#hangrypa

[hangrypa]

table rounding w hangry

Me: Alrighty, in Room 1, we have Mr. Smith. He is a 63y/o male with a history of Afib and Takotsubo cardiomyopathy who presented with flash pulmonary edema and DVT. Cardiology is following. Following extensive diuresis and an increase in his home metoprolol, he is no longer in RVR and now satting mid-90s on room air. Once we get the prior auth on his Lovenox, he can go home.

Attending: Perfect.

Me: He also has an adorable bulldog at home.

Attending: Ah.

Me: Okay, next up in Room 2, we have Ms. Jones. She is a 74y/o female who received allogeneic stem cell transplant about 2 months ago and presented with rash and diarrhea suspicious for diarrhea. Heme/Onc is following. She is on Methylprednisolone with significant improvement in stool volume, now putting less than 500ml out. Her rash originally was ~50% BSA and is now about 20%. She will be discharged on Prednisone taper, pending Heme/Onc recs.

Attending: Good.

Me: And she has a little goldendoodle at home.

Attending: Nice.

Me: All right. Then in Room 3 is Ms. Williams. She is a 67y/o female who presented with urosepsis secondary to new kidney stone. She's had a wild hospital course and was extubated just 2 days ago. It appears that she also is now deaf. We've consulted ENT, and they suspect vestibular neuritis. I reached out to them to ask about starting steroids. She likely will not be returning home for at least another 48hrs while we sort this out.

Attending: I see.

Me: She has a giant derpy mutt at home.

Attending: I take it that you like dogs.

Surrounding coworkers: [in unison] YEP!

#dogs #puppy love #hangrypa #PAblr #hospitalist #rounding #physician assistant #PA-C

[doctorspork]

@simplysupergirl replied to your post “I matched :)”

CONGRATS :) So proud of you xox

@hangrypa replied to your post “I matched :)”

CONGRATSS!!!!!

@borborygmus21 replied to your post “I matched :)”

Omg yessss

@jadea-thephsycebee replied to your post “I matched :)”

That is so awesome! Congratulations to you!!

@livvmd replied to your post “I matched :)”

Congratulations!

Thanks, all <3 Spent the day going through all the random crap in my mom’s garage in preparation for packing to move relatively soon!

#livvmd #jadea-thephsycebee #borborygmus21 #hangrypa #simplysupergirl #replies #I'm so exhausted oh my god #I need to shower but don't even want to get up

[populationpensive]

Pablrs on Slack!

Soooo it’s been a minute since the members of #pablr have chit chatted on slack! Last time was September of 2017! 

@hangrypa​ had brought up reviving this venue and I think it’s swell. Click on the LINK to be added! This is a new link from the old slack channel. Apparently, the free version of slack is a little limited in space and I don’t feel like deleting individual messages. :-D 

In the past, we have generally organized scheduled live chats centered on a variety of topics like pre-pa stuff/shadowing/volunteer, pa-s stuff, and pa-c stuff. Once we get people added, we wills start organizing chats!

If you have trouble adding yourself to the PA-blr of Tumblr SLACK, then email me at [email protected] for a direct invite. 

#pablr #pa-c #pa-s #pre-pa #physician assistant #physician associate #pance #panre #nccpa #aapa #medblr #CASPA #pa school #physician assistant school

[totipa-s]

Currently at 9K. A long way to go, but we can get there. We aren't fighting for independence, we are fighting to eliminate red tape and improve the availability of quality healthcare across America and our ability to pivot during a crisis!! We love our MDs/DOs and the collaboration we have with them. Their time is valuable and their patients need them as well! Their time shouldn't be needlessly spent reviewing charts/signing orders/signing paperwork if our docs/hospital admin don't think it is necessary (meaning we aren't under review or other need for supervision). This is to optimize team practice and allow PAs to practice at their full scope not eliminate current collaborative relationships!

White House FPA (full practice authority) Petition

The time is now. There are highly qualified PAs who are being forced to sit on the sidelines because they're current SP doesn't work in Emergency Medicine. This is ridiculous.

Let's do what we can to set our profession up for success (we all know this is needed). But more importantly, to remove barriers that prevent us from treating patients in a time when healthcare providers are needed more than ever. PAs have always been collaborative, and a legislative requirement will never change that. Let us take responsibility for our license and practice to our scope of practice.

