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Primary Care: Should we throw away the clonidine?
Rachel Beatty, ARNP
Typical Scenario
Let’s discuss a common scenario. You have a 50 year old male who has not been seen by a PCP in two years. His past medical history includes arthritis and hypertension. He does not smoke and has an occasional beer on the weekend. He has been off his medications for his hypertension for over a year. His BP in office is 182/110, HR 70, Temp 97.6, Respirations 16, 02 saturation 98%. His physical exam is unremarkable and he is asymptomatic. Your medical assistant asks you if you would like her to give him clonidine and do an EKG. She then asks if we will be sending him to the emergency room. The patient is now anxious and is wondering if he is going to have a stroke. What would you do?
[Read more…] about Primary Care: Should we throw away the clonidine?Monocular Painless Vision Loss
Eye complaints, particularly vision complaints, can seem daunting to a provider in an urgent care or emergency department setting. The eye is a complex structure. The anatomy and the neurology behind vision is intricate. Often, you may be practicing in an environment without the ability to consult an ophthalmologist. An understanding of urgent and emergent eye and visual problems is crucial. This post will deal with painless vision loss.
Night Shift Survival Guide
Healthcare workers know that their job never ends. Patients don’t stop coming to the hospital because it is a weekend, holiday or late at night. Therefore, we provide 24-hour coverage and support in order to take care of our patients – because that is what we do! We are super-humans who save lives! But at what cost? At some point in your career you have likely had to take on night shift and that means that you have to fight your own circadian rhythm in order to stay awake! How messed up is that?!? This is my personal survival guide (with help from my nurses) for surviving the vampire shifts! I will start this list of with more serious topics to take note of. Then, in true night shift fashion, we will take a 90 degree turn and jump off the deep end with some fun suggestions from those who have made a few life mistakes previously!
[Read more…] about Night Shift Survival GuideDecoding MIPS in Emergency Medicine – Radiology Edition
In our last edition, we discussed some ways of altering practice models or properly documenting patient care so that we stay within the current MIPS guidelines while continuing to provide the highest quality care. In this edition, we will discuss some of the MIPS guidelines as they pertain to Radiographic studies that are commonly ordered in ER/Urgent Care settings. As always, appropriate documentation as to why, or why not, a test was ordered is crucial not only for MIPS, but from a legal standpoint as well. So, let’s get into it!
[Read more…] about Decoding MIPS in Emergency Medicine – Radiology EditionGraduated, passed boards, got a job… now what?
“Don’t Hurt Anyone”
My first job as a nurse practitioner was ideal. I knew all the physicians. I knew all the nurses. I knew all the administrators. Yet, I was scared beyond belief. First and for most I did not want to hurt my patients. Second, I wanted the staff that I worked with to accept me as a competent nurse practitioner. I remember clearly two conversations from those first few days; “John, don’t hurt anyone” and two, “John, one of the most important things is know what you don’t know”.
[Read more…] about Graduated, passed boards, got a job… now what?
MEASLES: Coming soon to a practice setting near you (Are you ready?)
In case you have been in a news and media blackout recently, Measles is back. I have seen headlines such as “Measles cases rocket toward record level”, “555 Measles cases spread to 20 states,” and “Measles outbreak hits ‘completely avoidable’ 25-year high”…despite being declared eliminated in the United States in 2000. If you are still in current practice, odds are that none of us have seen measles in front of us or thought that we had pretty much eliminated it. Personally, I have only seen one case a few years back and it was in an un-immunized child of a migrant farm worker. To be honest, it could have been very easily overlooked as just another “viral illness” or “viral exanthem”. Sometimes, it pays to be lucky rather than good. The purpose of this blog is to help prepare you in case this walks into your practice setting…making you both lucky and good.
[Read more…] about MEASLES: Coming soon to a practice setting near you (Are you ready?)