Comments for ercast.org http://blog.ercast.org Emergency medicine podcasts, reviews and curbside consults Thu, 20 Aug 2015 01:12:23 +0000 hourly 1 Comment on Night Shifts by Craig Button http://blog.ercast.org/night-shifts/#comment-1114 Thu, 20 Aug 2015 01:12:23 +0000 http://blog.ercast.org/?p=5059#comment-1114 There a few of those fellowships out there. Hopkins has one also. With both NPs and PAs is going to depend a lot on their previous experience. Although many times they pull it off, many times they are poster child for the Dunning-Kruger effect. To often they think that having been an EMT-P or an ED/ICU nurse for years is going to be enough.

The scary ones are the ones that get rural jobs right out of school and don’t have adequate experienced supervision. Last hospital I worked a brand new PA, fresh out of school, military medic before PA school. Sole provider with no MD in the building. disaster waiting to happen.

Nurses could have dealt with this if we had directed the DNP to specialty work instead of basic core education.

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Comment on Neurogenic Shock by Rob Orman http://blog.ercast.org/spinal-shock/#comment-1111 Tue, 18 Aug 2015 21:10:37 +0000 http://blog.ercast.org/?p=5069#comment-1111 Indeed it is. It’s also the power of an egalitarian system of discourse. This didn’t exist a decade ago. It was either the person up on the stage or the listener. Now, we’re all contributors. Check out the new intro to the show, courtesy of you.

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Comment on Neurogenic Shock by Søren Rudolph http://blog.ercast.org/spinal-shock/#comment-1110 Tue, 18 Aug 2015 21:08:29 +0000 http://blog.ercast.org/?p=5069#comment-1110 The power of FOAM, my friend.

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Comment on Night Shifts by Rob Orman http://blog.ercast.org/night-shifts/#comment-1109 Tue, 18 Aug 2015 20:23:19 +0000 http://blog.ercast.org/?p=5059#comment-1109 Hey Hakkon! Thanks for sharing your experience. This sounds like an awesome program.

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Comment on Acute Ischemic Stroke by Rob Orman http://blog.ercast.org/acute-ischemic-stroke/#comment-1108 Tue, 18 Aug 2015 20:22:12 +0000 http://blog.ercast.org/?p=2306#comment-1108 Not yet!

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Comment on Neurogenic Shock by Rob Orman http://blog.ercast.org/spinal-shock/#comment-1107 Tue, 18 Aug 2015 20:21:37 +0000 http://blog.ercast.org/?p=5069#comment-1107 Hey Soren! Thank you so much for spotting this. You are, of course, 100% correct. I’ve always used the terms for the same entity (neurogenic) without really even thinking about it. Website has been corrected. You, my friend, have just peer reviewed!

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Comment on Neurogenic Shock by Soren Rudolph http://blog.ercast.org/spinal-shock/#comment-1106 Tue, 18 Aug 2015 14:17:24 +0000 http://blog.ercast.org/?p=5069#comment-1106 Thank you for at great podcast. During the discussion you switch between the terms spinal and neurogenic shock which gets confusing. Just to clarify -- Neurogenic shock is the hemodynamic result from spinal cord injury, whereas normally Spinal shock refers to the flaccidity and loss of reflexes seen after spinal cord injury.

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Comment on Night Shifts by Hakkon Rosendahl PA-C http://blog.ercast.org/night-shifts/#comment-1105 Tue, 18 Aug 2015 00:18:11 +0000 http://blog.ercast.org/?p=5059#comment-1105 Hey Rob,

My name is Hakkon Rosendahl PA-C. I am an APP EM Fellow at Mayo in Rochester, MN. I love your show. It’s useful, entertaining, and to the point. Things I’ve learned on your show have helped me many times in the ED. Your show and EMRAP keep me sane as I drive across Minnesota and Wisconsin for my fellowship each week. They also both keep me up-to-date on extremely important advances in changes within emergency medicine. I just wanted to comment on your most recent episode, which I had the pleasure of listening to on my way to Eau Claire, WI for my CCU rotation.

I agree with your assessment of midlevel’s lack of appropriate EM training in school. I can’t speak for NPs, but I do know PAs are only required to do 1 month of EM. In PA school, I did 2 months of EM and another 3 months in urgent care and was still completely unprepared to be an affective EM provider.

Fortunately, Mayo Clinic decided to start a mid-level Emergency Medicine fellowship in September 2014, roughly 3 months after I graduated from PA school in Des Moines, Iowa. My Fellowship classmate Matt, who is an NP, and I make up the inaugural class.

The fellowship is 18 months long, and every rotation is geared toward toward emergency medicine. We have rotations in radiology, ophthalmology, ultrasound, trauma, ortho, ENT, CCU, and anesthesia. Plus multiple fully dedicated EM rotations. We also get access to things that other places may not have such as the lumbar puncture clinic and Rich Levitan’s one day crash course in difficult and surgical airways.
Our classroom learning includes Tintinalli, Roberts & Hedges, Hippo EM board review, Rosh review quizzes, and EMRAP. It’s excellent and very up-to-date.

The point of our fellowship is to create competent mid-level providers who can function in emergency medicine. There is a currently a large shortage of properly trained/experienced mid-level’s and emergency medicine trained physicians in the Mayo Clinic Health System.

So far the program has been excellent. I now feel comfortable and have the proper foundation of skills to perform lumbar punctures, intubations, chest tubes, and surgical airways etc. The medical education from this program has thus far been excellent thus far. I often laugh/cringe when I look back and realize all the things I didn’t know when I first started the fellowship.

You and your guest were talking about being able to access the doctor to learn during a shift. Your guest was exactly right in stating that that ability to talk about a patient and learn things as the patients come in is hugely important to become a better provider. My classmate and I have found that most of our learning comes from the conversations we have about our patients with our preceptors. One huge benefit of the fellowship is that were able to sign up and take care of critically ill patients under direct supervision from the emergency medicine trained physician. It’s much easier for us to learn and take care of these patients because were not expected to move the patients through the ED like a regular employee.

I personally believe if mid levels want to break out of the fast track and function as competent emergency medicine providers they need further training. Whether it be by Fellowship/residency, personal study, trainings/classes, or a combination.

Looking forward to the next EMRAP and ER Cast.

Let me know if any questions about the program.

Thanks
Hakkon Rosendahl PA-C
APP EM Fellow
Mayo Clinic

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Comment on Night Shifts by LITFL Review 193 | LITFL: Life in the Fast Lane Medical Blog http://blog.ercast.org/night-shifts/#comment-1103 Mon, 17 Aug 2015 12:50:17 +0000 http://blog.ercast.org/?p=5059#comment-1103 […] in mucosal bleeding, massive hydroceles, night shifts and more on ERCast when Orman welcomes on Haney Mallemat. […]

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Comment on Night Shifts by danielle http://blog.ercast.org/night-shifts/#comment-1102 Fri, 14 Aug 2015 08:26:23 +0000 http://blog.ercast.org/?p=5059#comment-1102 Thank you for your answer to the NP/PA question. As a PA in surgery, I often encounter many doctors (and other health care providers) that do not fully understand or appreciate our abilities and potential. I completely agree with your point about NP/PAs requiring additional job training and motivation in order to succeed, but the investment is often worthwhile because they can become highly experienced in the specialty over time.
Thank you!

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