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ruralem's Achievements


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  1. I just used propranolol in an acutely anxious patient in the ED. Has multiple visits in last 3 weeks, hx of drug abuse, and I wanted to avoid benzos. used 20 mg PO and he felt much improved after 45 minutes. HR came down into 90's from 120's. Symptoms resolved. I'm a believer.
  2. EMRA antibiotic guide. Not free, but I use it on a daily basis. Also use epocrates.
  3. There were some discussions, but it would not be able to be anywhere close to where I want it to be. I will always have to take call and its fairly hard to maintain a consistent schedule.
  4. I appreciate the advice so far! My main consideration for moving is that I will have twice as much time as as I currently do. I don't need to make more money, I just want to make the same amount, and work less. The area we will move to is similar in terms of recreation, the main unknown is community and making friends. I feel like I am missing out on time with my family, and that is the whole point of living in a cool place, right? My wife is not resistant to moving, we are just comfortable here. I just don't see these hours being sustainable moving forward WHILE still trying to be a good dad and husband.
  5. Hey Folks, I have posted a couple times about this situation over the last few months, and it has recently come to fruition. I am taking a poll to see if others in my situation would do the same thing. I currently work in a rural critical access hospital, covering the ED and Same day care, with hospital rounding and some primary care sprinkled in. I work four 10 hour shifts per week, and take 5 nights and 48 hours of weekend call a month. My "salary" all said is about 116,000. My wife and I love it here, and she does not want to leave ... but I feel like I am working all the time and really not being paid too well. Couldn't be happier with my coworkers and support, but solo EM definitely has some stress, and I don't feel like I see my 1 yr old daughter enough. I just signed an offer letter for an EM/UC job in Washington, 2 states over for twelve, 12 hour shifts a month. Possibility of 4 on and 6 off. Extra pay for extra shifts. Double coverage, only days. 121,000 per year but no PTO. Otherwise good benefits ... 7% company contribution after 2 years.. We don't have family there and know a couple people there. Slightly higher cost of living. Am I making the right decision? Do me a favor and tell the future ... thanks.
  6. EMEDPA, could you move this to general discussion? Didn't realize I posted in the wrong place. If not, no worries. Thanks.
  7. EMEDPA do you work 48 hrs in a row? Whats the volume like?
  8. I have come to a turning point in my career and need advice, but I will try to summarize efficiently. I currently have a rural job where I work in the clinic and ED/hospital of 2 different facilities. Same day/ED during the day and call during the night. It is close to home (one facility is 3 minutes and the other is 50). I love my coworkers and have good support, and spend most of my time practicing solo doing whatever it is you do in a normal ED. The bad thing is I make 45/hr at this facility during the day, and 300/12 hr night call shift, or 600 for a 24 hr call shift in the weekend. Sometimes this is a good deal, sometimes not so much. I end up making about 120/year, but work 4 10's, plus 5 nights of call a month and one full weekend (48 hrs) a month. The other option that has come up is this: 24 hr shifts in a rural ED 3 hours away making 70/hr. Sounds like it is low volume (5-20 / day). I would work 2 24's a week with a 12 hr break in between. Have no idea what the staff or colleagues are like. Assume benefits at both places are the same and no travel stipend is provided. Which would you pick? I am torn... Thanks
  9. Hey Folks, I know there have been a couple posts regarding Wilderness Medicine Education here on the forum. I wanted to get the word out that I have started a "company" just for this purpose. My partner and I teach AWLS (Advanced Wilderness Life Support) courses here in Red Lodge, Montana. Our next course is July 28-30th of 2017. We really promote a "hands-on," trial by fire style learning approach, with some wilderness-based moulage scenarios. We also have a blog where we will post videos, case studies and little blurbs that we find useful. Of course, there is only one post so far because we just started the blog, but we hope to keep it quite regular! For course information/registration and our blog, visit www.hellroaring-medical.com. Our Facebook page is https://www.facebook.com/hellroaringmedical/, where you can find updates on blog posts and whatnot. This is all an act of love and pure interest, really, so if this seems like a shameless self-promotion, it sort of is ... but it may be comforting to know that I really just love this stuff, and we only come out even in the end. Having said that ... If this post is inappropriate, I will remove it! If you have any questions at all, feel free to contact me. Cheers, Pat
  10. Good luck. The moment he restricts our clinical role is the moment thousands of rural communities across the nation lose their only access to medical care. I can see it now, sticksville, mt forking over 300/hr to staff an emergency physician (who is probably locums), to see 10 pts a week.
  11. Ill join in. Had an interesting cardiac case yesterday. Pt came in with wide complex tachycardia. Adenosine 6, 12 mg PTA. Hr of 170, BP 80/40. Tried second dose of 12 mg adenosine while prepping ketamine just for kicks. Nothing. Conscious sedation with ketamine, 100 j cardioversion did the trick back to NSR. Admitted for tele, and about 2 hrs later, went into new onset afib RVR at about 130. Bolus 20mg dilt brought her down a bit ... started drip and PO dilt, increased beta blocker, lovenox. HR in high 90's today. Trop peaked at 3, then dropped. Pt came in right after with persistent ventricular bigeminy. Increased beta blocker and it went away overnight. Cards day..
  12. I work as a solo provider(when on call) at a critical access hospital in the northern US. I make 40/hr coming out to 84k/year for a 40hr week. I take and get paid extra for call on top of that at 300/night shift and 600 per 24 hr weekend shift. This is my second year as a PA but I have ER experience before, which is why I worked up quickly to being a solo provider. I would say I have average benefits. I am going to ask for 50/hr, coming out to about 100/year plus call. I think this is still under for the specialty (ED, hospital, clinic), but it is a desirable area, and we like it here. Do you guys think this is reasonable? I am willing to walk, and have other offers, it would just be great not to leave. They have had trouble staffing this position, so I may have leverage.
  13. I am a member, and it still wants me to pay for the report!
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