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Eastcoast PA-C

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  1. Policy in my system is that an ESI 2 is “co-managed” and the doc is supposed to see the patient as well (only happens in reality about half the time). ESI 3 needs to be presented verbally. ESI 4&5 are just charts being co-signed. I routinely go a full shift with none of my patients being seen by the attending. I currently have 5 years of experience, all EM. Sent from my iPhone using Tapatalk
  2. Our EDs are dilaudid-free, so I’ll use morphine if I need something that lasts. Fentanyl is my first line for pretty much everything though. Sent from my iPhone using Tapatalk
  3. Just curious, what was their reasoning for declining to do an IVC filter if someone was willing to go through the sedation and prep necessary for EGD and colonoscopy? Sent from my iPhone using Tapatalk
  4. She’s not a candidate for a minimally invasive procedure that wouldn’t require anesthesia? That’s some seriously poor protoplasm right there. Fun case! My lazy answer would be to call hematology and do whatever they tell me. The non-lazy answer would be that we are in need of anticoagulation that is reversible, and hopefully avoid big fluctuations in clotting/thinning. So my ideas are: 1. Heparin Sub-Q 2. Pradaxa 3. Daily INR tracking with home testing and hope for the best. 4. Hate to sound defeatist, but ave a solid conversation with the patient to lay out just what a predicament we a
  5. Sounds like someone needs an IVC filter. Sent from my iPhone using Tapatalk
  6. I was just wondering how everyone’s employers handle OT. Our system treats anything up to an hour past your shift as expected and does not reimburse. Past an hour extra and you can get paid for it. I’ve heard several times that it’s “the standard in the industry” and was curious about how it is for others. Sent from my iPhone using Tapatalk
  7. It doesn’t bother me unless they do it before the patient can actually be dispo’d (i.e. the troponin isn’t back). Our EMR tracking board is terrible for knowing when stuff is actually completed, so it’s sometimes a helpful reminder. But if the tracker makes it obvious that they are ready for dispo, I can see where it would come off a little passive aggressive. Sent from my iPhone using Tapatalk
  8. Personally I like wells because a low risk score gets you a much lower risk of PE than Geneva, like karebear says. But now I’m using Geneva in documentation because our risk management board put together a PE pathway that we are being asked to use. But in reality it ends up being gestalt a lot of the time since I have a predominant elderly patient population who would all fail PERC. So it ends up being more gestalt so I don’t reflexively order a dimer on everyone over 50 with chest pain or dyspnea. On a related note, there is something that hasn’t made sense to me for a while. “PERC negati
  9. Just got home from a shift with a “flu-like symptoms” patient. Vitals stable, HR right about 100 with some quiet lung sounds on the right. Afebrile, nontoxic. Something felt off about it so I caved and did labs and a chest X-ray to shut up the voice in my head. WBC was 42k, CXR showed right sided hemopneumothorax, which CT characterized as empyema with a 50% pneumo. Surgeon opted to take her to the OR to drain everything. Flu swab was negative though, so at least she has that going for her. Sent from my iPhone using Tapatalk
  10. Both fairly recent #1: 82F, belted passenger in MVC about 40 mph with “chest pain where the seatbelt was”. 9 broken ribs and a small bowel contusion and pressures in the 90s by the time transport to the trauma center arrived. #2: “Left big toe pain” in a 50-something male. No pulses in the foot and “oh, I forgot to tell the nurse that my fem-pop was on that side.” Heparin and shipped to the nearest vascular surgeon an hour away. Sent from my iPhone using Tapatalk
  11. I think it's a good place for shared decision making. Low overall suspicion, pt has someone at home to keep an eye on them, PCP follow up available, pristine neuro exam and the pt is reliable and agrees with foregoing the scan--just document like crazy. Anyone over 65 at least gets offered a scan and usually accepts. As an aside I'd also like to throw this out there: So far I've never seen a patient with an abnormal head ct that surprised me. There has always been a significant mechanism, mental status change or focal neurological finding. Just wondering if anyone has had a patient that was
  12. I'm in a similar situation but about a year ahead of you. You can't put a price on the training aspect. That right there is worth putting up with everything else (you would be paid half as much in any official PA EM residency and work just as much). But after a year or 2, it's up to them to respect what they've taught you and what they've made you capable of. Pretty soon you will be hugely marketable for jobs with better pay and hours--don't be afraid to take advantage of that. Sent from my iPhone using Tapatalk
  13. I think the "walk out" part is the most important. You can have the most articulate and effective response in the world, but if you hang around and give them the chance to argue/plead/threaten/sob story, they will just wear you down. Sent from my iPhone using Tapatalk
  14. Assuming that nothing has changed since I graduated, there was an individual interview with 2 faculty members with pretty straightforward questions, and a group interview with 2 faculty and 6 or 8 applicants. It was kind of a round table discussion on a few topics to gauge how everyone thinks and interacts. The rest is info sessions to try to convince you to take a spot there if it is offered to you. Hope that helps some. Sent from my iPhone using Tapatalk
  15. It's definitely a decent story for something like a labyrinthitis, but the persistence/severity of the symptoms and the headache are worrisome enough that I would at the very least CT. Family history could be helpful. It would be weird, but a posterior circulation infarct or bleed would have to be in the differential (even though the CT is pretty lousy at evaluation the posterior fossa). Luckily I'm in a place where neuro is one phone call away and always willing to give some advice and arrange follow-up. In my shop, this guy probably gets an MRI (and probably wouldn't have been triaged to
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