have done show that these are contraindicated, but I've seen providers give it to patients on aspirin. And what about warfarin and other anticoagulants? Do you ever give toradol to patients on these drugs? I've seen this done as well. I've never had to actually administer it, but there may come a time when I need to.
  5. I also work in Washington and read this part of the newsletter. It seems that most of the disciplinary actions taken on doctors are related to narcotics and most of the actions taken against PAs are due to personal health issues (probably mental health issues) that make it unsafe for them to practice. I did see a recent disciplinary action taken against a PA for missing testicular torsion in a child. I would think there would be more to the story than just a misdiagnosis, but I guess if the outcome is bad enough from a misdiagnosis then it very well could affect your license.
  6. Thanks, but the National Provider Database doesn't give info to the general public correct? I thought only healthcare facilities had access to that information. I could be wrong.
  7. Other than checking with a state medical board, I'm curious what others here recommend doing to check the records of physicians and other providers they will be working with. Things like disciplinary actions, malpractice claims, etc... Also is there a way to find out all of the states a provider has practiced in other than just asking them directly?
  8. Thanks for the helpful replies.
  9. beattie228 can you point me in the direction of those studies? I have read that irrigating under pressure can force foreign material deeper into the wound. Some sources advocate making an incision to widen the wound and gently irrigating it. I have also read some sources that say not to routinely get x-rays while others do. Every source I've read or listened to says the only evidence for treating puncture wounds is anecdotal and there is no agreed upon method for managing them, so that is why I'm curious what others do.
  10. Can those of you who work in the ER share some of your advice on the management of puncture wounds? There doesn't seem to be any clear consensus on how these wounds are to be managed. Obviously the wounds need to be cleaned and any foreign bodies removed as well as having tetanus updated, but how far do you go with exploring a wound if you are not sure if a foreign body is present? For example, if someone has a puncture wound through the sole of the shoe, and no foreign body is visible and the patient doesn't know how deep the puncture went or if there is any foreign material, what would you do in this scenario? I have heard some people core the wound, and others widen the wound until they are able to see the full length of the puncture. These methods also carry their own risks so I am just curious what those who have experience with this would do. And does anyone ever routinely use ultrasound for searching for foreign bodies in these types of scenarios? Thank you for the help.
  11. Have you joined this organization? I am a new grad PA in Occ Med and am looking for any good resources available and had not heard of this organization before.
  12. I have a question regarding when to administer tetanus immune globulin and am wondering if anyone has any insight on this. According to the guidelines, a person should get TIG if they have any wound that is not considered clean and minor if they have had less than 3 doses to tetanus vaccine (or if they do not know their immunization status). My question is in regards to what is considered a "clean and minor" wound. I realize anything that is contaminated with dirt/feces/saliva is considered dirty, but I am specifically wondering about splinters and minor burns. The reason I am asking this is because I work in an Occ Med clinic where workers come in with minor issues (such as splinter removals) and some are not immunized. TIG is very expensive and the only way for them to get it in my area is to go to the ED for it. I am just wondering if it is overkill to send someone to the ED for TIG for something as minor as a splinter if they're not up to date on tetanus. And in regards to burns, is any partial thickness burn, no matter how small, considered tetanus prone and therefore warrants TIG in some cases?
  13. Thanks for the replies. I agree if they value you they will pay you to keep your skills up to date.
  14. Has anyone ever come across a forced arbitration clause in their contracts? I have been reading that this is becoming more and more common in employment agreements, and it basically forces you to waive your right to hire a lawyer in a dispute and restricts you to only being able to settle disputes through arbitration. Seems that these types of agreements favor the employer much more than the employee. Is this something you would completely avoid agreeing to?
  15. New grad here with a couple questions about CMEs as I work through contracting negotiations. I am just wondering from those in the field how much of your CMEs are free or inexpensive and if it is generally necessary to shell out a lot of money to fulfill your CME requirements. Reason I am asking is because it seems that most people I've talked with say that your company should cover anywhere from $1500 to $3000 in CME expenses, however some jobs offer much less than this or offer nothing at all. I'm sure there is a lot of variability here, but if I were to take a job that doesn't cover CME expenses, is it inevitable that I spend a couple grand of my own money every year to cover this or could I realistically do so on a much smaller budget? Or is it appropriate to be insistent that your job cover at least $1500 in CMEs? The new rules for the PI and SA CMEs probably make this question a little bit harder to answer since everyone may just be getting used to doing it this way but any input is appreciated.
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