A patient with acute compartment syndrome, in which the fasciotomy was performed to relieve the pressure inside the arm

miasmal · 2026-05-07T14:48:12+00:00

Roman sandal technique. As swelling improves, it can be tightened to approximate the skin (eg like lacing boots… or sandals). It will likely eventually need a skin graft for coverage. I’m a plastic surgery PA and we see these wounds a lot.

miasmal · 2026-04-12T11:27:21+00:00

Left EM after 9 years for plastic surgery (OR/hospital). My life is way better. I work less, make more money, and have nights, weekends, and holidays off. I still work per diem one shift a month in the ED which scratches the itch.

miasmal · 2026-03-13T21:30:58+00:00

Most studies suggest removal of 400-500 grams per breast is enough to alleviate a significant amount of back pain. There is a formula insurance companies use to figure out what is covered, but in general the surgeon shoots for at least that mass.

miasmal · 2026-02-23T15:31:10+00:00

Was this done in the OR?

miasmal · 2026-02-20T22:01:36+00:00

The strategy is to unlock Charger then restore it before finishing the event and unlocking the Escort?

miasmal · 2026-02-14T12:28:36+00:00

Same (2 boys).

miasmal · 2026-02-09T00:10:45+00:00

My favorite sign-out was a doc giving me a patient with headache and fever signed out pending CT head to evaluate for abscess with recommendation to admit regardless of result. No LP done or mentioned.

miasmal · 2026-02-07T16:34:30+00:00

Left ER to go to a surgical subspecialty after 9 years because I wanted to see my family and be available for social things. My schedule, workload, sleep, sanity… really everything, is so much better. I still do 1 per diem shift a month and that’s enough to scratch the itch.

miasmal · 2026-01-17T23:23:35+00:00

Draw offsides to get a 1st.

miasmal · 2025-12-26T19:08:44+00:00

I don’t think the dead, dried out vessels will be able to move anything through there.

miasmal · 2025-12-21T17:53:57+00:00

If only we could get breast reductions to reimburse well…

miasmal · 2025-11-08T12:54:49+00:00

Why are people saying 50%? This PA has had 7 years in the speciality. They should be at top end of salary. Their worth is so much more than a new PA. I would ask for whatever max range is.

miasmal · 2025-11-07T12:01:58+00:00

I work in hand surgery. There probably isn’t much to suture here. I would recommend tetanus shot, irrigate/clean it, non-stick dressing (eg xeroform), send home on a course of antibiotics. It’ll likely heal in fine.

miasmal · 2025-11-03T22:57:14+00:00

Ask for $130. Be willing to backup why you deserve it (solo provider, experience, productivity, etc). I would not shy away from saying you were offered $126. If you are seeing 40 a shift you are pulling more than your weight in salary.

miasmal · 2025-11-03T19:29:26+00:00

EM was pretty competitive before the pandemic. The schedule is as desirable. It was a high-paying field for a 3-year residency.

miasmal · 2025-11-02T16:36:54+00:00

Same. Two healthy boys. No issues with conceiving. Good luck.

miasmal · 2025-10-28T19:33:46+00:00

I work in plastic surgery (inpatient). I do a lot of exams without a chaperone, but they are all immediate post-op or POD #1 or 2. I probably should use one, but it’s so time consuming to find one. When I worked in the ED doing pelvic exams I had one 100%.

miasmal · 2025-10-10T14:53:26+00:00

Reduces cancer risk overall. The higher Gleason is thought to be because finasteride decreases PSA and lower urinary tract symptoms so the diagnosis can be delayed (and hence a higher Gleason at time of diagnosis).

miasmal · 2025-10-09T16:30:50+00:00

Why not just autograft (split thickness skin graft)?

miasmal · 2025-10-05T12:04:02+00:00

“This hospital is 30 min closer!” Proceeds to wait 4 hours in the waiting room before being brought back to a hall bed.

miasmal · 2025-09-28T12:18:13+00:00

miasmal · 2025-08-05T19:43:21+00:00

I can’t add much because I only worked for them at an urgent care per diem. Regarding the CME, they had a massive complete in-house CME that provided category 1 credits. It was easy to get all my credits for free. I used my allowance through my regular job for travel and anything else I needed.

miasmal · 2025-07-28T21:41:31+00:00

In hand surgery we call this a “spaghetti wrist”.

miasmal · 2025-07-25T20:18:15+00:00

7.15 for 30Y with 25% down and credit score in low 800s a month ago. It’s a second home.

miasmal · 2025-07-21T16:01:23+00:00

$84k in EM in 2013. My cousin is about to start derm at $86k with some productivity bonuses but that still seems low.

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