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Elective procedures and hospitalization is gutted due to Covid 19 once again....


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My county can't seem to wrap its collective heads around the concept - WEAR A DAMN MASK.

Our numbers are skyrocketing but people are screaming about wanting their kids in person at school.

I don't get it.

Hospitals are at capacity, people are dying and folks are still thinking Thanksgiving is a party and kids gathering at school is ok.

Deep sigh

I will be remain on telework at least 2 days a week for the foreseeable future and only one day a week face to face as long as PPE holds out.

 

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My hospital just cut endoscopy rooms down to 1 to use the others as step down units...we've haven't had any open beds for admits from ED for several weeks, but have been able to continue with orthopedic surgeries without issue.  But, I've been working like a dog and saving to make a massive payment on my student loans (maybe even pay them off) before the end of the year...not doing that with this stupidity, keeping the cash.

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Big increase in cases in western Indiana.  Appears to be all community spread.  The hot spots seem to have been weddings and family gatherings.  Some days we're full and usually those days all of our secondary and tertiary referral centers are full.  Sending patients 1.5+ hours away at times.  Some days (today fortunately) I have beds for the too COVID sick to go home (mild hypoxia).  Fortunately, no cases in staff, a few in EMS - all from family, none in fire or PD.  But, at our size 4+ staff out would cause a major hurt, any provider being out would be a big hurt.

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58 minutes ago, FiremedicMike said:

It wouldn’t break my heart to do Peds and psych clinical online next semester.. 

Ugh don’t wish that.  The clinical you dislike the most are the ones you need the most.  You will likely not learn anything in these specialist beyond school so learn it now.....

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8 minutes ago, ventana said:

Ugh don’t wish that.  The clinical you dislike the most are the ones you need the most.  You will likely not learn anything in these specialist beyond school so learn it now.....

I know..  You’re the third smart person to tell me that.. I’ve just had my fill of fighting psych patients to the ground and debating the finer nuances of repeating the same question over and over for 15 minutes..  Plus kids are just small adults, right? (I kid)

My other confidants both said psych ended up being one of their favorite clinicals, I’m still meh about Peds though.. 

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1 hour ago, FiremedicMike said:

I know..  You’re the third smart person to tell me that.. I’ve just had my fill of fighting psych patients to the ground and debating the finer nuances of repeating the same question over and over for 15 minutes..  Plus kids are just small adults, right? (I kid)

My other confidants both said psych ended up being one of their favorite clinicals, I’m still meh about Peds though.. 

Do lockdown inpt psych if you get a chance with folks who are really psychotic. Do Peds EM if you get a chance. I did both of these and enjoyed both.

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6 hours ago, FiremedicMike said:

I know..  You’re the third smart person to tell me that.. I’ve just had my fill of fighting psych patients to the ground and debating the finer nuances of repeating the same question over and over for 15 minutes..  Plus kids are just small adults, right? (I kid)

My other confidants both said psych ended up being one of their favorite clinicals, I’m still meh about Peds though.. 

That's not a very good mindset to have regarding psych patients. I'd suggest refocusing your thoughts on what I'm assuming you've been taught during your schooling rather than your past experiences. 

There is an incredible amount of good done in the field of psychiatry, whether it's finding the right medication regimen that is both tolerable and corrects the symptoms or simply giving someone with a mental illness a feeling of worth by listening to them like a person.

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Considering that 85-95% of all psychoactive drugs in the US are prescribed by Primary Care - Psych rotation is important.

The pathology of psych and how it affects ALL of one's health is highly underrated.

I work with vets and over 80% have a DSM diagnosis.

As a PCP I am the frontline to dealing with it. Some days it is overwhelming and sad but it is my job and I need to do it right. 

ER sees a ton of psych - patients see ER as some degree of anonymity with their psych pathology and it often rears its ugly heads in the middle of the night when it is dark and the subconscious has time to wander off.

I did Parkland Hospital Psych ER - the county hold and the dustbin of all things odd. Priceless rotation 30 yrs ago without the benefit of atypicals which weren't out yet. 

Nothing like a global pandemic to test the serotonin and chutzpah of all of us - some folks are struggling more than they ever thought possible. 

We have to address their needs.

So, take the best psych rotation you can get and sponge it up.

Peds is tough. I was a student before a parent. I still don't like how some folks treat and raise their kids and the antivaxxers make me insane.

But, those tiny people become leaders one day and deserve a chance. 

I love listening to kids - we don't give them credit for the stuff they pick up on and understand.

I grew up with less than ideal circumstances and some horrors of my own - if I can protect ONE kid from that - win/win.

Learning to treat them aside from their parents whatever brand of weirdness is a true art. 

Try to find the best Peds rotation you can - one with folks who listen to the kids.

Do your best at all things - whether you like them or not.

I have been watching The Mandalorian - this is the way....................

 

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8 hours ago, MediMike said:

That's not a very good mindset to have regarding psych patients. I'd suggest refocusing your thoughts on what I'm assuming you've been taught during your schooling rather than your past experiences. 

There is an incredible amount of good done in the field of psychiatry, whether it's finding the right medication regimen that is both tolerable and corrects the symptoms or simply giving someone with a mental illness a feeling of worth by listening to them like a person.

