Orthopedics, Essential Resource

As I have mentioned before, my life prior to becoming a PA was based primarily in orthopedics. I have collected some great resources over the years and Essentials of Musculoskeletal Care 3rd Ed. is one of them. There are LOTS of ortho books out there, but I love this one for the following reasons:

1. It has straight to the point information on most of the major orthopedic injuries that you will come across
2. It has a section for joint evaluation with photos
3. It has a CD that contains pdf style exercise sheets for all of the injuries that it talks about in the book (Bonus: it allows you to customize the header to include the patient's name and your name so it looks very professional)
4. ICD-9 codes are included
5. It has Netter anatomy pictures

Netter Anatomy
"How to" Joint Examinations
Overview Page

Index, Examples of Shoulder Injuries



MPR iPhone App

The Monthly Prescribing Reference is an awesome free app. I use it daily during my clinical rotations. One of the most useful features for me is the "Interactions" feature.

At the bottom of the screen, select the "Interactions" icon.

In the upper right corner, click on the "Add" button and select the list of drugs that you are wondering about then click "View Interactions".

The drug interactions will pop up. Click on the drug vs drug section for more detail on the interactions. 

The interaction details are listed.

In addition, the references are at the bottom.

Monthly Prescribing Reference has been a life saver for me and has even helped me to catch a couple of interactions that had even been missed by my preceptors. Hope this helps!


Procedure Video: Acute Bleeding from a Peptic Ulcer

I am largely a visual learner. In fact, if I can't visualize it, I can't learn it. Therefore, I depend heavily on participating in procedures and finding videos to help me learn complicated medical concepts. I'm sure there are others out there like me so I will continue to share great videos that I find.



Back to the Basics - Taking a BP

I've been spoiled. My last rotation had electronic BP machines and my first rotation had the nurses do the BP always... Today I was asked to re-check a patient's BP manually so I had kick off the rust... here is a great video by the NEJM on the "hows and why" of taking a manual BP.


Kidney Pathology 101 (Basics)

paired, retroperitoneal organs wrapped in fat and Gerotas fascia

1. Filter system via removing metabolic waste products and maintaining Na+ and acid balance
2. Endocrine organ via secretion of erythropoietin and renin

Kidney's Functional Unit:
The nephron (which is made up of the cortex and the medulla).
The cortex contains the following: glomeruli, afferent/efferent arterioles, and prox/distal convoluated loops.

 The medulla contains the following: loops of Henle, vessels, and collecting ducts.

It is a group of capillaries with an incoming (afferent) and outgoing (efferent) arteriole. Its structure helps keep big proteins in the blood, while filtering out water and electrolytes into the tubules.

Juxtaglomerular Apparatus:
Secretes renin and regulate BP. Located in part of the distal convoluted tubule.

Renal Failure: Acute vs Chronic
In short, acute = reversible and chronic = irreversible. Acute is often due to an isolated insult to the organ such as ischemia or toxic injury and results in the patient developing azotemia (which also disappears once acute failure is resolved).  Chronic failure, on the other hand, comes on gradually and patients develop uremia.

Picture source: http://www.medindia.net/patients/patientinfo/acuterenalfailure.htm
Information Source: Hardcore: Pathology by Carter E. Wahl


Top 10 Things To Brush Up On Before Internal Med Rotations

I finished up rotation #2 this week: internal medicine. Two down, seven to go. All and all I had a good rotation... tough... but good. My attending was a big fan of pimping so I had several moments per day of high stress, but I learned a ton.

PROs - I saw a good deal of very complex patients and was able to see cases involving most every organ system --  and I feel way more comfortable with polypharm because most of my patients were on at least 15 medications. I also have more confidence in writing comprehensive daily notes.
CONs - Due to the fact that I was on a chronic care service, I did zero procedures.

Top 10 things to brush up on before an internal med rotation, esp a chronic service (pathophysiology, labs, treatment):
5-Renal insufficiency
6-Hip Fx
7-Fall work ups
8-Dementia/Mental Status Changes
10-Understanding electrolyte changes/Nutrition (for example, Ddx of hypernatremia/hyperkalemia and the what low levels of albumin/prealbumin indicate)


Capital Hill Visits

A couple of weeks ago I flew to DC to attend the Advocacy and Gov't Affairs Commission meeting at the AAPA. A part of the planned activities included a visit to Capital Hill to speak one-on-one with Senators and Congress(wo)men from our home states about issues that concern PAs and their practice of medicine.

The top 3 issues that were discussed were:
[please note links only available to AAPA members, once you sign in you will have access to background information and talking points]

1. Expanding Medicaid Health IT Incentives to PAs
2. Allowing PAs to Order Home Health Services
3. Allowing PAs to Rx Hospice Care

I initially thought it was going to be an intimidating process, but the AAPA staff worked really hard to prepare us with all of the material and handouts that we needed. Some of the AGAC members meet with politicians directly, while others met with health staffers. All and all I really enjoyed the experience and look forward to the next trip! About 1 week after my visit I received an email from one of Congressman Michaud's health staffer indicating that he was now willing to co-sign a bill to expand Medicaid Health IT Incentives to PAs! What great news! One step at a time...

NIH Video On PA Career

This NIH video was put out a few months back educating students on a PA career. This is a great link to share with friends and family contemplating a career as a PA. Feel free to post this on your FB page or Twitter account. Spread the PA word!


Chronic Kidney Disease & Mineral Bone Disorders

My attending asked me to give a 10 min oral report tomorrow on the hormone/mineral link between renal failure and fractures. I threw together this brief Keynote presentation so I would have some flow to my presentation and I thought I would share. It is not comprehensive, but it does touch upon the most salient points. I added my references at the end if you need more information.


The Dartmouth Atlas

Screen Shot. 
I completed my MPH at The Dartmouth Institute for Health Policy and Clinical Practice (TDI). TDI has an interesting program that is primarily geared toward current or future health care providers that are interested in public health/policy/hospital administration. The program is 12 months long and includes exposure to some of the greatest minds in health care policy such as Elliot Fischer, MD and David Goodman, MD. In addition, TDI has a large focus on variation of care in our health system - an idea pioneered by Dr. John Wennberg (TDI'er). Dr. Wennberg's  initial research caught fire and was then picked up by the Robert Wood Foundation.... the end result.... The Dartmouth Atlas.

The atlas looks at "Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America."

In short, the atlas is a phenomenal resource. Check it out. The Dartmouth Atlas.