Supervising/running nuclear stress tests as a new grad

[ctPA0307]

So I'm a new grad (5 months since graduating). I've been working at a cardiologists office for the past 4 months. I shadowed the other PAs for 3 months who were doing it and now I'm supervising (reading EKGs, administrating Lexiscan/Dobutamine, etc.) the nuclear stress tests. Obviously I'm working nuclear radiology technicians who have been doing this for years and there's always a doctor in the office. I'm ACLS trained but I've never put that training into use. 

 

My only thing is that I don't know if this is "kosher", so to speak. I don't know if there are any PAs that are on this site supervise nuclear stress testing, if so then it would be great to get some input. Or general input from any PAs would be great

[winterallsummer]

Have seen or heard of this done in multiple hospitals. Yes it is kosher. The attending is typically in the hospital and available for consultations as needed. There is a lot to learn so hopefully your support staff and attending are helpful and available for questions.

 

This is an evolving areas for PAs. The PA can run the nuclear lab with support staff one or more days of the week. You may have an attending or possibly fellow over reading your EKGs. Nuclear images interpreted by radiologist.

 

Not my specialty so can't offer you any resources except for this great book Cardiolofy made ridiculously simple which has dedicated chapters on this

 

http://www.amazon.com/Clinical-Cardiology-Ridiculously-Edition-Medmaster/dp/1935660047

 

Otherwise keep learning and you will get more confident and comfortable after your first year of practice.

[NLRP3]

I worked doing Nuc Med stress tests before school and all of our tests were run by PAs and NPs.

[UGoLong]

I ran stress tests in an office shortly after I started out. The doc has to be in the building for Medicare billing purposes.

 

Make sure you're trained on how to handle problems, like using aminophylline in addition to ACLS drugs.

 

 

Sent from my iPad using Tapatalk HD

[cbrsmurf]

What are the possible medical issues here (never worked in cards)? dyspnea, MI, syncope?

[UGoLong]

More common: dizziness, syncope, dyspnea, high grade AV blocks. MI is possible but very rare.

[EMEDPA]

we ran an obs unit for a few years out of our ED and did 3-5 basic treadmills/day. I probably did 80 or so. I had a pt develop vtach with a pulse during the study. another of my partners had a pt infarct on the treadmill. we probably had around a 5% positive rate because we treadmilled everyone with any kind of chest pain story even potentially worrisome. some of these were silly. the 90 yr old who walked 5 miles/day did fine. the 35 yr old ultramarathon runner who we stopped the study at 26 minutes because we couldn't get his HR over 120 with the treadmill almost vertical....

[ctPA0307]

The average number of tests per day is 10/11 and half can be pharmacologic stress tests (Lexiscan/Dobutamine-mainly saved for pts on supplemental O2 or actively wheezing). With Lexi, I do administer aminophylline if they experience severe symptoms or rare symptoms (nausea/vomiting). A good chunk of my pts are those with CAD (non-obs or obs by cath-treated medically, s/p PCI, s/p CABG, or s/p PCI and CABG) that have to do this test every 2 yrs to make sure there isn't any new areas of ischemia. 

 

Since there is a skill involved when running the tests and checking the pt's history to make sure the test can proceed safely, I wasn't 100% sure if a new grad should be running them. I did have 3 months of training though. 

[ICMNTV]

Hello!

I hope to be a PA student soon. But to answer your question, I supervised multiple stress labs in cardiology fellowship programs as a masters-trained cardiac exercise physiology.  I supervised all modalities of cardiac stress from standard graded exercise tolerance, nuclear (persantine/sestimibi), pharmacologic (adenosine/dobutamine), stress echos (bubble-studies for PFOs), electrophysiology (T-wave alternans), post cardiac valve surgery (AoV/Mv), too multiple clinical trials testing the effectiveness of antianginals, antiarrhythmics, pacemakers and automatic implantable defibrillators. I also educated community-based physicians on the value of referring their private practice patients to the hospital stress lab for testing. As you can imagine a primary care physician may not be aware of the sublties of stable/unstable angina or variant angina in a female patient. I thoroughly enjoyed educating non-cardiologists on the results of a positive, negative or equivocal stress test. 

 

The only time I really required direct fellow or attending oversight was for patients with known history of V-Fib/V-Tach. In these cases I was charged with setting up and running the procedure as per attending protocol (IV lines, crash cart box, defibrillator charged).  Working in stress labs in cardiology fellowship programs gave me enormous exposure to clinical, invasive and structural heart disease and overal internal medicine knowledge.  I frequently would attend Friday journal clubs with the fellows, pharma-industry sponsored lunch-n-learns and CME dinners.  Afterall these were my daily colleagues and attendings that trusted me with their patients.  The more I soaked up and learned the greater autonomy I had for running procedures and ACLS codes. Also the more I soaked up the more confident I was to know what I know and know what I didn't know.   

 

After spending over 7 years total doing stress tests, I transitioned over the interventional and electrophysiology side of cardiology as a invasive scrub technologist. My background in cardiac stress was of enormous value as I completely understood the patients non-invasive stress studies in context to their requirement for cardiac intervention. For example, a patient with an apical-lateral perfusion defect on stress typically required a LAD/Cx coronary stent intervention, or a patient with exercise induced dizziness would reveal in the EP lab complete heart block and require a dual chamber PPM/AICD.

 

So soak it all up.