Maybe Medical

I had a wonderful time sitting down with Mona, my first Supervising Physician when I graduated PA School, to talk about a variety of topics related to patient care and the medical experience. This was an unplanned interview so we went wherever the conversation took us and I couldn’t have been happier with the results. Our relaxed 2 hour conversation after dinner was edited down resulting in a wonderful 50 mins that I honestly feel anyone interested working in Medicine should listen to. Thank YOU for listening to it and continuing to make Maybe Medical a success! Medical Doctor (Physician)* Diagnose and treat injuries or illnesses. Examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare using evidence based medicine. 2018 Median Pay: Wage is equal to or greater than $208,000 per year (or $100.00 per hour). Educational Degree: Doctoral Degree (8 years of College on Average) Number of US Jobs in 2016: 713,800 Job Outlook 2016 - 2026: 13% (Faster than Average) *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physicians and Surgeons Incredible Video by Brene Brown on Empathy Urgent Care - Walk-in clinics focused on the delivery of acute care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers treat injuries and illnesses that are not serious enough to require an emergency department visit. Medical Residency - Training after graduating from Medical School. Minimum of three years for primary care physicians and some other specialties, but up to five years or more for some surgical specialties. Biochemistry - The study of the chemical processes within and relating to living organisms. Internal Medicine - The medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Primary Care (AKA PCP or GP [General Practice]) - Day to day healthcare given by a provider including health promotion, disease prevention, health maintenance, counseling, diagnosis and treatment of acute and chronic illnesses, and patient education. Mammogram - The imaging process using low-energy X-rays to examine the breast for diagnosis and screening, commonly with the goal of early detection of breast cancer. Anxiety - Intense persistent, or transient, excessive worrying and fear about factors not usually fear inducing. Depression - Medical illness with a variety of symptoms with the main one being a depressed mood or loss of interest in activities, may cause significant impairment in daily life and may result in suicidal attempts if severe enough and untreated. CMP (Comprehensive Metabolic Panel) - Blood test that generally includes Albumin, blood urea nitrogen (BUN), Calcium, Carbon dioxide (Bicarbonate), Chloride, Creatinine, Glucose, Potassium, Sodium, Total Bilirubin and Protein. Different from a Basic Metabolic Panel in that it usually includes Liver Enzymes of Alanine aminotransferase (ALT), Alkaline phosphatase (ALP) and Aspartate aminotransferase (AST). SSRI (Selective Serotonin Reuptake Inhibitor) - Very common class of medication used for depression and a variety of other mental health issues. Acid Reflux (AKA “Heartburn” or GERD [Gastroesophageal Reflux Disease]) - Usually due to excessive eating, laying down after eating in bed, or medication related in which there is a burning sensation in the chest, very common and may lead to further damage or cancer of the esophagus if untreated. Stages of Grief (Kubler-Ross Model) - Progression of emotional states experienced by both terminally ill patients after diagnosis and by loved-ones after a death. The five stages are chronologically: denial, anger, bargaining, depression and acceptance. The stages vary in duration depending on the person and not everyone experiences all five stages. GI (Gastroenterology) - The branch of medicine focused on the digestive system. Prilosec - Common Proton Pump Inhibitor that is used to treat GERD. Lipase - Pancreatic enzyme (used in the digestion of food) in which it is elevated due to alcoholism, medications, pancreatic cancer, and other reasons. Numbers Need to Treat - Average number of patients who need to be treated to prevent one additional bad outcome. Colon Cancer - Cancer of the large intestine, at times may not be apparent until a perforation (hole in the colon) or bloody stool occurs. Sepsis - A potentially life-threatening condition caused by the body's response to an infection. Extubate - To remove the endotracheal tube (breathing tube) when someone is ventilated (on a breathing machine). May be removed as they are improving and no longer need it, or when the determination of brain death has been made to allow the patient to die. Subdural Hemorrhage - Blood gathers between the inner layer of the dura mater and the arachnoid mater of the brain, generally related to trauma and may be life threatening. Blood Culture - A critical lab that checks for blood infection from bacteria, yeast, and other microorganisms. Having a blood infection is a condition known as bacteremia. Hospitalist - Medical Provider responsible for care of a patient admitted to the hospital. CHF (Congestive Heart Failure) - Heart’s inability as a pump to maintain blood flow to meet the body's needs. Signs and symptoms often include shortness of breath and leg swelling. Pneumonia - Infection of the lung, may be life threatening, usually due to bacteria, but may be fungal, chemical, or viral in nature. “Crashing” - A slang term used to describe a patient who is doing poorly and may be imminently dying soon. May include severely low blood pressure, heart arrhythmias, or issues breathing as a few common examples. 8 on 13 off - Working 8 days in a row of 10 or 12 hour shifts, then having 13 days off. Often a 7 on 7 off schedule is common. Scrubs Patient Advocacy - Doing what is best for the patient in all facets of care provided.  Listening to and understanding their needs. Renal Failure - May vary in severity from mild to “end-stage” kidney failure. May include leg swelling, feeling tired, vomiting, loss of appetite, or confusion. May require the person to be on dialysis. Vancomycin - A very strong antibiotic used to treat a variety of infections, may be used intravenously or by mouth. Drug Trough - The lowest concentration reached by a drug before the next dose is administered, often used in therapeutic drug monitoring. Tenements TB (Tuberculosis) - An infectious disease often caused by the bacteria Mycobacterium tuberculosis. Affects the lungs, but can also affect other parts of the body. Great Depression Era Aflotoxin Aspergillus Flavum Mold - A fungal toxin that commonly contaminates corn and other types of crops during production, harvest, storage or processing that may cause cancer. PA (Physician Assistant) - Providers who practice medicine on teams with Physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine. On average a Master's level degree of education. MA (Medical Assistant) – A health professional that works along side a medical team in an inpatient or outpatient setting. NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. They may work in a solo practice independently or they may work within part of a hospital system. They graduate from a Master's or Doctorate level medical program. OR (Operating Room) - Where surgeries take place. Reimbursement - Payment for care provided. Medicare - Government provided healthcare insurance to those over 65, young people with disabilities, and people with end stage renal disease. On-Call - Being ready and available to go into the hospital to provide patient care or answer medical questions while being away from the hospital/clinic. Insulin - Hormone the pancreas produces to help metabolize food for absorption and often either does not work or is not produced in diabetics, thus they may need external insulin. Scribe - Entry level medical personnel responsible for charting medical provider-patient encounters in real time, such as during medical examinations to assist the person in seeing more patients over a time frame. Homeopathy - A medical system with it’s foundation believing that the body can cure itself or with the use of tiny amounts of natural substances, like plants and minerals. Pulmonology - A medical specialty that deals with diseases involving the respiratory tract. Human Genome Project Neurology - The area of medicine focused on the nervous system.  This includes the nerves, brain, and spine. Psychology - The science focused on personal behavior and the mind, including conscious and unconscious process, as well as feeling and thought. MCAT (Medical College Admissions Test) - Standardized test used for students trying to get into Medical School. Meharry Medical School CVA (Cerebral Vascular Assault, Stroke) – Possible permanent damage to the brain from a loss of blood flow from either rupture of a blood vessel or obstruction from a tumor, clot, plaque, etc. 9 to 5 Tootsie Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

