Boatswain2PA Posted September 7, 2014 Share Posted September 7, 2014 I love rural EM because the patients are often simply the best kind of people. NEVER discount it when a farmer/rancher walks into your ED and says he thinks he hurt himself. You can guarantee at that point that they are. 3 Quote Link to comment Share on other sites More sharing options...
medic25 Posted September 7, 2014 Share Posted September 7, 2014 I love rural EM because the patients are often simply the best kind of people. NEVER discount it when a farmer/rancher walks into your ED and says he thinks he hurt himself. You can guarantee at that point that they are. Words to live by. Took care of a dairy farmer last week who fell working in the yard. Hip pain, full ROM, but couldn't bear weight. Plain films were negative, but knowing this was a guy who wasn't wimpy we did a CT of the hip and found a non-displaced fracture. Same rules for farmers also apply to fishermen. If you can survive to your 60's working a tuna boat, you know you're made of granite stock; if you're sick enough to make it to the ED, there's probably something wrong. 3 Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 7, 2014 Share Posted September 7, 2014 Open book pelvis fx on elderly rancher....he drove himself and WALKED into ED. First indication of real badness was when he urinated about 300cc of frank blood. Your right about fishermen, although there is a high rate of drug abuse in that population. Some are like the farmers/ranchers, others are not. Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 10, 2014 Share Posted December 10, 2014 First 18 hours of a 48 hour shift down and I've seen 8 patients. Admitted 4, shipped 3 including an elderly guy who fell off a roof and a middle aged febrile encephalopathic, and sewed up the face before dismissing 8th one. Got a good nap in, and still had time to work out twice Quote Link to comment Share on other sites More sharing options...
JMann Posted July 4, 2015 Share Posted July 4, 2015 Just discovered this thread somehow. These are the kinds of gigs I might be looking for after I do a fellowship. These cases are great too! Such a good learning tool. Boat- those are some tiny places you work/worked in. And the 24-36 hr shifts remind me of the fire department. I'm assuming those kinds of shifts are pretty uncommon. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 8, 2015 Author Moderator Share Posted September 8, 2015 I was just recruited and interviewed over the phone for a solo coverage night shift position at a local suburban community emergency dept that pays 25 dollars/hr more than my regular job and 10 dollars/hr more than my best paying rural job. The doc said he had heard good things about me from a variety of docs and pas in the community and wanted to offer me the position sight unseen. 8-10 pts in 12 hrs. docs cover days, pas cover nights. I'm going to do a few/month and cut back to the bare min at my regular job to keep my benefits there. The funny thing is, I have worked with many of the docs at this facility in the past and offered to work there full time 10 years ago on this very same shift for 15/hr less than they will be paying me now. the answer to my proposal 10 years ago was that "PAs covering an emergency dept that is not in a rural area is not the standard of care in emergency medicine". I guess it is now....:) ( I put this in the rural thread because it is the same group that staffs one of my rural jobs and it is a solo position- there is the potential in the future for me to create a full time job out of the rural job + this one, but I would lose a lot of scheduling flexibility if I did so). 1 Quote Link to comment Share on other sites More sharing options...
Guest Paula Posted September 8, 2015 Share Posted September 8, 2015 Makes me think I would enjoy going back to the first reservation I worked at when I graduated. No upper- ups in administration breathing down my neck to see more patients, etc. It was just me with the physician a phone call away. I liked it that way. You've come full circle EMEDPA!!! Quote Link to comment Share on other sites More sharing options...
JMann Posted September 16, 2015 Share Posted September 16, 2015 Sounds awesome! Solo coverage and closer to home, that's perfect. Congrats! Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 25, 2015 Share Posted September 25, 2015 And sometimes rural EM really sucks. Small towns, everyone knows everyone else. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 25, 2015 Author Moderator Share Posted September 25, 2015 And sometimes rural EM really sucks. Small towns, everyone knows everyone else. nice to know all the medics and nurses, etc on a first name basis. I have been at my full time urban trauma ctr job for 15 years and still know less than 1/2 the rns or techs on a first name basis. Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted November 18, 2015 Share Posted November 18, 2015 Because when the weather really moves in, and everyone within 100 miles is snowed in, so you can't ship anyone to the ICU...you get to care for the critically ill patients for 24 hours until the snow plows start moving. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 18, 2015 Author Moderator Share Posted November 18, 2015 Because when the weather really moves in, and everyone within 100 miles is snowed in, so you can't ship anyone to the ICU...you get to care for the critically ill patients for 24 hours until the snow plows start moving. snow not an issue where I am. rain/fog and no helicopters is. just had something new over the weekend at a rural job. pt with concurrent appy and chole. never seen that before. CT was dx for appy and suspicious for chole. u/s for chole also +. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 18, 2015 Administrator Share Posted November 18, 2015 snow not an issue where I am. rain/fog and no helicopters is. just had something new over the weekend at a rural job. pt with concurrent appy and chole. never seen that before. CT was dx for appy and suspicious for chole. u/s for chole also +. Heh, I bet the surgeon's biller is going to hate trying to get fully reimbursed for that! Quote Link to comment Share on other sites More sharing options...
