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LT_Oneal_PAC

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LT_Oneal_PAC last won the day on October 16

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About LT_Oneal_PAC

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    Physician Associate

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  1. Sorry. Full up on stupid today. We are at capacity and cannot process any more.
  2. Interested to see the answers. While I don’t practice in an ICU anymore, I don’t think that ECMO is becoming more prevalent. Heck, they are starting it in the field in Europe. Don’t think it’ll be long before it could be a rural EM skill before transferring to a tertiary center
  3. Keep it on topic, which financials will be considered in the realm of discussion. It’s not about the obviously dismal state of mental healthcare in this country. Another topic can be started for that if people want to discuss. Further people can disagree with fun little quips and jabs, but remarks bringing it to a personal level are not.
  4. Done cadavers twice. Electives would be more useful
  5. It would depend on the severity of the elbow fracture, do I have ortho in house and their recommendation for operative/non-op, your skills. So lots of questions I can't answer for every specific scenario. There is also lots of different answers for pain for reduction and splinting, which could entail a very long answer with ketamine. I'll focus just on pain control in the following 24 hours. After 24 hours it should all be non-opioid management. If you are going to send them home and they are a IV opioid addict, I wouldn't think you could send them home with a reasonable amount of opioid pain medication to treat their pain. You could send them home with a lortab 5 #4 tabs, just to check box you treated their pain and keep you out of trouble, but is this really best for the patient? Probably won't treat their pain, may just come back again for more, may go shoot up to control their pain. Personally, I would perform an axillary block. Low risk and relatively easy to perform. If you aren't trained in regional, could see if anesthesia would come and perform. Document neurovascular status well. Some worry about missing compartment syndrome, but there hasn't even been a case of this being missed by doing a block and thoughts that there is an alternate pain pathway not stopped by regional anesthesia. https://www.nysora.com/techniques/upper-extremity/axillary/ultrasound-guided-axillary-brachial-plexus-block/ So I think that a block with observation admit for pain control is reasonable. Do it all the time for hip fractures with a fascia iliaca block that will be operated on the next morning. If they aren't going to operate then I would consider block, admit for 24 until maximal swelling it done, discharge on NSAIDs, outpatient follow up with ortho.
  6. Not very. When nexplanon training came to my hospital, they let me attend, but they wouldn’t let me take a half day of leave to take it earlier when it was across the street. They are fine with learning whatever you want, but mine never let me out of clinic to do it. I took leave and floated to other departments to learn IUD insertion, colpo, vasectomy. Tried to train to do flex sig, but never could get around that and they wouldn’t order the equipment. If the clinic doesn’t already do it and order the equipment, your not going to do it. Good news is most places will have the capability for the procedures you’re asking about.
  7. A lot to be said for being happy in your job, but personally I think if they are trying to cheat you out of so much salary, they aren’t aiming high at keeping you happy. They may find other ways to squeeze you. Definitely would have my hours written into the contract. Maybe negotiate for a guaranteed salary increase every year in the 3-6% range and they can keep the RVU, or every year you get a higher percentage of RVU.
  8. Looks like there is some off service rotations, as they speak about an OB rotation, which is a really good thing and missing from even some good programs. Definitely would inquire about what off service rotations there are. I’ve from around that area, and not sure I would choose to train in the Deep South until practice environments improve. I don’t think it’s great for NPs or PAs down that way. Just personal opinion. biggest problem: ACGME requires 5 hours per week of education. They give 4 per month. Way below the mark unless you are doing a ton of asynchronous learning (reading and answering quizzes), but only 25% of education can come from that per ACGME. So they miss the mark on education. My residency also has journal club every month. Think your going to miss out on a lot of discussion doing it only twice per year.
  9. Back in 2008, I remember having to be vested for 7-8 years at my first nursing job. My residency offered a choice of 2 retirement plans. One with immediately vested and another that was vested at 5 years.
  10. Working in a CAH, We don’t have any consultants in house, so I don’t get to know them either way. Agree this is a minus at a larger center.
  11. I’m an EM and Hospitalist nocturn. Echo all of the above. Also for me, being more of an EM guy, I hate doing discharges and social work, which I don’t have to do on night shift.
  12. Brief interruption for anyone reading: We are not a policy group. The moderators are allowed to have personal opinions and express them freely in manner consistent with the ToS. The only position of the moderators is to keep the forum friendly and on track. We remove trolls, spammers, off topic content, and move content to where it belongs. We will not condemn an opinion except as individuals. finally, please stop derailing the thread for personal attacks. First, it doesn’t bother me. Second, it will end in closure. You may start another thread concerned only with me, but that may also be considered trolling. this informational post will be the last off topic post for this thread by me. Please start another for a different topic if you’d like.
  13. I made my friends by inviting lots of people out for things that I wanted to do, like rock climbing, frisbee golf, hiking, and the like. People who didn’t like the things I liked (and preferred going out drinking) stayed home, and people I was more likely to click with who came out. I made a few friends, but also my best friend who now I’ve talked to nearly everyday for 5 years
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