My dad George, experienced Firefighter and Paramedic, joins us once again to discuss the medical support that occurs during the wildfire seasons. I can’t thank him enough, and you, for helping us make Maybe Medical a success. Please continue to spread the word and visit Maybemed.com for a wonderful collection of Podcasts by an incredibly varied cast of guests who all help others by working in the Medical Field. Thanks!   EMT/Paramedic - Emergency medical technicians and Paramedics care for the sick or injured in emergency medical settings by responding to emergency calls, evaluating the medical need, performing appropriate medical services, and transporting patients to medical facilities as needed. There are various levels of EMTs (Basic, Intermediate, and Paramedic). Structure Fire - Refers to a fire involving a structure such as a residential, commercial, or industrial building. Chipper Crew - A crew using a wood chipper to break down scraps, tree limbs, etc. Very dangerous job as they can get caught in the branches and pulled in. FEMA Firefighting Tactics Poison Oak/Ivy Kenalog Side Effects Dexamethasone Standing Orders - Preapproved Protocols and Guidelines directing EMS crews to perform specific advanced life support before contacting a Physician. Orders implemented in cases in which delay of treatment could harm the patient. IM injections - Intramuscular Injections, bypassing the subcutaneous layer and going into the muscle, certain medications require specific locations of injection based on the uptake, duration, and desired effect of the medication. List of Various Blister Bandages Paratrooper - A soldier who is trained to enter combat zones via parachute from an aircraft. Smoke Jumpers - A smokejumper is a wildland firefighter who parachutes into a remote area to combat wildfires. Wilderness Medicine Training - WildMed.com & Wildnerness-Medicine.com OTC Meds (Over the Counter) - Medications that you can purchase from a store or pharmacy without a written prescription and does not require a pharmacist to obtain. National Wildfires Coordinating Group Online Course Materials FEMA NIMS Training Gator & Polaris National Interagency Fire Center Fatalities By Year Horribly Tragic Story of Arizona Firefighters (It’s unfortunate they almost seems to glamorize the story, just listen to their voices like they are putting on a show, but a story that is important to know.) Silvadene First Degree Burns - Affect only the epidermis (outer layer of skin). The burn site is red, painful, dry, and with no blisters. Commonly sunburns are 1st degree. Second Degree Burns - Involve the epidermis and part of the deeper dermal layer of skin. The burn site appears red, blistered, and may be swollen and painful. Third Degree Burns - Destroys the epidermis, dermal layer, and may go into the subcutaneous tissue (collagen and fat layer). The burn site may appear white or charred. Fourth Degree Burns - Burns down into the bones, muscles, and tendons. Destroys nerve endings affecting sensation. Dermatitis - General term for inflammation of the skin. May be from a variety of reasons, both internal and external. Cellulitis - A common, and sometimes fatal, bacterial skin infection affecting the dermis and subcutaneous layer. Often caused by, but not limited to, the bacteria Streoptococci and Staphylococcus Aureus. Neomycin Dermatitis Want to try an MRE? Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Brent K., CEO of Valley Immediate Care, joins us again on my recent trip to Southern Oregon.  We sat down initially to discuss the My Urgent Care 365 subscription model they have been using over the past few years, the goals, target audience, strengths, and hurdles.  Midway through the chat we went on a wide tangent where we covered various topics including Aesthetics Medicine, Tattoo Removal, and the fallout of those who suffer from Human Trafficking.  I can't thank him enough for sitting down once again and letting us have this moment. Please leave comments on the site and please rate us on your podcast feed to get the word out! Thanks Brent! Terms Covered in Episode Oceans of Opportunity, 2019 UCA Urgent Care Convention & Expo My Urgent Care 365 Urgent Care - Walk-in clinics focused on the delivery of acute care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers treat injuries and illnesses that are not serious enough to require an emergency department visit. U.S. Debt Ceiling, March 2019 ACA (Affordable Care Act, AKA “Obamacare,” passed in 2010) Medicare - Government provided healthcare insurance to those over 65, young people with disabilities, and people with end stage renal disease.  Overhead - The operating expenses of a business, including and not limited to rent, utilities, labor, taxes, supplies, etc Blue Cross/Blue Shield Association - One of the biggest health insurance groups in the United States consisting of 36 insurance companies started in 1929 as Blue Cross. Mother Fights for Lower Insulin Prices After Sons Tragic Death End of Life Care - Providing patient and family care when dealing with the physical, emotional, and mental phase at the end of life when dying. RN (Registered Nurse) - A health professional that has graduated from an associates or bachelor’s nursing program and has passed the required national exam who is registered to practice by a State Board of Nurse Examiners. MA (Medical Assistant) – A health professional that works along side a medical team in an inpatient or outpatient setting.  Training requirements vary from state to state with some allowing on the job training instead of completing a formal training program. CNA (Certified Nursing Assistant) - Takes care of patients under the supervision of Licensed Practicing Nurses and Registered Nurses in a facility. Morphine Drip - A supply of morphine (pain medication) generally given IV (intravenously) in a slow steady state, on patient demand at a set dose, or a combo of both. Deductible - The amount of money you are required to pay “out of pocket” (without assistance from insurance) until your insurance coverage kicks in. The deductible amount varies based on the plan and is generally inverse to the premium. Premiums - The monthly or per pay period cost to you to keep health insurance coverage whether you use it or not.  Healthcare Penalty for Lack of Coverage Diagnostics - Various tools (Imaging, labs, surgery, etc) to determine the nature and circumstance of a disease process on a patient. Copay - In the U.S. it refers to a payment defined in an insurance policy and paid by an insured person each time a medical service is accessed Morbidity - State of disease or injury. EverMed Direct Primary Care St Joe’s Sure Scripts How the Three Tiered Beer Distribution System Works List of Controlled Substances Benzos (AKA Benzodiazepines) - Class of psychoactive drugs commonly used as a sedative with many documented cases of addiction and overdose. Xanax, Ativan, and Valium are a few of the commonly known meds from this class.  Orthopedics - Branch of surgery concerned with conditions involving the musculoskeletal system. Dermatology - The branch focusing on the skin, both treatment and prevention of disease. American Academy of Aesthetics Medicine Redemption Ridge Human Trafficking Hotline NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans.  They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program. Botox Primary Care – Day to day healthcare given by a provider including health promotion, disease prevention, health maintenance, counseling, diagnosis and treatment of acute and chronic illnesses, and patient education. Depression Anxiety I-5 Corridor Electromagnetic Spectrum Visible Spectrum: Wavelengths and Colors Increasing the Number of Gray Shades in Medical Display Systems - How Much is Enough? Cool Sculpting Lysis - Breaking down of the membrane of a cell, by various manners, to compromise its integrity. Adipose Tissue - Medical term for fat. Under the skin is Subcutaneous Fat. Around organs is Visceral Fat. Bone Marrow contains Yellow Bone Marrow. Adipose tissue is also found intramuscularly and in breast tissue.  Liver Cleansing, How Stuff Works Flank - Aka “love handles” or sides of your trunk. May be more specifically referred to the back portion where the kidney’s are located, but at times used very generally.  Chiropractor - See Luther’s Episode! Peripheral Neuropathy SubQ Layer - Subcutaneous Tissue is the layer directly below the dermal (skin) layer, used mainly for fat storage. Commonly insulin is injected into this layer. Spider Vein Onychomycosis (Toe Nail Fungus) Nail Matrix Treatment of Onychomycosis (Discusses Terbinafine use too) Lisinopril - An ACE Inhibitor class of antihypertensive medication that is very commonly used to treat high blood pressure. When first starting it is advised to recheck kidney function to ensure the patient is tolerating it without unwanted side effects. Diuretics - Class of medications that induce urination, aka “water-pills,” as they help with excess free water. Often used for those with congestive heart failure and edema. My Urgent Care 365 Audiobooks.com SAS (Statistical Analysis System) - Software for advanced analytics, business intelligence, data management, and more. Price Fee Schedule for My Urgent Care 365 Fee for Service - Paying a fee for the service provided without the involvement of insurance.  