Friggin Irritating!

[Freeeedom!]

---

Members do not see this ad.

So I make the schedule for incoming residents/medical students/physician extender students...I have a nurse practitioner student who is currently on "clinicals". She wishes to work in an ED at some point. She has 1 year of RN experience prior to entering into the masters NP program.

This is what gets me...she needs only 160hrs of ED experience over 10wks, total (before she graduates). That is 2 1/2 months of rotations at 16hrs/wk...that's it for EM. How can anyone friggin learn by working 2 days a week? That is an incredible educational void!
Perhaps 160hrs over a month, but 2 1/2 months?! Terrible educational standards.

 

[Kalel]

They are able to keep low education standards because many of them learn on the job (with a much higher salary) working under the supervision of a physician.

 

[DrQuinn]

The ARNPs/PAs at my hospital see the low acuity patients. Normally not that big a deal. They can see all the back pains/ankle sprains they want. I'm not sure how I'll feel though, when I'm an attending and they're working under my license. *shudder*

Speaking of, I'm on the MICU team, had a possible admit for the unit... HIV+, GI bleeder (with no NGT aspirate), hypotensive, and orthostatic. Hb 6. The PA working in the ED (5-11 AM) worked her up... d'oh forgot to get the NGT, and d'oh forgot to *sigh* give some NS. Patient had no IVF in 4 hours. ack! I'm no brainiac, and definatel not an IM stud, nor an EM knowledge pool... but ack!

Q, DO

 

[Freeeedom!]

Quinn, you and I know that is a lawsuit waiting to happen. Better hope there isn't a bad outcome and the chart is reviewed...ain't kidding...everyone gets named for the PA's mistake. The deep pocket is the Physician.
If you (in the MICU) are called then the patient was realitvely unstable...no IV fluids in 4 hours needs to be reviewed. This should be presented in M and M or Q&A. Someone needs to review ED treatment of GI bleeds with the midlevels.

In fact, if the patient was in the ED for 4 hours..."early goal directed therapy" is the keyword here (pt should have recieved blood). While the Rivers article deals with septic shock, the key here is that 1. it is NOT the standard of care 2. so far out of bounds that it goes COUNTER to the latest thoughts on the treatment of shock.
M&M baby!

 

[DrQuinn]

Quinn, you and I know that is a lawsuit waiting to happen. Better hope there isn't a bad outcome and the chart is reviewed...ain't kidding...everyone gets named for the PA's mistake. The deep pocket is the Physician.
If you (in the MICU) are called then the patient was realitvely unstable...no IV fluids in 4 hours needs to be reviewed. This should be presented in M and M or Q&A. Someone needs to review ED treatment of GI bleeds with the midlevels.

In fact, if the patient was in the ED for 4 hours..."early goal directed therapy" is the keyword here (pt should have recieved blood). While the Rivers article deals with septic shock, the key here is that 1. it is NOT the standard of care 2. so far out of bounds that it goes COUNTER to the latest thoughts on the treatment of shock.
M&M baby!

You're right you ain't kidding! It was pretty aggravating, not only for me, as the EM intern on MICU (who knows better) but also for my MICU resident... and shoot, also for the patient! Actually, the patient left AMA because she was NPO... and didn't want to be put on respiratory isolation in the unit... go figure.

Actually, the further and further I get into my training, the more and more mistakes I realize are being made around me. Just had a transfer into the ICU for a patient who had been admitted two days ago to the medicine team for "altered mental status." CPK was 1250, but no one followed up on it, nor did they do an LP. Anywho, guy codes this AM, respiratory distress, and I get to figure out, two days later, why this guy has been "agitation, likely secondary to dementia." Gee, crazy when his troponin is 12. *sigh*

Q, DO

 

[Kalel]

so he had an altered mental status secondary to an MI? Also, I wouldn't do an LP if there was no fever, nuchal rigitity, or elevated white count.

 

[EMRaiden]

I had a patient transferred in last night with a Sodium of 189 .... when the Nurshing Home MD got the result had ordered D5W --- wide open. and 4 hours later transferred her. Actually she had been receiving D5 1/2 NS for 3 days- I still wonder what ther Na was before that. 😱

 

[jashanley]

I had a patient transferred in last night with a Sodium of 189 .... when the Nurshing Home MD got the result had ordered D5W --- wide open. and 4 hours later transferred her. Actually she had been receiving D5 1/2 NS for 3 days- I still wonder what ther Na was before that. 😱

Can someone say central pontine myelinolysis?

 

[WhataBreeze]

Can someone say central pontine myelinolysis?

Yes, this Thread and Posting is quite old. However, "Central Pontine Myelinolysis" is now almost 50 years old since Dr. R.D. Adams shed light on this horrific concequence of treatment.

My posting is not to cause issues. I have CPM and blessed not only to live but to still have faculties to be a Layman Advocate. Note, I'm actually very proud of you, the future to the "World of Medicine and Healthcare."

I ask one question of anyone who cares to keep this Thread alive. Why is it that in almost every hospital my research has covered, you can ask anyone in the ER if they are familiar with CPM, Central Pontine Myelinolysis or Osmotic Demyelinating Syndrome and I'm amazed to say the result I get is parallel to the reason that jashanley asked, "Can Someone Say Central Pontine Myelinolysis." G-d Bless...

Franky and Breeze

 

[bulgethetwine]

Yes, this Thread and Posting is quite old. However, "Central Pontine Myelinolysis" is now almost 50 years old since Dr. R.D. Adams shed light on this horrific concequence of treatment.

My posting is not to cause issues. I have CPM and blessed not only to live but to still have faculties to be a Layman Advocate. Note, I'm actually very proud of you, the future to the "World of Medicine and Healthcare."

I ask one question of anyone who cares to keep this Thread alive. Why is it that in almost every hospital my research has covered, you can ask anyone in the ER if they are familiar with CPM, Central Pontine Myelinolysis or Osmotic Demyelinating Syndrome and I'm amazed to say the result I get is parallel to the reason that jashanley asked, "Can Someone Say Central Pontine Myelinolysis." G-d Bless...

Franky and Breeze

I'm not sure which is more amazing to me...

That we have just resurrected a thread containing a post from Quinn's intern year, or that patients are now surfing websites like this as "patient advocates"?

I mean seriously, talk about "lawsuit material"....

 

[DrQuinn]

I'm not sure which is more amazing to me...

That we have just resurrected a thread containing a post from Quinn's intern year, or that patients are now surfing websites like this as "patient advocates"?

I mean seriously, talk about "lawsuit material"....

yeah. the WEIRD thing is, two of the users who posted on this thread were banned!

Q