Here is the petition. It currently has 6,000. Needs 100,000 to get a response. It might not be much, but it's something.

https://petitions.whitehouse.gov/petition/grant-pas-full-practice-authority-function-licensed-independent-practitioners-federal-jurisdictions

Here is a NYT video recently put out that does a great job describing the regulatory burden that is placed on PAs and forces willing and qualified PAs to sit on the sideline.

https://www.nytimes.com/2020/04/04/opinion/physician-assistants-hospitals-coronavirus.html

Please sign!

@emedpa

@populationpensive

@mrspediatricpa

@cranquis

@digiti-minimi

@brooklynpa-c

@hangrypa

@livingthepadream

@mynotes4usmle

@pa-c

@physicianassistantstudents

Please share, up vote, and make any comment to make this thread relevant.

#PAsarethesolution #physician assistant #PAblr #PA-C #AAPA #COVID-19 #putustowork #red tape #remove it #pa student #pa school #pa-s #pa #medblr #collaboration #teamwork #nursblr #pablr #coronavirus #populationpensive #simplysupergirl #mrspediatricpa #cranquis #hangrypa #emedpa

[pleasedotheneedful]

hangrypa replied to your post “Guys, I need to get another whiteboard solution going. My medical...”

I bought these at Home Depot, and they've worked great for me! They hang up on the wall well, too http://www.homedepot.com/p/EUCATILE-32-sq-ft-96-in-x-48-in-Hardboard-Thrifty-White-Tile-Board-HDDPTW48/205995949

lol I’m wondering if this isn’t exactly what I bought from home depot last time. it worked really well and it was a deal for $15 a piece. I’d have to see about getting the size cut down because I’m still paranoid about destroying my desk with a de-adhesing board but I’m open to it.

#hangrypa #replies

[albertarn]

20 Questions

tagged by @hangrypa

Rules: Answer 20 questions and tag 20 followers you would like to get to know better.

Name: Alberta RN Nickname: jmcneil46 Zodiac Sign: Gemini Height: 5′8 Ethnicity: Caucasian Orientation: Straight Favourite Fruit(s): pear Favourite Season: summer Favourite Book(s): Eye of the Needle - Ken Follet, Girls Guide To Hunting and Fishing - Melissa Banks Favourite Flower(s): peony, sweet pea Favourite Animal(s): horse Favourite Beverage: mojito Average Hours of Sleep: 8 Favourite Fictional Characters: Amelie, Karen from Will & Grace Number of Blankets You Sleep with: 3 Dream Trip: North Pole - Completed! Blog Created: May 2016 Number of Followers: 36 @caringintensely @rnightly @mursejesse @flyingeagleclaw @sarcasticnursejess @boluscoffeestat @copingnurse @calligifphy @doctorkintsugi @dr-dre-anatomy @ermedicine @farmhousetouches @giraffepoliceforce @howdoesthatevenhappen @imthedoctortobiasfunke @icuisafourletterword @justsmile-and-nod-rn @judgyrn @knitblr @l

[hangrypa]

s/p first year as a PA

I was hired as a hospitalist primarily for the transplant service. However, in the setting of the pandemic and staffing shortages, I am all over the place now and work in almost everything non-pediatric and non-surgical. 

In my first few months as a PA, I was incredibly overwhelmed. I went from being a learner who switches specialties every month to a fully-fledged provider making life-or-death decisions on an hourly basis. Oftentimes I’d find myself in the room of a patient actively crumping, surrounded by the patient’s family and multiple nurses awaiting instructions on what to do to save the patient. I thought that I faced a lot of pressure in school, but it was nothing compared to this. 

And just when I started to get a hang of it all, the pandemic hit. What a nightmare. As mentioned above, I was hired to work with with transplant patients. Prior to the pandemic, my transplant colleagues and I were masking and gowning for almost every patient: 1 surgical mask and 1 gown per patient and per patient encounter. But once COVID hit, we were rationing PPE. 1 N95, 1 pair of goggles, and 1 face shield for the pandemic. 1 surgical mask per week, and 1 gown only if a patient had Cdiff or a history of MDRO bacteremia.

What did the pandemic mean for our transplant patients? 

Our patients are on immunosuppressant medications to prevent transplant rejection. Unfortunately, this makes it difficult for them to fight infections. 

Our department did what it could to prevent COVID. We'd test patients on admission for COVID, regardless of symptoms or exposure history. If they were positive, they went to the COVID team and quarantined on their unit for a period of time and had to test negative before returning to our unit and being transplanted. We took many other measures to reduce COVID risk to the best of our ability. 