Send Out Labs - Labs processed in another facility. May be down the street at another hospital, or flown to a cheaper lab in another state to be processed.  DME (Durable Medical Equipment) - Equipment used by the patient in a recovery or longterm state.  List of DME Covered by Medicare Orthotics - Medical device used to support a body part. Prosthetics - Medical device used to replace a body part. Walking Boot Thumb Spica Splinting Shoulder Abduction Pillow Rotator Cuff Tear Surgery Centers for Medicare and Medicaid Services Transparency Requirements FAQ No Way to Enforce Hospital Price Transparency Rule, CMS Says Department of Health and Human Services Radiology - Branch of medicine focusing on the interpretation and utilization of diagnostic imaging. Radiologist may read ultrasounds, CT scans, MRI images, and other forms of imaging while also utilizing them for some invasive procedures.   Tele Med - See our previous episode! Top Lobbying Spenders of 2018 Reimbursement - Payment for care provided.   “Hang a Shingle”     Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Brent joined us to discuss Telemedicine and how he views the upcoming landscape, pitfalls, and strengths that we can offer patients as CEO of Valley Immediate Care, one of the leading Urgent Care Systems in Southern Oregon (and my first job as a PA-C!). I can't thank him enough for his time and sharing all the interesting information we covered. It definitely has me thinking differently about what it may mean for us as providers and patients in the future. Please visit Maybemedical.com to leave comments and please rate us on your podcast feed to get the word out! Thanks Brent! Terms Covered in Episode LinkedIn Instagram Telemedicine - Utilizing information technology to assess health for disease prevention and treatment or may refer to providing clinical health care from a distance. Urgent Care Association Urgent Care - Walk-in clinics focused on the delivery of acute care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers treat injuries and illnesses that are not serious enough to require an emergency department visit. Oceans of Opportunity, 2019 UCA Urgent Care Convention & Expo “Store and Forward” - Describes the process of collecting digital medical information (records, x-rays, etc.) then transmitting to another provider for information or evaluation. Remote Monitoring - Ability to use technology to monitor data (blood sugar, heart rate, rhythm, etc.) from a patient(s) in another location.   TeleHealth Alliance of Oregon Morbidity - State of disease or injury. Diabetes - Refers to a group of diseases that result from an inability to utilize or produce insulin (naturally produced hormone) and thus unable to process glucose (sugar) appropriately.  This leads to a large variety of complications. Assisted Living - A community living situation generally for senior citizens who need some assistance with daily activities, but do not require care in a nursing home.   Skilled Nursing Facility - A dedicated facility or part of a hospital that provides short and long-term medical care from a team of staff that consists of nursing staff, assistants, therapists, and many more.   Norovirus - A really nasty viral gastrointestinal infection that is easily spread in close communities (Nursing facilities for exp) and very difficult to eradicate.   Admission - To be brought in to the hospital for specific medical care.  Entails obtaining a medical history, making a medical diagnosis, writing orders for treatment and other diagnostic procedures, diet, activity, etc.   Mortality - Referring to death as a result, or the state of death.   Pilot Program - Generally a small-scale, short-term trial or experimentation and implementation of ideas that helps an organization learn how a large-scale project might work in practice.   MA (Medical Assistant) - A health professional that works along side a medical team in an inpatient or outpatient setting that is considered an entry level medical position, but is very active with patient care from start to finish and a great job for anyone who would like to help patients.   AgilityUC - Electronic medical records software   Brookings - Beautiful! Go take a trip in the early summer or fall.   Littmann Telesteth Welch Allyn Otoscope X-Ray - A type of radiation called electromagnetic waves that creates 2D images of the inside of your body.   CBC (Complete Blood Count) - Lab used to evaluate a variety of factors.  White blood cell changes may reflect infection or cancer, platelet changes may reflect a bleeding disorder or cancer, hematocrit and hemoglobin reflect the concentration of red blood cells and their oxygen carrying capabilities (or cancer, yes cancer is always a top consideration for many abnormalities), and many more values to assess.   CMP (Complete Metabolic Panel) - Lab used to evaluate a variety of factors.  Electrolytes such as sodium, potassium, and calcium may reflect a nutritional change or disease state, liver enzymes are evaluated to assess possible infection such as hepatitis or alcohol abuse, and many more values are included.   Physical Therapist - A medical provider and part of the rehabilitation team to help assist with treatment, recovery, and overall well being of patients with chronic conditions, illnesses, or injuries.   Workcomp - Insurance and medical benefits for employees who are injured on the job.   SAIF - Oregon Worker's Compensation Insurance and Benefits   HIPPA (Health Insurance Portability and Accountability Act of 1996) - US law that provides data privacy and security provisions for safeguarding medical information that all medical providers must adhere to. “See one, Do one, Teach One” Consult - When asked to weigh in officially with your medical opinion from your specialty on a patient managed by another medical team or provider.   Rash - Temporary or permanent skin changes due to internal or external irritant/disease process.   Roman   Hims Pillpack OHSU (Oregon Health Sciences University) Providence Express Care Cannabis - The proper scientific name for the recreational and medical product now becoming legal.  The term Marijuana was used by Harry J. Anslinger to make it sound "more Mexican" for fear mongering during the early war on drugs that was essentially a class and race war.  #TrueStory   ED (Erectile Dysfunction) - Inability to obtain or maintain an adequate erection for sex.   Lipidemia - High levels of fats in your blood, requires lifestyle changes (diet, exercise) and at times medications to prevent heart attacks, stroke, and other consequences of long term elevated lipid levels.   Viagra - Original marketed drug used for ED that was, like many things, an accidental finding when looking to treat blood pressure.   UTI (Urinary Tract Infection) - More commonly in females due to a short urethra (where the pee comes out) and often caused by E. Coli (bacteria that is normally found in the gastrointestinal tract).  Symptom trifecta is urgency (“I have to go NOW!”), frequency ("but I just went!"), and dysuria ("ouch, it burns when I go or right at the end!").  Goes away with antibiotics and some studies have shown that cranberry juice (not cocktail) or pills may help in the early symptoms or to prevent onset.   UA (Urine Analysis) - Urine test used often to evaluate possible UTI.  Great resource on what to look for on a UA.   Medical History - The detailed and thorough questions you must ask of a patient to figure out the diagnosis and treatment.  "LOCATERS" is what I think of during each patient interview.  Location, Onset, Character of the pain (if present), what Alleviates it (if any), Timing, what Exacerbates it (if any), any Radiation or is the pain in one spot only, and Severity.   Then you have to ask Allergies and Meds, Past Medical History, Surgical History, Social History (smokes, drinks, what type of job, married, kids, etc), and Family History.  All easy to memorize once you get use to it.   CliaWaved Skype   BP - Blood Pressure   SPO2 (Peripheral Capillary Oxygen Saturation) - Percent of oxygenated hemoglobin (protein responsible for carrying the oxygen molecule on red blood cells.) Amazing stuff!   Specific Gravity - Density of the solution.  Water is usually around 1.000  A pale ale may start around 1.060 before fermentation.  When the urine is more towards zero (less then 1.005) I assume the patient is very hydrated and the sample is diluted.  The higher the number (1.020+) may reflect a degree of dehydration or another disease process.   STI (Sexually Transmitted Infection) - Dear Reader, we use to call this a STD (!), but disease refers to a more permanent state and some "STIs" are curable with medications, thus not a disease. Yeast Infection (Candidal Vulvovaginitis) - Overgrowth of naturally occurring yeast in the vagina resulting in common symptoms of white thick vaginal discharge (drainage), itching, and sometimes painful intercourse (dyspareunia). Urine Culture - Taking the urine sample and growing it in a lab to see what the infecting organism is and what it is vulnerable to.  This guides our antibiotic treatment.    Orthopedic Surgery - Branch of surgery concerned with conditions involving the musculoskeletal system. Dermatology - The branch focusing on the skin, both treatment and prevention of disease.   Medicare - Government funded insurance for anyone over the age of 65.   Center for Connected Health Policy TeleHealth Reimbursement State Laws   Reimbursement - Payment for services and medical supplies from insurance companies.   CDC (Centers for Disease Control) - THE resource for all things health related in the US. Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

