RPa695 Posted November 6, 2012 Share Posted November 6, 2012 Hello all, I've gotten my first job working in an Emergency Department's Fast Track. PA's and NP's at this hospital only work in the fast track, and occasionally will see patients in other rooms if needed. I did my EM rotation at a large hospital and didn't have any exposure to the fast track, so I haven't gotten daily exposure to what will complaints will be coming through. I've discussed this with my supervising physician to an extent, but would like some input from PA's who work/ have worked in this situation about what will/will not be sent to the fast track. I can imagine a lot of suturing, sprains/fractures, URI/sinusitis/AOM, rashes, mild head injuries/HA's, cellulitis/abscesses, GYN issues, ophtho issues... etc... Just looking for some input I suppose so I know I'm as prepared as I can be when I start! :) Link to comment Share on other sites More sharing options...
Donahula Posted November 6, 2012 Share Posted November 6, 2012 Congratulations on the new job! I am a new grad in my 4th week of working in the fast track in a mid-sized ED. I have been seeing all of the complaints you listed, in addition our fast track sees abdominal pain, might be good to review your differentials and work-up for that. I have had a couple of acute pancreatitis cases so far. We also see chest pain that triage feels is not likely cardiac, so depending on how your ED works might be a good idea to review PE/Costochondritis/GERD etc, I have discussed a couple of these cases with an attending and gone ahead with the cardiac work-up. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2012 Moderator Share Posted November 6, 2012 http://www.physicianassistantforum.com/forums/showthread.php/4501-quot-it-s-probably-nothing-quot-fast-track-disasters Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted November 6, 2012 Moderator Share Posted November 6, 2012 I will never understand how patients whom I have a high likelihood of sticking a needle in them (ie chest pain, abdominal pain) are somehow "fast track" patients. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2012 Moderator Share Posted November 6, 2012 I will never understand how patients whom I have a high likelihood of sticking a needle in them (ie chest pain, abdominal pain) are somehow "fast track" patients. really, really, really bad triage.... Link to comment Share on other sites More sharing options...
primadonna22274 Posted November 6, 2012 Share Posted November 6, 2012 Oh my...LOL who slipped going into a restaurant, brought in by EMS, apparently felt to be a whiner and sent out to the waiting room in a wheelchair which we had a hell of a time getting her out of...intertrochanteric fx hip, and no ortho on call that weekend. Had to stabilize and transfer her. Just LOVE doing that from fast track. Also, she was magically more agreeable with pain medicine (poor lady!) Strep throat and a little adrenal crisis in fast track...textbook vitals and the guy knew his adrenal insufficiency well...and the med list was a dead giveaway...come on, not that many folks are on Florinef and a bunch of other steroids...RN gave me a blank stare. Another admission. And just recently (in prison setting): 2 wk of worsening dyspnea with normal vitals and a new heart murmur. Nurses were going to send her back to her unit after a neb tx (which didn't help). That's when I looked at her and heard the murmur. Lungs were clear. No significant LE edema or asymmetry. I didn't do Homan's (y'all know it's not that sensitive right?) but she didn't look right and so I kept her in the infirmary. 8 hr later she spikes a fever and gets much more dyspneic and now mildly hypoxic, gets sent out by ambulance (no small feat from prison): HUGE saddle embolus and multiple other PEs and 13 small DVTs in the left leg. Spent 8 days in the Hosp getting anticoagulated and the Cadillac workup for idiopathic VTE, and no clear answers. At this time the best guess is the isoniazid prophylaxis started 2 wk prior for +PPD made her prothrombotic. I've done a literature search and come up empty..but she's much better and very grateful that I "saved her life".... Link to comment Share on other sites More sharing options...
rcdavis Posted November 6, 2012 Share Posted November 6, 2012 Strong work L Link to comment Share on other sites More sharing options...
Guest Paula Posted November 7, 2012 Share Posted November 7, 2012 I learned in the three years I spent at a walk-in clinic and working locums at area CAH ER's to never, ever, ever trust triage. Be thorough. Do not hand out antibiotics for every stinking cold that comes in just because your colleagues do. The train wrecks you see can be subtle. I have had patients triaged with completely yellow skin and eyes with abdominal pain, active and evolving MI's, legionnaires disease ("cold symptoms"), stevens johnson syndrome, and infants in respiratory distress. Some of the patients are stubborn people who refuse ER at triage, and then I got stuck with them, and once I was able to explain why they needed ER care, they were quickly agreeable to going. You will learn a lot. Just never assume fast-track will always be "simple" patients. You will see plenty of simple patients but never assume anything and do complete exams and pay attention to signs, symptoms, history and PMH......all the stuff you learned in PA school. Link to comment Share on other sites More sharing options...
RPa695 Posted November 7, 2012 Author Share Posted November 7, 2012 Thanks guys! I think I will have to remind myself before every patient that just because this patient's problem is supposed to actually be simple that it will be simple. I've read through some of the things that others have seen in the fast track and I really hope I'll be able to catch those things myself.. :sweat: Link to comment Share on other sites More sharing options...
browndog Posted November 13, 2012 Share Posted November 13, 2012 Please be alert to the dangers of "fast track". Assume triage is wrong. Assume the charge nurse is pushing patients to you to keep the ED clear. Here are a few very recent examples of "fast track" patients that I have seen. Triage: Congestion. Reality: Hemothorax Triage: Rib Pain Reality: Tension Pneumo Triage: Shoulder Pain Reality: Septic joint Triage: URI Reality: Saddle PE Triage: Sinusitis Reality: BOTH subdural and epidural bleeds These are just the most recent ones. Please watch your back and do read the fast-track nightmare thread that E suggested. Always remember that it is YOUR license on the line. Good luck and have fun. Browndog Link to comment Share on other sites More sharing options...
futurePAS Posted November 16, 2012 Share Posted November 16, 2012 Sorry for the off-topic, but am I to understand that fast-tracks are basically urgent care clinics within the emergency department for lower acuity illnesses? Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 16, 2012 Moderator Share Posted November 16, 2012 I learned in the three years I spent at a walk-in clinic and working locums at area CAH ER's to never, ever, ever trust triage. Be thorough. Do not hand out antibiotics for every stinking cold that comes in just because your colleagues do. The train wrecks you see can be subtle. You will learn a lot. Just never assume fast-track will always be "simple" patients. You will see plenty of simple patients but never assume anything and do complete exams and pay attention to signs, symptoms, history and PMH......all the stuff you learned in PA school. The trick to EM and Urgent care is to be able to sniff out the bad ones - the problem is this is a skill set that only comes with time, effort, exposure and scary moments..... great to go into fast track as a new grad - BUT ask a ton-o-questions, never assume anything, and be prepared to make mistakes... Link to comment Share on other sites More sharing options...
Febrifuge Posted November 21, 2012 Share Posted November 21, 2012 Sorry for the off-topic, but am I to understand that fast-tracks are basically urgent care clinics within the emergency department for lower acuity illnesses? Within, or adjacent to, yes. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.