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About MrsGPAC

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  1. I love it! Definitely no lack of paranoia here!
  2. I've done the "official" one. Are there other ones that you've done that you thought were helpful? (Not that any airway practice is unhelpful...)
  3. Fellow rural EM folks--I have just (FINALLY) landed a solo coverage rural critical access gig that I thought I'd have to hold out for a few more years. I've been doing per diem shifts here for a while now but will be starting full time in July. I am super excited to finally have this opportunity. What courses have you felt were particularly helpful for this setting? (I've done ATLS, Bootcamp, Essentials, difficult airway). I have 5 years under my belt working a variety of high autonomy positions so have decent experience but limited solo coverage, so would like to expand my skill set. For context: It's a 5 bed ED in a critical access hospital, 24 hour shifts with hospitalist backup (around during the day/close to hospital but offsite at night). No surgical call on the weekends...(yikes)
  4. Same. 5 years, couple of URI's (probably from niece/nephew interactions) but otherwise nothing. I wipe down my desk, phone, keyboard, dragon microphone, badge, cell, pens with a purple wipe at the beginning of every shift and mask for anything with cough/cold symptoms. Glove for anything vomiting/diarrhea. I only bring food I can eat with a fork/spoon and only eat after I've scrubbed my hands down. It's probably OCD overkill most of the time but it has kept me healthy.
  5. So much this! I do not enjoy urgent care in the least. I find the never ending antibiotic fights and last 10 min of the day "I've had a runny nose for 15 years, I demand that it be cured right now" stuff more stressful than my solo rural ED gig.
  6. Yes! And usually a dilt drip works splendidly! I have just apparently been grabbing the super stubborn a-fib recently!!
  7. I have been striking out with dilt recently so have used metop a bit more (with obviously not much luck this time)
  8. Had a great "Not eating, drinking, taking meds. Confused" dropped off in my 5 bed solo ED this week. Recent flu admit, DC 4 days prior. Regular at this ED (I'm per diem, don't know all the regulars yet). Nurse (AMAZING nurse) says: "want an EKG?". Sure, weak old lady, sounds good. Brings me an inferior STEMI. Started c/o chest pain AFTER drop off. Go in to see the patient again, she is hypotensive, diaphoretic, writhing. Send EKG to nearest PCI center....because she's altered, wants CT head (in my tiny ER with no radiologist) prior to lysis and ship. Had lytics ordered since STEMI EKG. Choppers all out of range/at shift change. Locals won't transport without a nurse. Sup nurse won't let a nurse go. Patient lysed, into a-fib with RVR nearly immediately. Metop x 3 given with little change. Finally get a crew and my amazing nurse agrees to go. As they are wheeling her out the door she starts chatting away about grandkids and thrift stores...apparently talked the crews ears off the whole way down. Arrival EKG without ST changes, sinus rhythm. Unknown cath outcome. Alone in a small town, only provider in the hospital. Crazy stuff!! Makes me love ED more every day!
  9. CC: Flu 60 something female no medical care for years with cold symptoms (ST, runny nose) that have resolved. Why she is really here is a rash and general weakness. Rash started 6 months ago, weakness 4 months ago and worsening. SOB x 2 months. Mildly tachy at 115, vitals otherwise stable. Diminished lung sounds at the bases. Her "rash"... her left breast is basically gone--no visible areola. Open weeping wound with serosanguinous drainage. Right breast is on its way to the same. She has a massive fungating lesion from her sternal notch to umbilicus. Non-tender. She also had some unilateral leg swelling CTA shows multiple bony mets, liver mets, bilateral large pleural effusions So yeah, metastatic breast cancer dx...in fast track Hospitalists also noted 60 lb weight loss over the last several months (I never even asked...the diagnosis was pretty clear). Malignant pleural effusions, adeno suspicious for breast primary on liver bx. Heartbreaking case.
  10. Not Ellsworth. Pay there is ridiculously low, I agree!
  11. I have a couple thoughts on this: "I just don't like the disrespect people get as a PA"--Then work hard and be a rockstar. Sure you'll get some disrespect here and there. It is inevitable. Take great care of your patients, do the right thing, and brush it off. As an aside, I've seen my docs disrespected as often as myself by various specialties. It's rampant in medicine. "I fear having to be an older PA and having to take orders from a younger MD"--If you fear taking any orders, you should just go to medical school. Many of my docs are younger than me. They are awesome. They do not order me to do anything (although I get in some specialties that would be the case). They provide fantastic support when I need help with complicated patients. They have my back all day every day. "I just fear getting a lackluster education"--then don't. If you want the PA education, be a PA. Many PA's (including myself) have great autonomy. I feel like maybe you haven't spent enough time with PA's. Have you shadowed in multiple specialties? Again, I work in an ED and unless a critical imaging report comes across the printer and one of my docs gets to it first, or they are just trolling the board and interested in what's going on with a patient, they leave me to take care of my patients. They regularly pull me in on their complicated/interesting patients as both education and point of interest. They ask me as many questions as I ask them. I learn from them every day--they make me a better PA. When all is said and done, I feel like you just need to get through o chem and physics and go to med school. The hoops you are wanting to jump through for a PA education with NP autonomy (which as mentioned above isn't across the board) seem much harder logistically and financially than just getting a tutor and muddling through O chem and physics. I am getting the impression that you want control and prestige--and that's not a bad thing--but if that's what you want, go to medical school or you will surely regret your career choice.
  12. Ha! Yes. My resignation therapy (as of yesterday) is helping some. I mean, for me. :-)
  13. Seriously. This place is out of control. Came in the other day to a pt 80/50 BP tachy to 140, 24 rpm who had been sitting in an empty pod FOR AN HOUR with no provider and no nurse. Charge tells me "I've been keeping a close eye...blah blah blah". My response is "it makes me really nervous for these patients to sit back here..." Charge "well there are sick patients up front. I put in the dehydration protocol". I go in, the patient isn't on the monitor is basically just shy of extremis and the "dehydration protocol" (cbc/bmp) that was put in has not been drawn... Patient with pancreatitis in DKA (new onset DM...A1c late Nov 5.1. Anion gap of 34, bicarb <5. This particular pod is supposed to be 3's and soft 2's.... I've admitted more patients to the unit out of this place (in the 3 months we have used this system) than I have in 3.5 years here. Oy. I'm nearly bald now....
  14. CC: Shoulder pain "Fell off snowmobile "at low speed" PT: "My shoulder hurts and my collarbone is broken but my back hurts a lot worse--near my shoulder blade" Otherwise stable, stable vitals. Looks REALLY uncomfortable and you know this dude is tough. Comminuted clavicle fracture (knew that on exam) CXR shows huge pneumo with blunting of costophrenic angle so likely hemopneumo CT with 90% pneumo/small hemo component. In fast track (well, what we call PIT). Our triage situation is dire. We are going to kill someone. I have been screaming from the rooftops for years on deaf ears. Anyone else been able to make headway on this at your shop? I gave my notice here today so ultimately my days are numbered, but this is my community and it terrifies me.
  15. I do some solo coverage at a 7500 visit/year critical access hospital in Maine. Same experience as above. Rural Maine (well all Maine) folks are tough--and SICK, so it can be interesting. It's been solo PA coverage since I was a kid (I'm nearing 40). Great gig. 15-20 per 24 hour shift so pretty manageable. Hoping a full timer will leave sooner than later so I can jump into a full time role.
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