I think that advice is only partially true and very much depends on your clinical setting.   Psyche in the ED is very different than in any other setting except the field, in particular very different than in-patient, even a lock-down unit. In the ED you're dealing with an often out-of-control, sometimes violent, undifferentiated patient who's often under the influence of a (hopefully) to be determined polypharmacy of prescription and street drugs and a (hopefully) to be determined set of contributing medical problems.  Keeping your staff and the patient safe and getting the situation under control and de-escalated is your 1st priority and comes in to play far more than other settings.  I see this all the time both as an EM PA and as a FF/medic.  This is way different than what I saw on the lock-down VA psyche unit where I did my psyche rotation.  What you're talking about is a later step and is very good to do for that portion of the psyche population that responds to and complies with treatment.

Before that comes getting the situation and the patient calm enough to proceed and identifying and addressing as many of the medical conditions that contribute to behavioral disturbances.

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18 minutes ago, ohiovolffemtp said:

I think that advice is only partially true and very much depends on your clinical setting.   Psyche in the ED is very different than in any other setting except the field, in particular very different than in-patient, even a lock-down unit. In the ED you're dealing with an often out-of-control, sometimes violent, undifferentiated patient who's often under the influence of a (hopefully) to be determined polypharmacy of prescription and street drugs and a (hopefully) to be determined set of contributing medical problems.  Keeping your staff and the patient safe and getting the situation under control and de-escalated is your 1st priority and comes in to play far more than other settings.  I see this all the time both as an EM PA and as a FF/medic.  This is way different than what I saw on the lock-down VA psyche unit where I did my psyche rotation.  What you're talking about is a later step and is very good to do for that portion of the psyche population that responds to and complies with treatment.

Before that comes getting the situation and the patient calm enough to proceed and identifying and addressing as many of the medical conditions that contribute to behavioral disturbances.

I think the advice applies to a much wider aspect of medicine than you see. There is a lot more to this field than the ED, and I'm hoping that in the ED you're not just thinking about fighting a patient but rather getting them the care that they need.

I worked EMS for a decade, still teach, and will never teach my students that the extent of psych is out of control violent patients and I sure as heck wouldn't want an NP or PA student to think that.

Your experience is in the minority in medicine when managing patients with psychiatric disorders, @Reality Check 2 is the one to speak regarding this topic.

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Just to be clear on a few points.

1. I’m talking about RN clinical here, I’ve not started NP school yet.

2. My psych experience goes beyond wrestling people to the ground for ketamine and arguing over the color of the grass.  I certainly don’t consider myself to have provider level experience, but that’s not the objective for this rotation anyway..

3.  I already signed up for in person clinical for next semester last week.  My comment was mostly tongue in cheek.

4.  I did consider that it’d be much more convenient for next semester to have online clinical, this semester has been exhausting, but as I said, I’d already made that decision..

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7 hours ago, FiremedicMike said:

Just to be clear on a few points.

1. I’m talking about RN clinical here, I’ve not started NP school yet.

2. My psych experience goes beyond wrestling people to the ground for ketamine and arguing over the color of the grass.  I certainly don’t consider myself to have provider level experience, but that’s not the objective for this rotation anyway..

3.  I already signed up for in person clinical for next semester last week.  My comment was mostly tongue in cheek.

4.  I did consider that it’d be much more convenient for next semester to have online clinical, this semester has been exhausting, but as I said, I’d already made that decision..

Gotcha, I'd thought you had started NP school already.

I have a tendency to get annoyed at the EMS perspective of fighting with psych patients. I was there, I did it, I thought that way too, and in a significant chunk of those encounters we were certainly the least qualified people to deal with them... although we were the only ones.

You see it in the ED environment as well, not trying to pick a fight with @ohiovolffemtp by any means but you can't take a single facet of the psychiatric patient and extrapolate that to the entirety of medicine. A psych rotation can show you some amazing pathology and seeing people get better is a great experience. There is minimal wrestling/fighting because people are doing their jobs well, you learn to deescalate without a special K dart. 

And again... psychiatry isn't all violent schizophrenics and excited delirium. 

Hope your rotations go well!

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3 hours ago, MediMike said:

Gotcha, I'd thought you had started NP school already.

I have a tendency to get annoyed at the EMS perspective of fighting with psych patients. I was there, I did it, I thought that way too, and in a significant chunk of those encounters we were certainly the least qualified people to deal with them... although we were the only ones.

You see it in the ED environment as well, not trying to pick a fight with @ohiovolffemtp by any means but you can't take a single facet of the psychiatric patient and extrapolate that to the entirety of medicine. A psych rotation can show you some amazing pathology and seeing people get better is a great experience. There is minimal wrestling/fighting because people are doing their jobs well, you learn to deescalate without a special K dart. 

And again... psychiatry isn't all violent schizophrenics and excited delirium. 

Hope your rotations go well!

Actually, EMS is not the least qualified to deal with psyche patients.  We often do two things that others didn't do well: verbally de-escalate them, and realize that medical conditions that needed immediate attention were often part of the picture.  That is what both EMS and the ED do.  I don't know if you've done EM, but resolving all of the medical issues, whether substance abuse, infection, trauma, diabetes, etc is a pre-req before you can place a person in any kind of treatment.  In-patient mental health facilities won't take anyone who has even a hint of any unaddressed medical problem (and usually won't take them until those medical problems are resolved, or at least only requiring oral meds) and outpatient treatment programs won't address those problems.  This isn't about restraining and sedating patients unless it's absolutely necessary, it's about not assuming that the patient has only psychiatric issues and not failing to address the total picture.  De-escalation can fail, especially in patients who have significant substance intoxication, serious head trauma, blood glucose levels that are very high or very low, leading to restraint and sedation as a necessary transition step - just as it can in patients who have those same issues without any psychiatric component.  Simply put, there are times when the brain isn't functioning well enough for words to influence it.

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