People still died. To see someone get transplanted successfully and then die of a virus is horrifying. Unfortunately, despite our admission tests, sometimes patients contracted COVID within the hospital. Patients would be happily FaceTiming their family one moment, telling them all of their plans for once they were discharged- then the next day they'd be intubated. We tried Remdesivir, Dexamethasone, prone positioning, etc. But the virus moved through them quickly, and these efforts often were too late. No amount of hoping and praying brought them back. 

As a first year PA, I learned to go to an empty conference room, close the door, and remove my mask before calling to the family of the deceased. This way, as they gathered around the phone in their homes, the family could hear me unmuffled as I delivered the news. Also, this way my tears didn't ruin my mask for the rest of the week. 

I learned a lot this year. It's been a mixture of crying and laughing. There are times that I question why I ever became a PA, and then there are times when this career feels like home. In addition to transplant, I’ve also been working in the  ED, IMC, ICU, inpatient hospice, clinic, and infusion center these past 6 months. I’ve learned quite a lot along the way.

Lessons learned as a first year PA:

1. Check your pager hourly: This is in addition to checking it whenever you get paged. Sometimes I’ll get paged while I’m rounding, read it, and then forget about it. Now I go through my pager at every hour to ensure that I already responded to all my pages and then answer ones that I missed/forgot.  On a semi-related note, a while back I wrote about good paging etiquette.

2. Let people know when you're out: I work a rotating schedule. As a result, it’s hard to predict when I’m in or out of the hospital. Sometimes I’ll come back on service and find urgent emails or texts that are a few days old. Now I leave an away message with my return date and my supervisor’s contact information on both email and hospital text. If someone really needs to get a hold of me, my supervisor has my personal cell phone number.

3. Be conscientious of what time you consult: I generally try to get all of my nonurgent consults done before 3pm. Many services have only 1 resident covering after 3pm, so I try not to page/call unless I have an emergency. 

4. Call the nurse if something needs to be done urgently: Being a nurse means being the ultimate multitasker. Room 5 is due for his IV Amphotericin, Room 2's Foley is supposed to come out prior to void trial with Urology, Room 1's infusion completed and is beeping, and Room 4 is a bit altered and yanked out her PICC. Now I’m placing an order for Room 3 to get IV Lasix due to concern for pulmonary edema. However, the nurse may be preoccupied with Room 4 and not see the order in the computer for some time. If I really need to the patient to get the Lasix right way, I’ll place the order through EMR and then call the nurse and see what their situation is. If they’re crazy busy with Room 4 and likely to be unable to get to the Lasix within the next 15min, I ask whether they’re okay with me asking another nurse to give the Lasix now. Usually the answer is yes.

5. Value your nurses: Nurses know the patient best. They’re the ones answering call bells, giving meds, doing dressing changes, etc. Unfortunately they oftentimes bear the brunt of everyone’s frustrations, from patients to patients’ families to attendings to managers. Not to mention, they’re the ones doing the dirty work. Bedside nurses are the heartbeat of healthcare, but they also are high risk for burnout. Always support your nurses, whether that’s volunteering to answer a patient’s family member’s 17th phone call of the day or responding to a patient’s call bell yourself. 

6. Know how to get a hold of someone quickly: It’s less than ideal to page someone repeatedly. At my hospital, if I need to talk to an attending urgently, I call the operator and ask them to connect me directly to the attending’s cell phone. If a patient is crashing and we’re not in the ICU, I dial the emergency number and call a rapid response, which sends people running into my patient’s room. 

7. Plan your discharge meds from Day 1: The goal of every admission is to treat the patient and then discharge them safely. Send medications early for prior auth and call the pharmacy to make sure that they have medications in stock. (One time a patient’s insurance didn’t cover Levofloxacin, of all things.) 

8. Keep social work and care coordination aware of all needs from the start: Does your patient looks unsteady? Place a PT/OT consult and let social work and care coordination know that the patient might require home therapy services and/or DME so that they can start looking at services and companies that may be covered by insurance. Does your patient have a central line? They’ll likely need a home health service to teach them how to care for it daily at home. Do they seem to require frequent transfusions? They’ll probably need labs on discharge. Is the patient’s living situation safe (no heat/AC, possible abuse at home, financial difficulties, etc)? They may need alternative housing.

9. The attending is not always right: Generally speaking, the attending has the last say on how the team manages a patient. However, I’ve come across situations in which an attending’s decision put a patient in more danger. Sometimes asking them about their decision can help steer the care plan toward better patient care. Other times you just have to stand your ground and be okay with being on the receiving end of an attending’s misdirected rant. Report these instances to your manager and to other higher-ups.

10. Always have gloves in your pocket: You never know when you’ll find a mess. Or which part of the body someone asks you to examine. Or how hygienic a person is (or is not).

