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LT_Oneal_PAC

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LT_Oneal_PAC last won the day on September 7

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About LT_Oneal_PAC

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    PA-C. EM PGY-1

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    Physician Associate

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  1. LT_Oneal_PAC

    My reaction when

    the MVC patient with an ETOH of 350 tells me he wasn't drinking
  2. LT_Oneal_PAC

    My reaction when

    The attending says admit to the ICU and they can do the central line.
  3. LT_Oneal_PAC

    My reaction when

    When the patient is telling me the story of how something “accidentally” became lodged in their rectum.
  4. Someone is talking in the trauma activation while I’m listening to breath sounds or while I’m calling out the survey
  5. OTP doesn’t remove collaboration with physicians, but remove collaboration with a specific physician. It ideally would move to a general “I will collaborate when necessary” type involving education and your specialty scope.
  6. LT_Oneal_PAC

    em photo quiz( occasional series)

    The old adage still holds true, treat the patient, not the monitor.
  7. LT_Oneal_PAC

    em photo quiz( occasional series)

    Good work! If I were really concerned with hypotension and symptomatic bradycardia, I might go with a dirty epi drip. Take one cc of cardiac epi and inject into liter bag, then titrate to life. This will give you 1mcg/mL. All IV tubing has the gtt rate on the packaging, though you might to find someone with grey hair to remember how to calculate a gtt rate ? We are using high dose insulin more than glucagon these days.
  8. Agree with Emed on all points. Lots of unknowns here to say what caused her shock, but definitely in shock. Still best to give her abx. I likely would have started her on norepi. Also don't see troponin, though this would likely be elevated anyway given her kidney function, but this could be ACS with shock, though agree with Emed likely metabolic. Would have thrown a US probe on her to look at heart function and IVC for fluid status. You couldn't get a temp because she can't even keep enough blood central to mount a core temp.
  9. I do this because I love medicine. I love the science, the helping, the adrenaline. I definitely would have been a MD/DO if I could start over, but I’m happy. Certainly places I have worked have helped shape that, being respected and feeling like a colleague. Same life circumstances, would do PA every time. I did feel burned out in the military, but they just kept piling on the work and there is no quitting. I’m happier now, even though I work equally as much/more in residency because I have dedicated didactic time that helps me feel more fulfilled at work.
  10. LT_Oneal_PAC

    Residency after working - not as a new grad.

    Sorry, I don't remember seeing a notification for this. Definitely worked for me. I had some outstanding letters of recommendations from the assistant program director for the FM residency I worked at, as well as from colleagues that commented on my ability to function as a full provider. Plus, I wasn't as stressed at the interview. They did ask some questions. To paraphrase, they stated I could probably get a job in EM just fine without a residency based on my experience in the military and my high level of functioning in FM, so why would I want to do the residency. FM specifically has been very beneficially to me in EM because I have seen so many EM follow up visits in my clinic and know exactly what an FM provider would and would not be comfortable handling, though sometimes I think I was more comfortable than some of the guys around here based on what they send into the ER for me to work up, lol. I end up being much more comfortable than some other providers in not ordering several lab tests and scans, being confident in my physical exam skills, which have improved significantly with my implementation of US. I'm also more willing to start patient's on medications until they can have follow up with their PCM. Lastly, I know a lot of long term management/complications in chronic medical problems that many of the EM providers either don't know or are very rusty on.
  11. LT_Oneal_PAC

    Accelerated BSN to PA?

    Financially speaking long term, probably better just to do the EMT. I will say that the experience as a RN is top notch and you could get a job in a specialty in a inpatient specialty so you could have a better idea of what you would like to do and give you an "in" at a place you would want to work after school. If your goal is derm, nursing isn't going to help much in that regard. I've never regretted my nursing experience though.
  12. LT_Oneal_PAC

    What's up with some pharmDs?

    I love my ED clinical pharmacist. They are, quite frankly, smarter than me. My local retail walgreen pharmacist? Him/her I can do without.
  13. Assuming you are being honest that we misread your post, then you misread the original quoted post that it meant to never get XR. In which case, maybe you should practice some restraint and reaize you can misread and don’t be so upset when others do the same. However, I think you meant exactly what we think, and that is you often order unnecessary XR in low risk back pain. Furthermore, if you have a problem with anything I post, you are welcome to report it as I am not above reproach.
  14. LT_Oneal_PAC

    Residency after working - not as a new grad.

    I did. Worked in the Navy and family medicine before doing and EM residency.
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