  We talked about his background as a paramedic and currently working as a Trauma Surgery PA. We laid down so many points for anyone looking into getting into the medical field. We covered so many topics during our chat he wondered if there was any value to it, but I know due to his background and personality we were covering really important information when we were chatting. This is the whole reason for Maybe Medical! Please visit Maybemedical.com to leave comments and please rate us on your podcast feed to get the word out! Thank you Tyson!       Physician Assistant Stats:* Physician Assistants practice medicine on teams with physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine.   2017 Median Pay: $104,860 per year ($50.41 per hour)   Educational Degree: Masters Degree   Number of US jobs in 2016:106,200   10 Year Job Outlook: 37% growth, much faster then avg.     *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physician Assistants, (visited August 5, 2018).     Terms Covered in Episode M.D. (Doctor of Medicine) - Requires completion of a (usually) four year graduate medical school training program to become a Physician.  They examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare.   Psychiatry - Medical specialty focusing on Mental and Behavioral Health.   Salary - Opposite of hourly pay.  Salary is paid no matter how little or excess work is performed.  Does not fluctuate based on productivity or hours worked unless previously agreed upon.   Production Bonus - Extra pay for seeing more then the require amount of patients, or some variation of productivity.   Attending Cosign - Legal signature and acknowledgement of a Physician Assistant's note.  Agreeing with their interpretation of diagnostics, medical diagnosis, and treatment plan.  Requirement of number of cosigned notes varies by state with many asking 10% of charts be reviewed by the Supervising Physician.   Reimbursement - Payment for services and medical supplies from insurance companies.   Third-Party Reimbursement   RVU (Relative Value Units) - Measure of value used in the US to determine services provided by practitioners to gauge the value, and thus the reimbursement from insurance companies, for care given to patients. Trauma Surgery - Surgical field dealing with acute traumatic injuries such as falls, motor vehicle crashes, gunshots, blunt and penetrating injuries, etc.   "Scut Monkey" - Slang term for an inexperienced medical student.  Responsible for much of the paperwork and other undesirable duties...also the subtitle of an EXCELLENT book.  Seriously, buy it!   Discharge - To be released from the hospital and given specific follow up instructions, support services, and pertinent medications. Admit - To be brought in to the hospital for medical care, surgical care, or recovery.   OR (Operative Room) - Where surgeries take place. ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.   May consist of intubated, sedated, and ventilated patients.   Pre/Post Op - The phase just prior to or after surgery for a patient   Inpatient/Outpatient - Inpatient is someone staying, at minimum, overnight in the hospital, outpatient generally refers to a clinic patient.   Level One Trauma Center - A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation and includes teaching residents and medical students in all fields.   Resident - Physicians who have graduated from an accredited medical school and hold a medical degree who are now enrolled in a post graduate medical program, with varying years, with the focus on a specific medical/surgical field.   Chest Tube - A tube placed in the chest cavity to evacuate blood, pus (exudate), or air.   “Bronchs” (Bronchoscopy) - Surgical technique of visualizing the inside of the airways for diagnostic and therapeutic purposes using a flexible camera/suction device (bronchoscope) inserted into the airway (mouth, nose, trachea) of a sedated patient.   Supervising Physician - Each PA has a Supervising Physician on state record who has partnered for medical care.   Subspecialty - Specific medical or surgical focus.  For example bariatric surgery instead of general surgery or pediatric neurology instead of pediatrics.   EMT/Paramedic - Emergency medical technicians and paramedics care for the sick or injured in emergency medical settings by responding to emergency calls, performing medical services, and transporting patients to medical facilities as needed.   ER Tech - Staff who work in all aspects of patient care under the supervision of the Practitioners and Nursing staff.   Many have a paramedic/firefighting background.   “Ride-a-long” - Volunteer position to ride with EMS staff seeing the real world day to day duties of their career.   On Scene - On location of the medical event.   Aaron - Super Amazing Guy and Critical Care Nurse Practitioner.   Certificate Program - Generally around a two year program at a local community college.   EMS (Emergency Medical Services) - Services that treat illnesses and injuries that require an urgent medical response, providing out-of-hospital treatment and transport to definitive care.   Paramedics, Police, Firefighters, etc.   Undergrad - Generally refers to a Bachelor program (four to five years) after high school.   Monitor Tech - Trained technicians who observe and interpret a patient's heart status and other vital signs remotely in the hospital.   Phlebotomist - Staff skilled at drawing blood/obtaining labs.   ER (Emergency Room, Emergency Department, Emergency Ward, Accident & Emergency Dept) - Department that must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention that arrive unplanned by walk-in, private vehicle, or ambulance.   Urgent care - Walk-in clinics focused on the delivery of acute care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers treat injuries and illnesses that are not serious enough to require an emergency department visit.   Auger - A large helical drill bit used often for drilling earth or wood.   Prerequisites - Classes you may need to take before further applying to a program.   Usually a focus on science/math for the medical flied.   Bachelor’s Degree - On average four to five year University Program to pursue a degree in a specific field.   Intubate - When an ET Tube, or similar artificial airway, is placed, either in an emergency, where there is loss of respiratory function, or planned such as in surgeries.   MI (Miocardial Infarction) - "Heart Attack" refers to a blocked coronary artery that has caused, or is moments away from causing, irreversible cardiac (heart) tissue damage.   Mapping Navajo Nation: Vice News Tonight on HBO (watch it!)   Protocols - Specific guidelines that allow EMS to treat patients en route to the hospital based on the medical situation and skill of staff.   EMS Transfers - Often non-emergent transfers from one medical facility to another.  May be as simple as a hospital to nursing home transfer a few mins away, or a half day trip to a metropolis with better medical services.   Pension - A regular payment made during a person's retirement from an investment fund to which that person or their employer has contributed during their working life.   Colleen - Supportive Wife and Amazing Flight Nurse   Travel RN - Nurse who travels for limited contracts working in all variety of places and roles.   On average 8 to 13 week contracts.   Wake Forest Physician Assistant Program   PAEA - Physician Assistant Education Association   List of PA Programs   PA History   Prescription - Legal written order for prescribed medications from a medical practitioner and dispensed by a pharmacy.   Surgical Programs   American College of Surgeons List of Surgical Specialties   A1c (Hemoglobin A1c) - A blood test that measures your average blood glucose, or blood sugar, level over the past 3 months.  Hemoglobin is a protein found inside red blood cells that carries oxygen to the body.  Used during the evaluation and treatment of diabetes.   Diabetes -  Refers to a group of diseases that result from an inability to utilize or produce insulin (naturally produced hormone) and thus unable to process glucose (sugar) appropriately.  This leads to a large variety of complications.   Byetta - A medication used for type 2 diabetics that promotes insulin secretion by the pancreas.   Vascular - A surgical subspecialty focusing on arteries, veins and lymphatic circulation using medical therapies, minimally invasive procedures, and surgical intervention.   