11. Verify weird vitals: I was very new when I walked into work, opened a patient’s chart, and promptly bolted down the hallway when I saw a patient’s O2 sats recorded as 15-20s. I found the patient sitting up in bed, eating breakfast, and bewildered by me bursting into the room. Turns out that overnight someone mistakenly recorded his respirations as the O2 sats.

12. Remove whatever tubes you can: Anything entering the body is an infection risk. Does your patient still need that Foley placed by the surgery team? No? Yank it (don’t actually yank because ouch). Is your patient A&O and able to eat without aspirating? Remove the NG tube. Does your patient have good veins and require infrequent transfusions/labwork? Pull their central line.

13. Take a buddy with you to emergencies: Two heads are better than one. Even if you’re a seasoned provider and well-equipped to manage an emergency, you might need another body to help with performing CPR, making urgent calls, grabbing supplies, etc. 

14. Ask your patients about premeds for procedures: We all have different levels of pain tolerance. A procedure goes far more smoothly if your patient is comfortable. Note: if you’re going to premed with Ativan or an opiate in the outpatient setting, make sure they have a driver.

15. Be good to your charge nurse and unit secretary: I don’t know how they do it. If I had to manage the unit’s signout, patient complaints, calls from other floor, being yelled at by providers, verifying paper orders, and finding beds for incoming patients- all at the same time - I’d lose my mind. 

16. If your patient is mad, just shut up and listen: There are many things that you can’t control: the time it takes for a patient to get a room, the temperature of hospital food, the dismissive attitude of your attending, etc. And oftentimes the patient knows this. My reflex is to want to apologize for things and overexplain why different things are happening. But sometimes the patient just needs to rant. Take a step back and just listen. That can make all the difference.

17. Fact check your notes: The framework for your progress note often is the note from the day prior. It sounds obvious, but make sure that you go through the note and make updates and changes accordingly. If today is 01/15, there’s a good chance that the Fungitell from 12/31 is not still pending. 

18. Try to learn some nursing skills: This is one of the areas in which I most envy my NP colleagues. If a patient’s IV pump is beeping or their central line need to be flushed, I oftentimes awkwardly step out of the room and look vacantly into the distance for a nurse. I’ve finally figured out how to spike a bag (albeit I do so very slowly, and it certainly makes the RNs giggle some). I talked to our unit’s nurse manager, and she’s willing for me to learn some nursing skills from the staff during a slow day- we’ll see when thing slow down!

19. Be kind: Generally speaking, being in a hospital is stressful. Patients are feeling out of sorts, and staff are working with constant dinging in the background. I rant plenty on this website, but I’m kind to everyone at work (with few exceptions) because it makes things more comfortable for everyone. Additionally, if you are always kind to your patients and colleagues, your reputation will speak for itself. One time I was walking down a hall with poor reception while on my ASCOM with a notoriously standoffish nurse from another unit. My phone cut out. She called my unit’s nurse manager to complain, and the nurse manager told her that I would never hang up on purpose. My interactions with the nurse going forward were always more pleasant in nature.

20. Support your team: The best colleagues are not the smartest colleagues; the best coworkers are the ones who have your back. Whether it’s a medical emergency or just a strange situation, it’s important to be supported and to give support.

I know that I’ve learned a lot more than this, so I’ll likely be adding to this throughout the year. Happy Snow Day, all!

#hangrypa #PAblr #physician assistant #PA-C #PA

[hangrypa]

My patient who beat breast cancer and leukemia died today.

She was in complete remission. She was essentially in perfect health until 1 week ago when she presented with shortness of breath. She was intubated shortly after for COVID.

She died today.

I don't know know how to put my feelings into words. I'm devastated that she won't get the fresh start that she dreamed of for her post cancer life (she had a bucket list that she had been hoping to complete in a post-COVID world). I'm outraged that she managed to beat cancer twice, and then a fucking virus takes her from us. How is it that we pulled a cancer survivor back from the brink of death, and now she's gone just like that...

And she was so young. Just barely 38.

#hangrypa #hospitalist #pablr #physician assistant

[hangrypa]

rest in peace, my friend

One of my patients passed away last week.

We had known each other for over a year now, and we cultivated quite the friendship. Mostly me yelling at him to take care of himself ("No working in the metal shop when you're thrombocytopenic") and him pretending to listen ("I don't know where these bruises came from, must've been from sitting and reading"). Over the past several months, I also got to know his family, including his wife ("What did he do wrong this time?") and brother ("Yep, that sounds like him").