FfIghter23 Posted November 18, 2015 Share Posted November 18, 2015 Because when the weather really moves in, and everyone within 100 miles is snowed in, so you can't ship anyone to the ICU...you get to care for the critically ill patients for 24 hours until the snow plows start moving. Hey more time for the hospital to bill 99291/2 for critical care time :) Quote Link to comment Share on other sites More sharing options...
FfIghter23 Posted November 18, 2015 Share Posted November 18, 2015 snow not an issue where I am. rain/fog and no helicopters is. just had something new over the weekend at a rural job. pt with concurrent appy and chole. never seen that before. CT was dx for appy and suspicious for chole. u/s for chole also +. Saw that once before. The surgeon was a racehorse and did laparoscopic 3 port for both in abouf two hours. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 19, 2015 Author Moderator Share Posted November 19, 2015 Saw that once before. The surgeon was a racehorse and did laparoscopic 3 port for both in abouf two hours. yup, my guy did them both as lap technique as well. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 21, 2016 Author Moderator Share Posted February 21, 2016 working my rural double coverage job this weekend. just had an interesting trauma. guy on bike high on meth hits drunk guy crossing street. 2 different ems crews. initially didn't know they were from same incident. bike rider with subdural bleed, drunk walker with maxillary fx and multiple nasty facial lacs. accident occurred on only bridge access to town, closing highway for extended period. 1 Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted February 21, 2016 Share Posted February 21, 2016 And sometimes it sucks. Beautiful Saturday so everyone in town is outside, doing things, and getting hurt. Single coverage ED with 24 hour shift + large/complex laceration on a kid that took well over an hour to get it closed properly, meanwhile they kept on coming in.... Today was my DOMA....Day Off My A$$. Is it still Sunday? Where's my coffee.... Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 22, 2016 Share Posted February 22, 2016 Had one of those days where we're on a CT diversion - took forever to get one at one of the urban tertiary care centres for a patient of mine today...I then had to let that poor soul know that they likely had metastatic cancer...they didn't know they even had primary cancer. I'm getting a tad bit annoyed at diagnosing advanced CA in the ER. ON the bright side, I made an older lady with dementia smile when I bivalved her wrist cast and she made me laugh when she tried to set me up with her not unhot daughter...at least there was a bit of balance to the day :-D. SK Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 16, 2016 Author Moderator Share Posted March 16, 2016 started new rural per diem position last night. 2 hr drive from home, but nice low volume situation at good rate of pay. saw 8 pts in 12 hrs last night with only 1 transfer. may create a full time job out of this and one of my other rural per diem jobs in 4-5 months. both are run by the same group and might be a good exit strategy from my current full time urban trauma ctr job. I like the people at my regular job, but 30+ pts/shift with fairly low acuity is starting to get very old....I would probably stay on 1-2 shifts/mo there just for social reasons. just did my first chest pain workup here. bedside trops are awesome. Neg workup, but good to go through the process to see how they do things around here. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 3, 2016 Author Moderator Share Posted April 3, 2016 walked into rural job to find 3 pts waiting, immediately followed by older gent in 2:1 aflutter at a rate of 145, immediately followed by a stemi from ems that coded enroute. first time I have given tnk during a code. we got pulses back, remained hypotensive after fluids so started levophed. lifeflighted out with pulses and a reasonable bp and arrived at receiving facility in stable but critical condition. rock and roll. this is why I wanted to work solo/rural and I got my wish! 6 Quote Link to comment Share on other sites More sharing options...
SERENITY NOW Posted April 3, 2016 Share Posted April 3, 2016 That's awesome. I hope to follow in your footsteps someday. Low volume high acuity really sounds like the ideal setting. Lots of learning still left to do until I can be that good, but a guy has gotta dream! Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 3, 2016 Author Moderator Share Posted April 3, 2016 That's awesome. I hope to follow in your footsteps someday. Low volume high acuity really sounds like the ideal setting. Lots of learning still left to do until I can be that good, but a guy has gotta dream! have not given tnk in a code before, but figured with this rhythm before the pea arrest there was no downside. seemed to work ok. should know in a few days what neuro function is like... Quote Link to comment Share on other sites More sharing options...
Evolute Posted April 7, 2016 Share Posted April 7, 2016 E- any update on your code? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 7, 2016 Author Moderator Share Posted April 7, 2016 E- any update on your code? have not been back there since. next week.. Quote Link to comment Share on other sites More sharing options...
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