Orthopedics - Branch of surgery concerned with conditions involving the musculoskeletal system.   Plastic Surgery - Surgical field specializing in restoration, reconstruction, or alteration of the human body.   Transplant Surgery - Surgical specialty in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.   List of PA Residency Programs   Montefiore PA Surgical Residency   Consult - When asked to weigh in officially with your medical opinion from your specialty on a patient managed by another team.   Didactic Phase - Refers to the classroom aspect of medical education.  The opposite would be clinical phase working with actual patients.   “Steps” - Refers to the USMLE   Schwartz's Principles of Surgery   Staff PA - Hospital employed Physician Assistant.   CT Surgery - Cardiothoracic surgery deals with issues of the thorax, generally the heart and lungs.   Vein Harvest - Generally endoscopic removal of a vein to replace a coronary artery (cardiac bypass).   "Pimping" - Refers to the process of getting questioned, sometimes spontaneously, on random medical topics until failure by your preceptor.   Pathophysiology - The processes associated with disease or injury.   Neurosurgery - Surgery dealing with the Nervous System (brain and spine).   Pathology - The area of medical focused on conditions typically observed during a disease state.   Foreign Body - An object that is not supposed to be there.   IM (Internal Medicine) - The medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. AKA “Internists.”   Hospitalist - Practitioners who focus on the treatment of hospitalized patients.   Follow up - The scheduled visit to see how the patient is progressing in their recovery or disease state after a hospital discharge or clinic visit.   Pneumothorax - AKA “Collapsed lung” is when air leaks into the space between the lungs and chest wall.  This may be due to blunt or penetrating trauma, or spontaneous due to congenital (developmental) or disease origin.  Treatment is a chest tube.   OR Device Rep - Professional representative who assists and educates the surgeon during a procedure with an expertise in their area and their company’s equipment (knee replacements, defibrillators, etc).   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

Rounding out the trifecta of wonderful nurse guests this month on Maybe Medical is Flight Nurse Colleen R.! We covered how she feels you need to be able to fly by the seat of your pants to perform in her role, as well as have an emergency and critical care background. We talked about work and home partnerships and how to balance it all while supporting each other. She was extremely inspirational and I can not express my gratitude enough for her taking the time to sit down with us. Thank you Colleen!   Registered Nurses* Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.   2017 Median Pay: $70,000 per year ($33/hour)   Educational Degree: Initially Associate's Degree or Bachelor's Degree   Number of US jobs in 2016: 2,955,200   10 Year Job Outlook: 15% growth, much faster then avg.   *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, on the Internet at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 16, 2018).       Terms Covered in Episode American Nurses Association Trauma Surgery - Surgical field dealing with acute traumatic injuries such as falls, motor vehicle crashes, gunshots, blunt and penetrating injuries, etc. Pulmonology - A medical specialty that deals with diseases involving the respiratory tract. Consult - When asked to weigh in officially with your medical opinion from your specialty on a patient managed by another team. Perforated Bowel - Opening in the intestines due to trauma (knife, bullet, etc) or disease (infection, cancer, etc).  Is a surgical emergency.  Yuck. Sepsis - A potentially life-threatening condition caused by the body's response to an infection. Ventilator - To move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe, or breathing insufficiently. "Coding" - What we casually use to describe a cardiopulmonary arrest in which there is a sudden loss of function of the heart or loss of respiratory function that requires immediate intervention in a life or death situation. IR (Interventional Radiology) -  A subspecialty of radiology that uses minimally invasive, image-guided procedures to diagnose and treat diseases in nearly every system or organ of the body. CVA (Cerebral Vascular Assault, Stroke) – Possible permanent damage to the brain from a loss of blood flow from either rupture of a blood vessel or obstruction from a tumor, clot, plaque, etc. MI (Miocardial Infarction) - "Heart Attack" refers to a blocked coronary artery that has caused, or is moments away from causing, irreversible cardiac (heart) tissue damage. ET (Endotracheal) Tube - A tube of varied sizes that is inserted into the trachea for establishing and maintaining a patient's airway. Choose Your Own Adventure Books ER (Emergency Room, Emergency Department, Emergency Ward, Accident & Emergency Dept) - Department that must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention that arrive unplanned by walk-in, private vehicle, or ambulance. ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients. Bachelor's Degree - On average four to five year University Program to pursue a degree in a specific field. Sacred Heart University College of Nursing Bridge Program - A postgraduate program that is usually shorter then traditional programs that take into account previous experience. Physical Therapist - An important medical provider and part of the rehabilitation team to help assist with treatment, recovery, and overall well being of patients with chronic conditions, illnesses, or injuries. Prerequisites - Classes you may need to take before further applying to a program.  Usually a focus on science/math for the medical field. PA (Physician Assistant) - Providers who practice medicine on teams with physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine. On average a Master's level degree of education. NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans.  They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program. ASN/ADN - Associate’s Degree in Nursing.  Usually around two years. EMT/Paramedic - Emergency medical technicians and paramedics care for the sick or injured in emergency medical settings by responding to emergency calls, performing medical services and transporting patients to medical facilities as needed. ER Techs - Staff who in all aspects of patient care under the supervision of the Practitioners and Nursing staff.  Many have a paramedic/firefighting background. Travel RN - Nurse who travels for limited contracts working in all variety of places and roles.  On average 8 to 13 week contracts. Smart Pumps Compact Nursing States NCLEX (National Council Licensure Examination) - A standardized exam that each state board of nursing uses to determine whether or not a candidate is prepared for practice. Wake Forest School of Medicine PA Program Harborview Medical Center King County Medic One "Board & Collared" - Refers to the practice of placing a patient on scene on a very hard and rigid backboard to immobilize them and place a neck collar on them to prevent any head movement in the event of a spine injury while they are transported to the hospital.  They are incredibly uncomfortable. Intubated - When an ET Tube, or similar artificial airway, is placed, either in an emergency, where there is loss of respiratory function or planned such as in surgeries. First Responder - Generally refers to the first on scene in an event.  May be police officers, firefighters, or paramedics for example. "Packaged" - Patient is ready to be transported.  IVs are in, airway is secure if one is present, patient is strapped in, paperwork is read.  Let's roll!   EZ-IO - Used to gain access for medications or fluids when unable to get a line in a blood vessel.  Using a drill a hollow bore is inserted into the broad side of a bone.  Yeah, you drill into bone. "Push Line" - An IV that gives you access for medications that need to be administered over a short amount of time.  Pain meds, sedatives, cardiac meds, etc.   Vasopressors - Class of Antihypotensive medications that are used to raise blood pressure by contracting blood vessels.   EJ - An IV placed into the external jugular of the neck.   Central Line - Larger then an traditional IV placed into veins in the neck, chest, groin, or through veins in the arms.   EMS (Emergency Medical Services) - Services that treat illnesses and injuries that requiring an urgent medical response, providing out-of-hospital treatment and transport to definitive care.  Paramedics, Police, Firefighters, etc.   Level One Trauma Center - A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation and includes teaching residents and medical students in all fields.   Med/Surg/Floor Nursing - Refers to what you would think of "general hospital patients." Those with pneumonia, new cardiac issues, skin infections, etc that do not require focal subspecialty involvement (cardiac, neuro, ortho, etc) or critical care support.   