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About TheDude

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  1. Here's my unfavorite patients from both of my specialties... Cardiothoracic Surgery: The 20 y/o somethings where we replace their valves from all the meth use "I promise Ill get better"....find significant other injecting them post-op with meth...then they demand pain RX's out the ass, come back 2 months later with endo again.... The 4 month post-op that demands pain RX's....tells me that pain is a vital sign....(thanks nursing admin for making this a prob.) The "my "insert family member" is a nurse and said you should be doing this The "I won't follow your post-op in
  2. @SHU-CH the ROSS is a great option but you have to find a surgeon who's been trained in them and as you stated, experienced. They are becoming more rare due to other techniques chosen and lack of training unfortunately.
  3. Im current CV Surgery, have been whole career. With his age, I'd go with mechanical. Now here is the devil's advocate part, can he be trusted taking his "thinners" and maintain good iNR's? This is always a conundrum with younger patients because no matter how well they have their head screwed on, there is always a concern.
  4. Recently, a facility I do PRN stuff at (EVH, 1st Assist Cardiac) was bought by the large corporation I used to work for. I left there on good terms and went to a private practice group of CV Surgeons and have never looked back. I had to go through credentialing again and all was well and was credentialed. I recently did a case with no concerns but was alerted by my former office manager as well as another PA I worked with that my previous surgeon (and I use that term loosely...I'll explain later) wrote a very nasty and scathing letter to the credentialing board to not have me credentialed.
  5. Hey all, I am considering the ANG but wanted to pick some of y'all's brains about it. I have been a PA for 4 years and have spent all of it in Cardiothoracic and Vascular Surgery as well as UC and rural EM part time on the side. Where I am geographically located we have an ANG squadron here that utilizes PA's. I've done some basic research and understand that I would go in on a direct commission as a 2nd Lt. if my memory serves me correctly. Here are some of the questions I have though. 1.) Is the health services specialty officer program initial training in San Antonio for 5 wee
  6. I am echoing what everyone else said, but sh*t happens. CXR's can be clear as day or clear as mud. I look at tons of CXR's every day (CV Surg) and heck even my attending (31 year surgeon) has missed things. I think Sas said it above where looking for a rib fracture is damn near impossible unless its obvious, well, to add to that, so can a pneumo be damn near impossible to spot on occasion. You did the right thing and tried to contact him.
  7. That depends on the procedure and also the anticoagulant, as well as access to certain equipment such as cautery or silver nitrate. In CV we don't do hardly anything in the office. I can tell you this from experience. Plavix and Fish Oil are the worst in my humble opinion when it come to bleeding. We can bovie the snot out of things and they will still bleed. Fish Oil is a big culprit, but at the same time a necessary evil for some patients.
  8. I'm in Cardiothoracic and Vascular Surgery. I work for a fairly busy private practice group consistent of 4 CV Surgeons and 2 Vascular. I do about 80% OR and 20% ICU, no floor work or clinic-although I do clinic occasionally. I was told early in my CV Surgery career that it's not a career but rather a :"lifestyle" which is very true. Some days I am in the OR from 0630 to Zero-dark thirty (0030), and some days I am in and out and home by 11a. It varies and that will depend on your specialty. I take call, I work weekends, I miss family obligations here and there. It's not a 9-5 job
  9. My first day in CV Surgery goes like this. Showed up at 0545 to round-this was after credentialing was approved and sat around my house for about 4 weeks so this was truly day 1 besides computer training and all. First patient to see was a pre-op for a thoracotomy. Reviewed all the notes, looked at his films, reviewed the consent. Time was about 0630 and went in to talk to him about the surgery, Had a somewhat altered mentation, and as a former flight paramedic I wasn't a total idiot, but had a bad gut feeling about this fella. Didn't feel comfortable signing his consent for the surg
  10. Cardiothoracic and Vascular Surgery here as well as part-time Urgent Care and ER Base salary CV Surg is in the 130's working 25-45 hours a week depending on how busy we get. No extra pay for OT or call. Decent benefits and a pension with hospital as well as qualifying for loan repayment with 5 years of employment Cover CV Surgery call at 2 other facilities...1099 for payment, vein harvesting/1st assist fee of 350/case. Part-time UC and ER combined extra 25k/year with 1-2 shifts per month either 24 or 16 hour shifts. No benefits. I work my rear off now so I don't have to
  11. Was actually talking with my supervising surgeon about this same topic this morning. I'm in CV and after the bulk of the case is finished, I do the rest-drying up, placing temp pacer wires, sternum wires and then the rest of the closure. The surgeon never leaves the hospital but will sometimes go back to his office which isn't that close to the OR or see patients and what not. I've had a few crash while closing or after we've wired the sternum back together or even better when the last suture is thrown, and we open back up and do what we have to do. Could I place someone back on CPB emerge
  12. Howdy all A local hospital has contacted me about coming on as a PRN CV Surgery PA with primary responsibility of vein harvesting along with some first-assist stuff. In the interview they asked me if I wanted to be 1099 or W2 and then also talked to me about salary vs hourly as well. They didn't offer pay rates as of yet as they have never truly had a PA on staff either full time or PRN so I am the first. I'm an FTE with salary pay at another facility so this will be on a PRN basis and weekend when not taking call at my main facility. This facility is also not very busy and rarely doe
  13. Most of the time I learned things while on rotations in school. And I've also learned some while on-the-job so to speak. And then I've learned a lot by being thrown into the fire. I'm in CVT Surgery and when it came time to learn vein harvesting, one of the other PA's in the group taught me the basics, and eventually got me comfortable to be on my own. Basic office surgical skills can be studied from books and all, but honestly doing them over and over and over is what will help. I don't think your school failed you, it's sometimes up to you to dive in when on rotations to get e
  14. I sell drugs. I'm a friendly dealer, I stopped carrying a gun and I always give extra to get more customers... I do UC and Rural ER aside from my primary specialty of CV Surgery. And I also pimp myself out to other hospitals for EVH and EAH for CV Surgery. Word of caution, if you start making good money with the additional income, just be smart with it.
  15. I'll echo what everyone else has said and add my two cents. I have been doing UC on the side from my primary specialty of CVT Surg, but can say that if you have a bad gut feeling, send them. My attending I work with in CVT Surgery always tells me this quote and it applies usually to most that we do in all specialties, "If you're thinking about it, there's reason enough to do it." Meaning, if I think someone needs a CT or LP or something, I send them. Now that's not saying that every ABD pain goes or asthmatic or anything that starts with an A, but I am sure you get the gist if what I'm say
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