Called a patient for a telemed visit. Kiddo’s mom is a nurse. When I asked about PMH and “do you vaccinate?” (b/c I don’t ask ARE you vaccinated, that just gets people grouchy), she says “oh, we delayed his schedule.” I’m thinking *ok, at least you bother to vaccinate* and I ask the inevitable follow up question of “so where is your 2 y/o on the schedule?” And GUYS I kid you not, she was like “oh he hasn’t gotten shots since he was 4 months.”
OK. That’s a little more than a delayed schedule. So you don’t vaccinate. Got it.
So, we are preparing for the forecasted COVID influence in the next week-2 weeks. My unit has been nearly cleared out. We only have 5 patients on service. We basically pushed all of them to one end of the unit and will put our vented COVID pts on the other side. We have instituted temporary scheduling for me and my colleagues. My colleague who is pregnant is now doing telemed from home. I will likely not see her until maternity leave is over :-( As for me and my other PA-C buddy, we are alternating with one person in house and the other person working from home/being on call. So, I get to work from home all next week.
This essentially means that I am doing some telemed visits, inpatient charting like problem lists and discharge summaries, PI projects for the unit, and brushing up on my critical care/ ventilator management skills.
Honestly, I am counting my blessings that I haven’t gotten laid off or something. I was on the AAPA discussion forums and SO many people have been laid off and royally fucked by losing their health insurance and such. A lot of them were ortho PAs. I suppose all industries and employers are showing their true colors during this crisis.
As for the rest of life, not much has changed. Mr Poppen and I are perpetual introverts so the whole stay at home thing hasn’t been a big deal. I’m sad the weather isn’t nicer, though. We will be closing on our new house soon so we have packing and things to do. I suppose that will also keep us busy.
All of this is really surreal. I’m trying to prepare myself for a complete shit show at work. I’ve been going through intubation and A-line placement again just in case. Revisiting some drips and paralytics. We haven’t had a large resuscitating burn in 2 months and skills can get rusty. I hope that living in the midwest means that we won’t be completely fucked. But I’ve found it is better to prepare for the worst and be pleasantly surprised than oblivious.
Working on the frontlines and the government won’t even give us what we need to be safe…. this is unreal.
Also the Starbucks near the hospital is closed for our 24 hour shifts. Just bad all around.
My state is still largely unaffected by large masses of COVID cases but my hospital is preparing for it. All our elective cases are canceled. I realize I won’t be bored for long - it’s the calm before the storm
Today’s average day in the ER:
helping a PA stitch up the fourth broken and lacerated digit of a six year old. Palpating an achilles tendon that was nearly entirely torn using the Thompson Test. Observing a 22-month old fetus with an ultrasound machine, and then ending the day with dragging an unresponsive man out of his car, shoving him onto a bed, a security guard performing CPR the entire time, ALL to have him come back moments later once he was swarmed with ER nurses and docs in a room intubating, inserting IV lines, and yes- still performing CPR all at the same time !!
Should I add *trigger warning* for my content about COVID? Because damn, it is getting super overwhelming out there. I’m wondering what your institutions are doing for COVID precautions?
Besides the 2348230943975230 emails I get on the regular, my institution is currently doing the following (subject to change at least 8 times daily):
Some perks of this whole shit show is that all parking fees are being waved for staff. So I pay to park in a shitty satellite lot and until this is over, I guess I get to park there for free. Also, it has been nice to have a more quiet OR. Sometimes, it just gets annoying with too many bodies present.
I will say that, for my big burn patients (>20%), this PPE thing is concerning. We generally put these patients on protective ISO because they are immunocompromised after their injury. Now we can’t do that. This is a little concerning because we do have people with MDR-GNR and I don’t want to inadvertently transfer that to a new burn.
A gentle reminder to be kind to your friends and family who work in healthcare. We are tired. We are nervous. We are the last people who will be given the opportunity to stay safe at home.
Ok, this whole Coronavirus thing is important. We need to have good hygiene, conserve PPE, and socially distance. But, I tell you what. Going to the grocery story with the shelves ransacked was absolutely anxiety inducing. Like, none of this hoarding is necessary. At all. I wish people would be more…neighborly.
Me and one of my gen surg resident buddies debating on the difference between a fupa v pooch v food baby v belly bloat.
Exactly one year ago today, I began my career as a PA-C. It’s a surreal place in which to be. The year has felt so slow and yet buzzed by so fast. I’ve learned a lot. I’ve cried. I’ve been on top of my game. I’ve been completely spent. I’ve been wrong. I’ve felt alone. I found friends. I laughed. It’s been…a year.