Nocturnist - Hospital-based practitioner who only works overnight.   Admit - To be brought in to the hospital for specific medical care.  Entails obtaining a medical history, making a medical diagnosis, writing orders for treatment and other diagnostic procedures, diet, activity, etc.   Post-Op/Recovery Room - The period right after surgery.   GI (Gastroenterology) - The branch of medicine focused on the digestive system.   Orthopedics - Branch of surgery concerned with conditions involving the musculoskeletal system.   Neurology - The area of medicine focused on the nervous system.  This includes the nerves, brain, and spine.   Potassium - A naturally occurring mineral and electrolyte consumed in our diet.  Involved in metabolism, hormone secretion, blood pressure control, fluid and electrolyte balance, and more.  Normal standard range is around 3.5-5mEq/L. Critical Values - Any values considered to be too high or low and requires immediate medical attention to prevent further issues. "Bagging" - The act of using a manual balloon like bag that is squeezed for each breath to a patient. "Titrate a Drip" - To adjust the flow rate or dose delivered of medication in a IV or central line. Peggy Sue - Badass Patient Advocate "Shake and Bake" - Hyperthermic Intraperitoneal Chemotherapy is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Patient Advocacy - Doing what is best for the patient in all facets of care provided. Listening to and understanding their needs. Multi System Organ Failure - A cascading domino like effect where multiple organ systems start to shut down due to injury/illness. Krista Haugen and Survivors’s Network Post Resuscitation - The fragile period after performing CPR or similar resuscitation of a patient. M&M (Morbidity and Mortality Meeting) - Where we dissect individual challenging cases to identify what other choices could have been made for possible alternate outcomes. Off-Label - Using a medication that may not necessarily be the indication that it was originally intended for.  For example Demerol that is a pain medication is excellent for post-operative rigors (shakes).  A small dose works like magic...fun! IV Fluids - Intravenous fluids are given through an IV, central line, or IO and usually consist of normal saline or lactated ringer's solution. Levophed (norepinephrine bitartrate) - Medications used to raise blood pressure in critical patients. Used to be referred to as "Leave 'em dead" as any patient sick enough to require norepinephrine to manage their shock, then they were most likely going to die.  Very commonly used nowadays. Epinephrine - Endogenous hormone that is given to patient's to treat a number of conditions including anaphylaxis, cardiac resuscitation, and bleeding.  Inhaled epinephrine is used to help treat symptoms of croup.  Is used in the ICU and cardiac unit to help maintain a high enough blood pressure.   PRBC (Packed Red Blood Cells) – Blood that is transfused after finding the right compatible blood type for the patient.   Plasma – Fluid in blood that is responsible for carrying red blood cells, white blood cells, platelets, etc. Is often used during blood transfusion to help stop the active bleeding by adding pro-clotting factors.   Credo Cube   Transfusion Guidelines Airlift NorthWest   MONA - Morphine, Oxygen, Nitroglycerin, and Aspirin are all meds that should be administered to a patient experiencing chest pain.   Emergency Nurse Association   Balloon Pumps - Intra-Aortic Balloon Pumps use a thin flexible tube that is inserted into the aorta of the heart to pump blood artificially in a heart-like fashion.   ECMO (Extra Corporeal Membrane Oxygenation) - Treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill patient.  Provides heart-lung bypass support outside of the body.  You are damn near dead at this point   Skills Lab/”Sims” - Focused area to learn new medical techniques or further practice known skills.   Society of Critical Care Medicine PFCCS - Pediatric Fundamental Critical Care Support ACLS - Advanced Life Support PALS - Pediatric Advanced Life Support Certification NRP - Neonatal Resuscitation Program ATLS - Advanced Trauma Life Support Certification   CCRN - Critical Care Registered Nurse CEN - Board Certification of Emergency Nurses Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

When chatting with Sam it reminded me how much I missed the ER.  She gave us a wonderful perspective on how it is to work in the ER and what traits would make an ideal ER RN.  We discussed the various routes to become a nurse and she shared her personal pros and cons with us about nursing in the emergency setting.   Thank you Sam!   Registered Nurses* Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.   2017 Median Pay: $70,000 per year ($33/hour)   Educational Degree: Initially Associate's Degree or Bachelor's Degree   Number of US jobs in 2016: 2,955,200   10 Year Job Outlook: 15% growth, much faster then avg.   *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, on the Internet at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 16, 2018).   Terms Covered in Episode American Nurses Association UC College of Nursing   CNA (Certified Nursing Assistant) - Takes care of patients under the supervision of Licensed Practicing Nurses and Registered Nurses in a facility. Microbiology - The study of microorganisms, encompasses numerous sub-disciplines including virology, parasitology, mycology and bacteriology.   Satellite clinic - A facility owned by a hospital, but operated at a distant site.   Urgent care - Walk-in clinics focused on the delivery of acute care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers treat injuries and illnesses that are not serious enough to require an emergency department visit.   Pediatrics Medicine - A branch of medicine that involves the medical care of infants, children, and adolescents. BSN - Bachelor of Science in Nursing, more schooling then Associate's. Usually four to five years. ASN/ADN - Associate’s Degree in Nursing.  Usually around two years.   NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans.  They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program. Med/Surg/Floor Nursing - Refers to what you would think of "general hospital patients." Those with pneumonia, new cardiac issues, skin infections, etc that do not require focal subspecialty involvement (cardiac, neuro, ortho, etc) or critical care support.   Drug Reps - Pharmaceutical Representatives are professionals that work for the companies that manufacture, market, and sell medications that work with clinics, hospitals, and other health care facilities to educate about new products and continue to support current products.   PureWick External Female Catheter <---- You know you want to click that link!   IV (Intravenous) - Delivering medications through the skin into blood vessels.   Orthopedics - Branch of surgery concerned with conditions involving the musculoskeletal system.   Blood Culture - A critical lab that checks for blood infection from bacteria, yeast, and other microorganisms.  Having a blood infection is a condition known as bacteremia. i-STAT   Bed Sores (Decubitus Ulcers) - A break down of skin/tissue developed by pressure caused by lying in bed in one position in an immobile patient. Can lead to serious infections and subsequent issues.   Telemetry - Staff review data from special equipment to track a patient's heart rate, blood pressure, breathing and other vitals from a remote location that may be near or removed from the actual patient's location.   NCLEX (National Council Licensure Examination) - A standardized exam that each state board of nursing uses to determine whether or not a candidate is prepared for practice.   Prerequisites - Classes you may need to take before further applying to a program.  Usually a focus on science/math for the medical flied.   ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients.   O.R. (Operating Room) - Where surgeries take place.   Patient Advocate - Caring for the entire well being of the patient, not just the focal issue.  Making the best choices for the patient in their care.   Charge Nurse - Head nurse for the unit during that shift.   "Coding" - What we casually use to describe a cardiopulmonary arrest in which there is a sudden loss of function of the heart or loss of respiratory function that requires immediate intervention in a life or death situation.   Sepsis - A potentially life-threatening condition caused by the body's response to an infection.   EKG (Electrocardiogram) – Graph representing the electrical conduction of the heart to determine cardiac disease or injury.   Lactic Acid - An organic compound produced as a by product from metabolism.  Used as a lab value during times of stress from infection/trauma or to assess the response to treatment.   X-ray - A type of radiation called electromagnetic waves that creates pictures of the inside of your body.   Triage - To assess the urgency of wounds or illnesses, to decide the order of treatment of a number of patients or casualties.   Surviving Sepsis Campaign   NG Tube (Nasogastic Tube) - A tube inserted through the nose, into the back of the mouth, down the throat, and into the stomach.  Used for removal of stomach contents (bowel obstruction, overdose) or sometimes used for feedings. Foley Catheter - A tube that is inserted through the urethra to the bladder to empty urine.  May be left in place and a bag attached to it.   Dobhoff - A special type of nasogastric tube with a smaller-bore and more flexible so it is more comfortable to the patient. It's inserted by the use of a guide wire called the stylet, which is removed after the tubes correct placement is confirmed using a x-ray.   Trauma Certified Registered Nurse   Physician Assistant Specialty Certificates of Added Qualifications (CAQ)   GI (Gastroenterology) - The branch of medicine focused on the digestive system   Dialysis - The process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally.   French Toast - Should not have too much egg crust.   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

