Free AAPA app

The AAPA has developed an app! They officially launched it at conference and I wanted to give you a little overview. Cost: FREE
Easily accessible links to JAAPA, PA Professional, the PA microsite, and Joblink!

Keep up with the social media buzz and the trending #hashtags.

Keep up with the latest news in the AAPA profession.


PA MAN - I Love Conference!

This, in a nutshell, is why I love conference. PAs know how to have fun. Hope to see everyone there in Boston next year! Check out the video...


Atrial Fibrillation

AFib, The Basics

  1. irregularly iregular
  2. irregular RR intervals
  3. not a P wave in front of every QRS
  4. atrial rate = 400-600bpm, ventricular rate = 80-160bpm
Etiologies = PIRATES
P = pulmonary (COPD, PE)/pheo/pericarditis
I = ischemic heart dz +/- HTN
R = rheumatic heart dz
A= anemia/atrial myxoma
T = throtoxicosis
E = ethanol ("holiday heart)/cocaine
S = sepsis (post-operative)

  1. fatigue (most common)
  2. tachypnea
  3. palpitations
  4. lightheaded

Work Up
(Test yourself... why would you order each of these? what are you looking for?) - answers below
  1. EKG
  2. ECHO
  3. TSH (?)
  4. Baseline coags

  1. EKG = narrow complex QRS (<120msec), variable RR, irregular or absent P waves
  2. ECHO = maybe thrombi, maybe dilated L atrium
  3. TSH (?) = hyperthyroidism can cause AF
  4. Baseline coags = getting baseline prior to starting anticoagulation

Of note: if you are looking for THROMBI..."normal" ECHOs (transthoracic) has low sensitivity - transesophageal ECHOs allow for better visualization of L atrial appendage (location where most thrombi form) 

source: First Aid for the Wards by Le, Bhushan, Skapik
pic source: http://www.saintvincenthealth.com/Services/Heart/Heart-Resource-Library/Atrial-Fibrillation/default.aspx


Diabetes Insipidus, Part 2

Diagnosing DI

Polyuria = urine vol > 3L in 24 hrs - there are many causes of polyuria and it is important to figure out if the cause is DI or something else prior to establishing treatment

Urine osmolality (osm) of > 300 mOsmol/kg + high serum glucose --> think diabetes mellitus
Urine osmolality (osm) of > 300 mOsmol/kg + high serum urea --> think renal dz
Urine osmolality (osm) of < 200 mOsmol/kg + polyuria --> think DI

So you have a patient that has urine ohm < 200 + polyuria and you are thinking DI... how do you differentiate between central DI and nephrogenic DI?

Answer: water deprivation test

Central DI
urine osm < plasma osm after dehydration
after ADH injections urine osm increases by >50%

Psychogenic DI

urine osm > plasma osm after dehydration
after ADH injections urine osm increases minimally

Nephrogenic DI

urine osm < plasma osm after dehydration
after ADH injections urine osm increases by <50%

Makaryus/Mcfarlane. DI: diagnosis and treatement of a complex disease Cleveland Clinic Journal of Medicine Jan 2006 Vol 73:1
pic source: medicaltextboks.blogspot.com


Old and New Blog Entries

I have had several people email asking me to make it easier to find "old" posts. I have converted the dated section to include "Titles" as well. Hope this helps!

You can also look under the different "Themes".

If you aren't finding what you are looking for... shoot me and email and I will working on adding a post to answer your question.

Upcoming topics from emails received include the following:

-Suturing techniques
-Scubbing in for the 1st time
-Better note writing tips
-Making the best out of your rotations
-Important neurosurgical exam findings


Blog for Women in Surgery

I recently came across this blog... seems to just be starting up, but has lots of promise. I've added it to my favorites list.