Diet is important! Clear liquid, full liquid, soft diet
Orders. Apparently you need a separate order for IV vs mediport. Dammit, just access them!
Output. -2L. No positive fluid balance.
Metoprolol is great for rate control. Not for BP.
There are a ton of ways to order stool cultures. Cdiff. Enteric pathogen. Extended pathogen, etc.
Blood cultures. Sometimes it takes forever for fungus to come back.
If the IV extravasates, you might need to call plastics.
Check the urine bag. There might be a kidney stone in it.
Look under a patient’s oxygen tubing or behind their glasses. There might be a pressure ulcer there.
For discharge readiness, make sure you have line care set up. And labs.
Call the pharmacy for specialty drugs after you send the script. They often won’t stock them. For the serious antifungals and/or long-acting pain medications, send script and then call pharmacy to see if patient’s insurance covers it.
If they’re older, came in with lightheadedness/back pain, or if there’s any chance that they could possibly fall at home, make sure you have a PT/OT consult prior to discharge.
Ask the patient if they’ve pooped recently. Nurses are pretty good at tracking I’s & O’s, but sometimes the patient sneaks out of their room, goes to the cafeteria, and takes a dump while they’re there.
If they’re throwing up, ask if it’s a nausea thing or a blockage thing.
If possible, try to be aware of the way medications come packaged. For instance, dilaudid comes in 0.5ml vials. Try not to dose 0.6ml.
If the patient hasn’t been taking thyroid medications and has generalized myalgias, check CPK.
If the BP is unusually low, ask the nurse whether the patient was sitting/standing/just moved, etc.
If temp is crazy high, ask for a different route of temperature.
Assess your patient if you get any crazy weird vital signs.
Get palliative involved when you can for any pain or goals of care conversations.
If a patient has a question about their prognosis, try to check in with the primary first. Sometimes the primary is an ass and will tell you but won’t tell the patient. Tell the patient. They deserve to know.
If you know it’s going to be a tough situation, ask the nurse to give you a page/call in 10min.
If your patient is coding, take someone with you. You’ll need the support.
I was looking at my academic pathway timeline that I’ve created for myself to achieve my dream to become a Physician Assistant. Reading it made me feel discouraged as hell. I was planning on getting into my Radiologic technologist program in my town. But my college decided to change the faculty members in some of the programs and the radiologic technology program was one of them. Over the summer, my school changed it prerequisites entirely and all that progress I made to be accepted vanished and now I’m back at square one. I’m in my late 20s and I feel like I should have this done by now and start my dream career in the beginning of my 30s even though it’s not going to happen. So I changed my major out of frustration and now I feel like my journey is going to be longer now. I just feel like settling with becoming a Sonographer. Which was another goal of mine. Personally it doesn’t matter which career I go in as long as I’m helping people. Which what matters most to me.
Medicine is, more often than not, shades of grey. Very rarely do I ever have situations that are starkly black or white. The grey is hard. The grey is confusing. The grey is stressful. But, at the end of the day, it is nice to know you have supportive friends and loved ones who are there for you.
I just try to do what I think is best with the information that I have. That’s all any of us try to do.
In what world would you EVER agree to buy something/receive a service WITHOUT knowing what it costs? Seriously.
Well, in the United States health care system, the answer is “All the damn time.”
I have a pt who needs a procedure and the insurance company can only estimate that it could cost between $3,000 and $70,000 out of pocket but they can’t *know* for certain until the procedure is done.
Like, ok, you give me a range of 5-10k? That’s one thing. 3-70k? Like, what the actual fuck?
Fuck insurance companies. Fuck them for denying essential care to my patients. And FUCK THEM for being IMPOSSIBLE to ACTUALLY talk to. Like, a real person and not a damn phone tree.
I’ve been training in family medicine for about 2 weeks now and come Monday I’ll be on my own without a medical coordinator (in the company are Mexican physicians who know the computer system in and out). So far I like the clinic, but man it gets busy. All the patients I’ve seen are very friendly and they love bringing their kids to me. My manager asked me to try and see 25 patients on Monday, and I think I can handle it. My main thing is not being able to speak Spanish that quickly to get my point across. But that’s it for me! I’ll update in probably another 3 months lol.
Please, check out this awesome video!! It simply and succinctly covers some basic differences between NPs and PAs, and Liz is so engaging!