I've known Tiffany for quite a long time now and she truly is like a sister to me.  I was so excited to have her on the show, but I've never once worked with her.  Despite this, she is such a wonderful person that if I ever was to be sick, injured, or my family needed care I would be so fortunate if she was the nurse.  She has been caring for people her entire life, even when not her responsibility.  I hope you feel as inspired as I am after listening to her.   As we discussed here is a wonderful Florence Nightingale quote:   The most important practical lesson that can be given to nurses is to teach them what to observe, how to observe, what symptoms indicate improvement, what the reverse, which are of importance, which are of none, which are the evidence of neglect, and of what kind of neglect.   Thank you Tiffany!       Registered Nurses* Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.   2017 Median Pay: $70,000 per year ($33/hour)   Educational Degree: Initially Associate's Degree or Bachelor's Degree   Number of US jobs in 2016: 2,955,200   10 Year Job Outlook: 15% growth, much faster then avg.   *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, on the Internet at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 16, 2018).   Terms Covered in Episode American Nurses Association   Palliative Medicine - An interdisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses. It focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness.   Geriatrics Medicine - A specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults.   Pediatrics Medicine - A branch of medicine that involves the medical care of infants, children, and adolescents.   NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program.   Travel RN - Nurse who travels for limited contracts working in all variety of places and roles.  On average 8 to 13 week contracts.   Autonomy - Being able to work independently.   CNA (Certified Nursing Assistant) - Takes care of patients under the supervision of Licensed Practicing Nurses and Registered Nurses in a facility.   Personal Home Care - Providing medical care in a home setting.  Either in a group facility, as a visitor to an individual home, or as a live in caregiver providing 24/7 support.   Pharmacy Tech - A health care provider who performs pharmacy-related functions working under the direct supervision of a licensed pharmacist.   Corpsman - An enlisted member of a military medical unit.   Prerequisites - Classes required to set an educational foundation prior to enrolling in more focal studies.   Bachelor's Degree - On average four to five year University Program to pursue a degree in a specific field.   LPN (Licensed Practicing Nurse, aka Licensed Vocational Nurse) - Provides nursing centered patient care as part of a medical team.  Requires less years of education with less responsibilities on average compared to a Registered Nurse.   ASN/ADN - Associate’s Degree in Nursing   BSN - Bachelor of Science in Nursing, More schooling then Associate's.   ER Techs - Staff who in all aspects of patient care under the supervision of the Practitioners and Nursing staff.  Many have a paramedic/firefighting background.   Antimicrobial - An agent that kills microorganisms or stops their growth.   Oncology - Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer.   ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients.   CCU (Cardiac Care Unit) - Part of the hospital that focuses on postoperative cardiac surgical patients and those who have suffered from cardiac events or other variety of cardiac related disease processes.   ER (Emergency Room, Emergency Department, Emergency Ward, Accident & Emergency Dept) - Department that must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention that arrive unplanned by walk-in, private vehicle, or ambulance.   CABG (Coronary Artery Bypass Graft Surgery) - "Bypass" surgery is a surgical procedure to restore normal blood flow to an obstructed coronary artery.   MI (Miocardial Infarction) - "Heart Attack" refers to a blocked coronary artery that has caused, or is moments away from causing, irreversible cardiac (heart) tissue damage.   Epinephrine - Endogenous hormone that is given to patient's to treat a number of conditions including anaphylaxis, cardiac resuscitation, and bleeding.  Inhaled epinephrine is used to help treat symptoms of croup.  Is used in the ICU and cardiac unit to help maintain a high enough blood pressure.   Dobutamine - Inotrope class of cardiac medication used in the treatment of adults with weakened cardiac function due to poor effort of cardiac contractions (pumping of the heart) that may result from cardiac disease or cardiac surgery.  Helps the heart to beat stronger and more efficiently.   Dopamine - Medication used as a stimulant for low blood pressure, cardiac arrest, or slow heart rate.   Vasopressors - Class of Antihypotensive medications that are used to raise blood pressure by contracting blood vessels.   Insulin - Hormone naturally produced by the body to help process carbohydrates that is given via injection to diabetics who are unable to either produce, or are no longer as sensitive to, their insulin.   Massive Transfusion Protocol - Protocol that a hospital system has when need of large quantities of blood and blood products are needed to be transfused for a patient with significant blood loss that may still be ongoing.   Florence Nightingale - Founder of Modern Nursing   Certified Breastfeeding Specialist - Specialized healthcare provider who work with mom and their baby to assist in feeding and help those experiencing breastfeeding problems, such as latching issues, painful nursing, or low milk production.   Prenatal Care - Care being provided to those pregnant or planning to become pregnant.   Acute Care - The opposite of long term care.  Providing care for expected temporary illness or injury.   Foley Catheter - A tube that is inserted through the urethra to the bladder to empty urine.  May be left in place and a bag attached to it.   Skills Lab - Focused area to learn new medical techniques or further practice known skills.   Colostomy - A surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Poop and liquid moving through the intestine empties via the stoma into a bag attached to the abdomen.   Oregon State Board of Nursing   Latching - The application and placement of the child's mouth to the nipple/breast to form an appropriate connection for feeding.   Colostrum - The nutrient rich first form of milk produced immediately following delivery of the newborn and contains antibodies to protect the newborn against disease.   Breast Pumping - Using a machine to mild the breasts for milk to be used at a later date or if there is issues with the infant latching on to the nipple for adequate feedings.   Torticollis - A rare, and often temporary, condition in which the neck muscles contract, causing the head to twist to one side.   Teddy Bear Constipation - Your teddy bear is "overstuffed."   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Despite working with Chanelle for only a few months I came away from every interaction feeling confident that the patients we were working with together were going the get the absolute best care.  She is a wonderful mix of confidence and compassion that makes every patient put 100% of their trust in her.  I learned so much from her in this quick chat before her shift at the hospital and I know you will as well.  Thank you Chanelle! Radiologic Technologists* Radiologic technologists perform diagnostic imaging examinations on patients that are licensed by the American Registry of Radiologic Technologists, which is an organization offering credentialing in medical imaging, interventional procedures, and radiation therapy. 