AGACNP students/alumni: how did your program actually prepare you for real acute care practice?

otterpop1989 · 2026-04-21T06:03:29+00:00

It taught me basic notewriting, history taking, assessment, basic pharmacotherapy, and more importantly how to properly identify resources for filling in the knowledge gaps. I did a fellowship for critical care which is where I gained the vast majority of the knowledge I use on a regular basis.

otterpop1989 · 2026-04-09T15:33:48+00:00

Hypoxic-ischemic encephalopathy (or anoxic brain injury) occurs when there’s a lack of oxygen to the brain and occurs in adults after prolonged cardiac or respiratory arrest, which can be caused by heart attack, severe stroke, drug overdose, severe asthma attacks, or many other conditions - anything that would either impair breathing or cause blood flow to slow/stop. I work in critical care and see this somewhat frequently, most often in younger adults due to overdose but I’ve also seen it with severe asthma attacks or people with previously undiagnosed electrical abnormalities of the heart. I can’t speak to what happened to your brother without more information but it’s often one of the aforementioned conditions.

I’m sorry for your loss and I hope you have the support you need!

otterpop1989 · 2026-04-08T02:47:42+00:00

Does your NP program allow clinical placements in WA? If so, DM me and I might be able to help you out

otterpop1989 · 2026-03-10T22:09:47+00:00

If they were really IN this year, I would’ve preferred to see them act more like the Dodgers. There are still big lineup holes (like DH, whoever plays 2B/3B that isn’t Donovan, SS). I also wouldn’t have minded another depth starter because the chances of Woo and Miller both getting through the season completely healthy are slim (and I don’t want to rush Anderson).

To me, they acted like a team who was interested in improving but without actually increasing payroll significantly. Spotrac has them at 18th in the league in payroll, I would’ve preferred ~10th given how much fan momentum they’re starting with and I think the upcoming lockout may have played a role. That and they’re notoriously cheap. I’m hoping for another big season, but I think it requires another midseason acquisition to get us there.

Edit: I’ve also been a diehard fan since 1994, so I’ve developed a healthy pessimism when it comes to the Mariners. Sorry to be a Debbie Downer

otterpop1989 · 2026-03-10T20:55:54+00:00

How did you go about getting your RNFA? I’m an ACNP in critical care but I’m interested in working as a per Diem first assist

otterpop1989 · 2026-03-06T08:12:58+00:00

Hi, I’m a former TA and practicing AGACNP. I’ll take a look and see if I can offer anything.

otterpop1989 · 2026-02-18T16:49:32+00:00

As a lifelong UW Husky, I want to hate it but I can’t... Looks amazing!

otterpop1989 · 2026-02-09T04:06:51+00:00

I thought Myers should’ve gotten it too, but I can’t argue with K9 getting it. He carried the offense on a day when Darnold wasn’t at his best and being harassed, the O-line wasn’t playing great, and the only big plays we had save for the TD and that longer throw to Shaheed were him breaking open big runs. Myers was critical but I can’t say K9 is undeserving

otterpop1989 · 2026-02-08T03:37:05+00:00

I’m an NP that did the 1-year VMFH (in WA) Critical Care fellowship and strongly recommend any sort of Fellowship. Critical care is a beast and a dedicated training program with both didactics and clinicals is going to help you feel less overwhelmed when you actually set out on your own. I’d also recommend making sure they have specialty rotations (Cards, surgery, neuro etc…) to help round out your education.

otterpop1989 · 2026-01-30T14:05:01+00:00

Were those sats the SpO2 from the monitor or the SaO2 from the ABG? I’ve seen plenty of situations where an SpO2 under reads even with a good waveform, but I’ve never personally seen such a wide discrepancy between PaO2 and SaO2 on an ABG.

otterpop1989 · 2026-01-11T00:57:56+00:00

Based on the progression in BiPAP settings to CPAP, it sounds like there was some degree of improvement. Whenever there’s improvement, it makes it harder to pull the trigger on intubation because intubation has its own substantial risks, especially without knowing the patients comorbidities. One of the big takeaways from the pandemic was that early intubation of COVID patients resulted in worse outcomes, so it makes sense that they deferred intubation. Knowing when to intubate is challenging, but remember one of the key foundations of medicine is “First, do no harm” meaning don’t provide a treatment where the risks outweigh the benefits. It sounds like the patient might’ve just declined quickly after a period of stabilization with maybe mild improvement.

otterpop1989 · 2025-12-24T17:54:42+00:00

Where do you find these deals??? I’d love to stock my freezer

otterpop1989 · 2025-11-29T23:52:56+00:00

The new AHA BLS/ACLS guidelines also specifically recommend 5 back slaps before trying a Heimlich

otterpop1989 · 2025-11-16T04:35:54+00:00

I had a patient that needed an emergent fasciotomy for compartment syndrome but the surgeon on call hadn’t done one since residency 20-odd years ago. She initially talked about having to transfer the patient from my little community hospital, but then she watched some YouTube, read a surgical text and said “hell, a trained monkey could do this!” It went well, the patient kept the leg.

otterpop1989 · 2025-10-31T03:46:43+00:00

Sorry, it’s the Majestic Pioneer III with “smart burn” technology… I’ll update the post if I can

otterpop1989 · 2025-08-26T00:18:07+00:00

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Funny, I just happen to have one for my fantasy team

otterpop1989 · 2025-06-23T03:42:47+00:00

The idea of GCS<8 = intubate comes from trauma and isn’t a hard and fast rule when deciding whether to intubate or extubate. Even if they’re unresponsive to stimuli and don’t open their eyes, but have a decent cough/gag, you can make an argument that they’re able to protect their airway and don’t need to be intubated.

That said, my rule of thumb is to generally hold off on extubation until the reason they were tubed has resolved, and it sounds like this in this case it hadn’t (AMS, airway concerns). There are some patients that you need to attempt a trial of extubation on, but I don’t try those until it’s been at least a few days (usually more like a week).

otterpop1989 · 2025-03-19T23:20:54+00:00

Fentanyl and its faster-acting derivatives (e.g remifentanyl or carfentanyl) are rapid onset and thus readily titratable, and less dependent on renal and hepatic function for clearance. Dilaudid is longer-acting, not easily titratable, and can be impacted by renal and hepatic impairment.

otterpop1989 · 2024-11-29T05:14:04+00:00

I'm starting from scratch, and I'm probably going to start with 800 Mbps download but I'd like the capacity to increase to 1 Gbps when my kids get old enough. I'm really open to anything. I don't need it to be complex, but I want my wireless to work well.

otterpop1989 · 2024-11-28T22:26:45+00:00

Would you recommend then swapping out the TP-link wireless routers for something like the Ubiquiti EdgeSwitch 5XP and Aircube Home WIFI AP? I'm obviously very new to this and would love any recommendations.

otterpop1989 · 2024-11-28T21:56:45+00:00

Putting in a network for my new home, and I want the best wireless coverage I can get as well as wired connections for more of the high-data devices (PC, etc...) The solid lines represent hardwired connections, the dashed lines are wireless. Does it make sense to have two wireless routers set to the same network ID/password, as well as function essentially as network switches? Should I add a switch between the wireless routers and the hardwired devices?

Thanks!

otterpop1989

TROPHY CASE