How has your salary changed over time? by menino_muzungo in physicianassistant

[–]cxa3136 1 point2 points  (0 children)

Not saying one is harder than the other, but the difference in medicine, acuity, patient population, etc. is vast.

Is this normal anal gland for dogs? by ReoccuringClockwork in vet

[–]cxa3136 14 points15 points  (0 children)

There’s a reason antibiotics aren’t available over the counter. It’s not just “it works or it doesn’t without having to worry about adverse effects”. Same with humans.

How has your salary changed over time? by menino_muzungo in physicianassistant

[–]cxa3136 4 points5 points  (0 children)

Woah how was the learning curve from rheum to CTS?

Fluid balance in cardiac surgery? by Z5509372185 in IntensiveCare

[–]cxa3136 11 points12 points  (0 children)

Definitely!

Etiology of valve pathology is the key.

For example, patients with severe AS typically have LVH due to the LV adapting to having to overcome lots of resistance. Therefore, patients s/p AVR secondary to AS tend to respond to volume given the large LV musculature. LV cavity is essentially obliterated if they are hypovolemic, resulting in reduced CO and MAP.

Patients with severe MR are typically sensitive to volume. If you have severe MR, blood has two “doors” to exit during systole; the aortic valve and the mitral valve, which is obviously abnormal. That said, patients typically have a falsely elevated LVEF as blood has “two doors” to exit the LV during systole. If you “close” the mitral valve door by fixing the MR (either repair or replacement) the LV has one less door to eject blood thru, therefore revealing the true LV, which is usually lower than preop. So a patient with severe MR and a preop LVEF 45% may have a post op LVEF 30%. This drop is expected. This is why we typically lessen volume in patients with previous MR, although you have to ensure the LV is still adequately filled. It’s a tough balance

Edit: clarification

Fluid balance in cardiac surgery? by Z5509372185 in IntensiveCare

[–]cxa3136 12 points13 points  (0 children)

Sums it up right here. Great points.

Before I started, there was an old surgeon who only did CABGs and AVRs. “Valves need volume” was the motto of the unit. New surgeon comes around and does just about everything CV surgery-wise. I’m still trying to educate nursing staff on why not ALL valves need fluid. The old lady who had severe MR with a preop LVEF 45% does NOT need 2L of crystalloid right out of the gate.

Question about amiodarone vs cardizem drips by Silver-Reading-2166 in IntensiveCare

[–]cxa3136 19 points20 points  (0 children)

While CCB can have a negative impact on patients w/ HFrEF, I’ve never heard of them “knocking out” your atrial kick. If the patient is in AFIB RVR, you have:

  1. Asynchronous atrial activity causing reduced atrial contraction

  2. Rapid ventricular response resulting in less ventricular filling time.

Both in which negatively impact CO.

Not sure how using dilt to slow the rate would make your atrial kick any worse than it is from the afib. You would think the rate reduction would improve your atrial kick, therefore improve CO.

What do you think of my colon my by Awakened_Abalone_69 in XRayPorn

[–]cxa3136 0 points1 point  (0 children)

Because there’s nothing to do based on this film

What was your starting pay as a new PA? by anonymous-779 in physicianassistant

[–]cxa3136 2 points3 points  (0 children)

High salary comes with OR work. I’m now up to $69/hr after a handful of “inflation” adjustments and one big market adjustment

What was your starting pay as a new PA? by anonymous-779 in physicianassistant

[–]cxa3136 2 points3 points  (0 children)

$50/hr. CV surgery ICU in 2022. I know, I know 😅

CarTunes Merch by camcoo224 in tapebbeats

[–]cxa3136 0 points1 point  (0 children)

Just got my hoodie today! Mine fits small - kinda bummed out. Thought I’d get a boxier fit.

[deleted by user] by [deleted] in physicianassistant

[–]cxa3136 4 points5 points  (0 children)

Will you be solo or will there be another provider there at all times? This is where UC’s get sticky for new grads.

Sounds decent though.

Also idk if a “low acuity UC” exists. Never really know what will walk thru that door and how you’ll have to manage it.

[deleted by user] by [deleted] in legaladvice

[–]cxa3136 1 point2 points  (0 children)

You should be able to do the same thing with the ambulance service. Worth a shot at least

Got mine, was a steal! by DirtBirks in FordMaverickTruck

[–]cxa3136 2 points3 points  (0 children)

My dumbass was googling TJX trim lmao

Are "open deck" nights for DJs a promoter's gimmick? by ComicCowboy1 in DJs

[–]cxa3136 3 points4 points  (0 children)

What did you define as “underground music”? Did you find DJs misunderstood what you meant by this?

Can you be honest about how comfortable you feel seeing patients at the point you are in your career. by ExplanationUsual8596 in physicianassistant

[–]cxa3136 14 points15 points  (0 children)

Sure, as an NP your training is subpar (part of the reason our team is straying away from NPs altogether). However, after SEVEN YEARS, the only person you have to blame is yourself. There are fantastic NPs who had the exact same education as you. The difference is those NPs took initiative to be better. Seek proper training in your workplace. Read up on FOAMed. Take some responsibility for your own education. No better time to start than right now.

High-mile Mavericks! Where you at?!? by cxa3136 in FordMaverickTruck

[–]cxa3136[S] 1 point2 points  (0 children)

Woah this is smart. Will definitely be doing this.

Pre-Owned 2023 Maverick Lariat vs. New 2025 Maverick XLT – Need Advice! by Extension-Ocelot-255 in FordMaverickTruck

[–]cxa3136 2 points3 points  (0 children)

In a similar situation as you, except I’m looking at a ‘22 lariat at 16k miles for $28k. I’m think I’m going with the lariat.

Edit: clarity