Below was our first interaction ever.

Nurse: I think your patient may have had a fall.

Me: Thank you for letting me know.

[walks into patient room]

Me: Hi, I'm Hangry. I'm one of the PAs.

Patient: [has 3 inch gash on forehead but looks determined to pretend that it is not there] Hi.

Me: How are you doing today?

Patient: Excellent.

Me: Glad to hear it.

Patient: So we agree that I don't need to be here.

Me: [watching some blood trail down from the gash] Alternatively, I have a few questions for you.

Patient: Of course, you do.

Me: Any dizziness or lightheadedness at home?

Patient: [looks stubborn] No.

Me: Any headaches or falls?

Patient: [ignoring blood almost entering his eye] No.

Me: You sure?

Patient: ...

Patient: I may have lightly tapped my head.

Me: Against a giant razor blade?

Patient: Against an object that used to be a tree.

Me: Uh huh.

Patient: That's all.

Me: I'm scanning your head.

Patient: No, you're not.

Me: Yes, I am.

Patient: No, you're not.

Me: Sir.

Patient: You're not scanning my head. I don't even need to be here.

Me: Would your wife agree?

Patient: ...

Me: So can I scan your head?

Patient: FINE.

I miss him already.

#patient stories #rip #hangrypa #PAblr #medblr #physician assistant #PA-C

[hangrypa]

when your hospital forgets to put your department on the list for the vaccine

#how did this even happen #we have so many covid patients #howdidthishappen #hangrypa #PAblr #medblr #physician assistant #hospitalist #covid #pandemic #vaccinate #vaccinations

[hangrypa]

today I learned that my coworkers can hear me when I hum to myself

In the hallways.

And they can hear me from down the hall, too.

And so can my patients.

#oops #musical hangry #I was humming the star-spangled banner #hospitalist #hangrypa

[hangrypa]

me when the new Jackass Fellow says something rude to my patient

#don't get into healthcare if you don't care #dickwad #hangrypa #rant

[hangrypa]

patient reaches into her vagina to fetch something that she “saved” for us

#no no no no #whyyy #please don't #hangrypa #hospitalist #healthcare #medicine #PAblr #medblr

[hangrypa]

To the sitter who told my suicidal elderly patient that they were disgusting:

Go fuck yourself.

I'm going to call HR and your manager repeatedly until your ass gets fired.

And I'm going to report you for elder abuse.

Caring for people is a privilege.

One that you don’t deserve.

Go fuck yourself.

#Who the fuck does that #Healthcare #Medicine #Hospitalist #Hangrypa #PAblr #Hospital medicine

[hangrypa]

sometimes I wonder about going into management

Not because I want to be a manager.

But because management is so crazy incompetent.

Good intro to my MBA application essay, right?

#management #hangrypa #physician assistant #PA-C

[hangrypa]

Number of Times this AM that Hangry said “FUCK”

#1: Forgot shield when going into a patient’s room

#2: New and relatively healthy patient desatted to 83% on room air

#3: Laryngectomy patient projectile vomited

#4: Stubbed toe running up the stairs

#5: Forgot gown when going into the room of a patient with Cdiff

#6: Patient with AMS called spouse to say that she’s coming home (she’s not)

#7: Tried to discontinue 1 med and accidentally canceled another. Damn EMR.

#8: Lost stethoscope

#9: Patient’s blood cultures positive for weirdass bacteria despite IV antibiotics

#10: Text from friend, “I tested positive for COVID.”

#11: Patient’s (who came in with DKA) K <3, supposed to discharge today

#12: CBC s/p 2 transfusions showed 3 platelets (how?!) 

#13: Accidentally stole the attending’s shield

#14: Hypokalemic patient refusing electrolyte repletion

#15: Patient with heart failure suddenly short of breath

#16: Immunocompromised patient’s scan looks like Toxoplasma

#17: Altered patient trying to pull out her midline

#18: Patient on active chemotherapy spiked fever of 39.0C

#19: Dropped pager

#20: Patient’s IV infiltrated when contrast was administered prior to CT

#21: Desatting patient’s CT looks suspicious for the C-word

#22: Patient on sedation vacation appears to be seizing

#23: Lost ASCOM in a patient’s room

#24: Patient to be discharged just had a tremendous amount of diarrhea

#25: Lost track of the attending during rounds

But really.

FAHHHHHHHHCCCCCCKKKKKKK!!!!!!!!!!

#hangrypa #PAblr #physician assistant #PA-C #hospitalist #hospital #medicine #healthcare #inpatient