4.27.2014

PAProgramSearch.com: Great Pre-PA Resource



I recently received an email from Ken Johnson, the developer of PAprogramsearch.com. Ken and his significant other went to the same process that many of us did when searching for PA programs and also encountered the same frustrations. It is difficult to find out which schools have which requirements. I ended up with a spreadsheet of the schools that I was going to apply to, their prerequisites, and checkboxes for the things that I had completed. Since there's no standardization of PA programs and their prerequisites at this time is difficult for students to keep track of.... in comes PAprogramsearch.com.

This website allows you to check off particular classes that you have taken as well as shadowing hours, etc. And then produces a list of schools with the "match percentage". The site is very easy to use it appears to be up to date. I always recommend going to be official program website to double check the prerequisites (as they can change at any time) but this is a great place to start.

Financial disclosure: 
I have no monetary or other connections to this website or the developers . Just sharing a resource. 

Home page

Check off the classes that you have completed and add your GPA/Experience in hours at the top.

A list of "matches" is generated.

4.23.2014

Subcuticular Suturing

I came across this blog post on how to do a subcuticular closure. It is well written with step by step pictures so why reinvent the wheel. I am just going to repost. Enjoy!




Source: http://abnormalfacies.wordpress.com/2012/02/20/running-subcuticular-suture-technique/

4.20.2014

Pain Control and Anti-Emetics

When prescribing pain medications you must also consider the side effects that those medications may have on your patient such as nausea, constipation, rash, etc.

We will talk about anti-emetics today.

There are many classes of anti-emetics to consider. Most services have their favorites, but due to patient allergies and the ineffectiveness of some medications on some patients - it is good to have a few back-ups in mind to try. You can also consult the pharmacy team that you work with for additional advice. This list is not comprehensive.

Dopamine antagonist: 
Prochlorperazine (good for opiod related nausea), Metoclopramide, Haloperidol

5HT3 antagonists: 
Ondansetron* (PO and IV)

Antihistamines: 
Diphenhydramine**

Anticholinergics: 
Scopolamine

Antipsychotics: 
Olanzapine


*can lead to headaches and constipation
**can be sedating





Source: MPR http://www.empr.com/antiemetic-treatments/article/125873/

3.07.2014

Pain Control: Opiods

I will go over some general information regarding opioid use for analgesia. In subsequent entries I will go over different opioid use for 1) mild to moderate pain, 2) moderate to severe pain, and 3) severe pain. I would say for my practice most patients fall into the moderate to severe pain, but for a short period of time.

Opioids

Key Points:

  • No ceiling effect (as a general statement this means the larger the dose, the larger the effect)
  • Tolerance can develop with chronic use
  • Overuse can lead to respiratory depression or seizures
Examples

Mild to moderate pain: codeine or tramadol
Moderate to severe pain: hydrocodone, oxycodone, hydromorphone
Severe pain: morphine, codeine, methadone

**Some of these can crossover between categories based on dosage.








Source: Handbook of Neurosurgery, Greenberg 6th ed

3.04.2014

Pain Control: Toradol

Working in a surgical specialty, I have had to learn how to manage pain successfully.... and I must admit with some patients, I'm still learning. Pain is subjective so there is no magic recipe that works for every patient... you will have patients that 1) have intolerable side effects or allergies to your normal post op prescriptions, 2) have a history of narcotics abuse, 3) are drug seekers, 4) are people in true pain, and 5) are everything in between. It is good to have an idea of different pharmacological options to treat pain. Over the next few entries I will go over some of the main pain medications we use and some random ones as well.

TORADOL (ketoraolac tromethamine)

Key points:

  • only parenteral NSAID approved for use in pain control in US
  • Analgesic effect is more potent than anti-inflammatory
  • Single dose administration = 30mg IV or 60mg IM (in healthy adult)
  • Multiple doses = 30mg IV/IM q6hrs (max 120mg/day)
  • PO is available, but used only as a continuation of IV/IM therapy - comes in 10mg tabs
Why might you use toradol?
  • if constipation is an issue with your patient
  • if you are worried about sedation/respiratory depression 
  • patients with narcotic dependency
  • if your patient gets nausea with narcotics
Cautions:
  • do not use for > 72 hrs of pain control - some say 5 days is the max
  • can prolong bleeding time (secondary to platelet inhibition) in post op patients - use caution 
  • although injections bypass the GI system, patients can still get GI irritation
  • monitor for renal side effects



Source: Handbook of Neurosurgery Greenberg, 6th Ed