2017 Median Pay: $58,440 per year ($28/hour) Educational Degree: Associate's Degree Number of US jobs in 2016: 241,700 10 Year Job Outlook: 13% growth, faster then avg. *Sourced from and edited based on information found on Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Radiologic and MRI Technologists, on the Internet at https://www.bls.gov/ooh/healthcare/radiologic-technologists.htm (visited October 25, 2018). Terms Covered in Episode AART - American Registry of Radiologic Technologists Inpatient/Outpatient - Inpatient is someone staying, at minimum, overnight in the hospital, outpatient generally refers to a clinic patient.   Pre/Post Op – The phase just prior to or after surgery for a patient Fluoroscopy - Imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. Radiologist - Physician who specializes in interpreting diagnostic images such as CT, MRI, X-ray, etc.  May also perform procedures during diagnostic tests. Psych Patient - Someone generally suffering from a schizophrenic break, suicidal thoughts, or self harm when they are seen in the Emergency Room.    Constipation - Difficult time having a bowel movement (poop), induced by lack of hydration and movement when in the hospital, may progress to the more severe term call "Obstipation." Small Bowel Obstruction - Physical blockage of the small intestine more commonly due to previous surgeries that can cause adhesions (walls of intestines stick together).  May resolve on it’s own with time or may require surgery to correct.  Abdominal series - Used to help diagnose cause of abdominal pain.  X-ray series that usually consists of a standing abdominal x-ray, laying abdominal x-ray, and chest x-ray. Diagnose - Identifying the cause of the medical issue.  R.T. (Respiratory Therapy) - Therapists in the hospital that assist in all manner of care regarding the respiratory system during times of recovery from illness, injury, or maintenance of a long term lung disease.  O.R. (Operating Room) - Where surgeries take placeEsophagram - Exam performed of the esophagus (tube that goes from mouth to stomach) to assess frequent heartburn (upper abdominal pain), gastric reflux (food/acid coming back up), aspiration (food or fluid in your wind pipe, aka Trachea), difficulty eating, drinking, or swallowing.Barium Sulfate - Low toxicity high density chemical compound used as a radio contrast agent in x-ray and other imaging of the digestive tract.  Speech Therapy - Therapist who specialize in all manner related to language formation and often assist patients who are having difficulty eating to help properly retrain or assess how to physically get nutrition.  Aspirate - To have food/liquid accidentally go down the Trachea (“wind pipe”) and may result in pneumonia (lung infection, may be fatal).Ultrasound - Diagnostic and therapeutic imaging using high frequency sound waves.Prerequisites - Classes you may need to take before further applying to a program.  Usually a focus on science/math for the medical flied.  Clinical's - Rotations where students are working in the hospital or clinic getting medical exposure during their training.  CT Scan - Image made using computerized axial tomography (aka CAT Scan), which gives us various angles to assess the anatomy with much more detailed look compared to x-ray.  Radiation Therapy - Type of cancer treatment that uses beams of intense radiation (energy) to kill cancer cells in hopes of a cure or sometimes as a comfort measure to decrease the size of the cancer.  Positioning - The right orientation of the patient for the x-ray to take an image of a part of anatomy.  Varies by each image.  A variation off of the desired positioning will result in a subpar image.  kVp (Kilovoltage Peak) - The voltage applied to the X-ray tube.  The radiation dose to the patient is directly proportional to the square of kV. Milliampere-seconds (mAs) - Measure of radiation produced over a set amount of time via the X-ray tube. Thyroid - Butterfly shaped endocrine gland located on the front of the neck responsible for thyroid hormone that assists in regulation of metabolism and protein synthesis.  Nuclear Med Technologists - Technologists who prepare and administer radioactive drugs to patients for therapeutic and diagnostic purposes.  Gastrograffin Challenge - Diagnostic procedure used for assessment of small bowel obstruction.  Involves administration of water-soluble barium like contrast followed by serial abdominal x-rays.   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

Barrington is a wonderful friend and an excellent practitioner. He is very unique in that he decided to go back to school to become a Physician of Osteopathic Medicine after he was a successful practicing Physician Assistant in surgery. It is amazing how hard he works in every aspect of his life. I knew from working with him how hard and dedicated he was, but after hearing his stories, I have even more respect for him. Thanks for your time, Barrington!   Physician Assistant Stats:*Physician Assistants practice medicine on teams with physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine.  2017 Median Pay: $104,860 per year ($50.41 per hour) Educational Degree: Masters DegreeNumber of US jobs in 2016:106,20010 Year Job Outlook: 37% growth, much faster then avg.*Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physician Assistants, (visited August 5, 2018).   Physician and Surgeon Stats:**Physicians and surgeons diagnose and treat injuries and illnesses. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancers; and deformities, such as cleft palates. They work in all fields of medicine. 2017 Median Pay: Greater then $208,000 per year ($100 per hour) ***Educational Degree: Doctoral DegreeNumber of US jobs in 2016: 713,80010 Year Job Outlook: 13% growth, faster then avg.**Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physicians and Surgeons, on the Internet at https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm (visited August 26, 2018). ***Other publications list Orthopedic and Cardiac Surgeons as making around $500k/yr   Terms Covered in Episode Cradle to Grave – Caring for patients from Neonatal to Geriatric population. OB/GYN (Obstetrics/Gynecology) – Medical field that deals with pregnancy, labor, post partum care, and women's health specialties. MA (Medical Assistant) – A health professional that works along side a medical team in an inpatient or outpatient setting. EKG (Electrocardiogram) – Graph representing the electrical conduction of the heart to determine cardiac disease or injury. Phlebotomy – Drawing blood from patients in an outpatient or inpatient setting. CASPA LECOM (Lake Erie College of Osteopathic Medicine) MCAT (Medical College Admission Test) - Standardized examination for prospective medical students Academic Index – Tool used by some colleges to summarize the academic performance of students AACOM (American Association of Colleges of Osteopathic Medicine) Manipulation – Applying pressure to a person's spine or other parts of their body to adjust and correct alignment to reduce pain and improve function Cervical Strain – Strain of the neck Muscle Relaxer – Prescription medications used to relax muscles during acute phase of healing NSAIDS (Nonsteroidal Anti-Inflammatory Drugs) – Motrin/Advil (Ibuprofen), Aspirin, Aleve (Naproxen) used to treat acute and chronic pain and inflammation injury and disease related Muscle Spindles – Stretch receptors within the body of a muscle that primarily detects length of the muscle. It has both sensory and motor components. Appendicitis – Infection and inflammation of the appendix requiring surgical intervention Visceral vs Somatic Pain – Visceral neurons transmit information from the organs and somatic pain comes from the skin or skeletal muscles Dermatome – Area of skin that is mainly supplied by a single spinal nerve Cholecystectomy – Surgical removal of the gallbladder COPD (Chronic Obstructive Pulmonary Disease) – Chronic inflammatory lung disease that causes shortness of breath among other pulmonary symptoms further divided into Chronic Bronchitis or Emphysema Pre/Post Op – The phase just prior to or after surgery for a patient Atelectasis – Complete or partial collapse of lung space, occurs when tiny air sacs called Alveoli become deflated Lymphatic System – Network of vessels in which lymph drains from tissues into the blood Lymphedema – Swelling in an extremity caused by lymphatic system blockage Tension Headache – Headache triggered by physical and/or emotional stress Fascia – Thin sheath of fibrous tissue over a muscle or organ Myofascial Release – Therapy used to treat pain and immobility by relaxing contracted muscles Muscle Energy – Therapy using gentle muscle contractions to relax and lengthen muscles to reduce pain and improve function Primary Care – Day to day healthcare given by a provider including health promotion, disease prevention, health maintenance, counseling, diagnosis and treatment of acute and chronic illnesses, and patient education HVLA (High-Velocity Low-Amplitude) – Chiropractic thrust used to adjust patients Sacrum – Triangular bone in the lower back inferior to the lumbar spine between the hip bones of the pelvis.   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.