Approach to Volume Disorders, Part 1

Volume disorders are tough. They haven't come easily to me, but I hope once I start practicing the experience will help me along. I will do a 3 part series on the approach to volume disorders.

Fluid Compartments (Normal)

Assessing Volume Status

Fluid Replacement Therapy

Hopefully they will help you in your basic understanding.

Fluid Compartments:

• Men and women are different. Men: TBW* = 60% of body weight, Women: TBW = 50%
• % of TBW decreases with age and increases with obesity (Why? Fat contains little water)
• How is water distributed?
• Intracellular (ICF) = 2/3rd of TBW (the largest proportion of TBW = skeletal muscle mass)
• Extracellular (ECF) = 1/3 of TBW
• Interstitial fluid = 1/3 of ECF
• Plasma = 2/3 of ECF
• Water exchange:
• Intake (normal) = 1500mL PO fluids, 500mL in solids/oxidation PER DAY
• Output (normal) = 800-1500mL in urine daily is normal
• 600-900mL per day is from insensible losses (variable bases on fever, trachs, hyperventilation, etc)
• 250mL lost in stool
• MIN OUTPUT per day = 500-600mL assuming normal kidney function
• Fluid shifts are based on hydrostatic and oncotic pressures (pull out your physiology book for a refresher in this)

TIPS:
For the fluid compartments think 60-40-20!
TBW is 60% of body wt (50% for women)
ICF is 40% of body wt
ECF is 20% of body wt

What are 3 reasons for oliguria?
1. low blood flow to kidneys
2. kideny problem
3. post-renal obstruction (need a Foley cath!)





*TBW = total body water




Source: Step up to Medicine (Agabegi and Agabegi)

Interested in Global Health?

This video/ppt by Kaiser.edu is Global Health 101 in less than 15 minutes. If you are interested in working as a PA in the global market this is a perfect introduction to help you get a better idea of what's going on outside of the United States.

2011 PA Salaries

Advance for NPs and PAs in a site/magazine that puts out salary data each year for NPs and PAs based on surveys. It is a good way to gain general knowledge about salaries in your area, but keep in mind the numbers are based on a voluntary survey.

These salaries can seem inflated or even below average because it is largely dependent on how many people answer the survey. If one plastic surgery PA answered the survey and stated that s/he made $200K, it would look like plastics PAs were some of the best paid - when in reality, this is not true. Also, if 10 family practice PAs answered and most of them were around $85K, but 2 only make $70K that would drop the average even though those 2 might be anomalies.

Take home: Look at the data. Consider it. Don't consider it the end all be all. The best way to get an idea of salaries in your location and specialty is to ask people that work in the field. I don't recommend walking up to a PA and asking them what they make. You won't make many friends that way. But you can ask them what they think the salary range would be for a new grad working in their department with your skill set.


Source: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Online-Extras/The-2012-National-Salary-Survey-of-NPs-PAs.aspx

Secrets of the Social Media Trade

I have received quite a few emails over the past few weeks asking me how I keep up with all of my social media outlets. I'm on Twitter, Facebook, Linked In, and obviously ...blogging. The secret is Hootsuite. Hootsuite is one of many free social media dashboards available today. I haven't tried any of the other ones so I'd be interested to hear if you have.

Why is Hootsuite the secret to my success? Because it allows me update ALL of my social media outlets at the same time. I can input a message once and send it to all outlets with one click. In addition, Hootsuite allows me to schedule messages to go out at any time in the future. This enables me to sit down once or twice a week and set up the majority of my postings for the week. This is an enormous time saver.

If you are looking for a way to save time, but keep all of your social media outlets up-to-date or if you are just starting up your social media endeavors- check out Hootsuite or another dashboard. 

Post-Grad Advice

It has been 3 months since I graduated from PA school. I still haven't started work and I'm not in the minority of my class. I write this entry as a "heads up" for soon-to-be grads. Our class was told that it could take 4-6 weeks to start working after graduation, even if you were already offered a job! I think that time frame is a good minimum to think about. You should plan for about 2-3 months without an income just to be safe. If you start working prior... great! but if not, you will have a bit of a cushion for things like rent, bills, loan payments, and your licenses.  Getting all of your national/state stuff for credentialing will cost you around $1500. Even if your institution says they will pay, it is typically in the form of reimbursement - that means you need to have the money upfront.

Tips to Start Working Sooner

• Fill out as much as you can on your state license application and state controlled substance application right after graduation. You won't be able to do everything, but having it ready to go so that as soon as you get your NCCPA ID you can finish it up.
• Request official transcripts from your previous institutions. You will need them for your state license and often this is the step that holds up the process. Some school can take 5-7 days to mail out official transcripts.
• If possible, hand deliver the documents to the offices instead of putting them in the mail. If it isn't possible, think about expedited delivery.
• You will need your supervising physician to sign paperwork. Depending on your relationship with that individual and their schedule, think about scheduling an appointment soon after graduation because they can fill out their sections completely prior to you getting your PANCE results.

With all of this being said, even if you do everything ahead of time - you still might not start work for 2-3 months because some of the process is out of your control.

• Some hospital credentialing boards only meet once a month, so even if all of your stuff is in if you've missed that month's meeting then you will likely have to wait til the following month.
• Your hiring department may not be able to on-board you right way, especially if they hired several new grads. They may stagger your start date with other new grads for training purposes.
• Stuff gets lost in the mail. It happens.

Take home: Be organized and get as much of the application process done ahead of time as possible. Plan for 2-3 months without an income and be sure that you have $1400-1500 "extra" money to pay for your licensing. 

Family Practice Notebook

The FPNotebook site is a wealth of information - unfortunately- much of it is buried. They have changed their site a bit and added more advertisements which makes everything a little harder to find, but on there is still a lot of great info (especially under the tabs such as Derm and Nephrology).

Interested in Becoming a Surgical PA?

If you are interested in becoming a surgical PA - you should definitely check out the American Association of Surgical PAs (AASPA). Their website if a wealth of information for all types of surgical PAs - trauma, CT surg, burn, head and neck, and neurosurgery - just to name a few. If you click on the subtype that you are interested in, a fairly generic job description will pop up along with job qualifications and general duties and responsibilities. These contain good "buzz" words when it comes time to spruce up your cover letter and resume.

What else does the site contain?

• Student Scholarship! $1,000
• Surgical PA Residency Programs 
• Tips and Techniques  (small section - I hope they expand it soon)
• Professional Organizations
• How much to become a member?

Fellows = $150/yr (PA-C/graduates only)

Residents = $80/yr

Students = $75 (good for your entire time as a student!)

• Student Opportunities for Leadership (sit on the AASPA Board)

Disclaimer: I was not asked to promote this group nor do I receive compensation for doing so.