Can you put virtual shadowing hours on CASPA?

Yes. But schools weigh it differently, so don't assume every program will count it the same way. Check with the ones on your list.

This episode is a virtual shadowing session with Jourdyn, an emergency medicine PA and one of our coaches. She walks through real cases from the ER and talks through how she actually thinks - what she's ruling out, what she's asking, how she decides what happens next.

Emergency medicine is fast and loud and nothing like TV. Jourdyn is honest about the pace, the teamwork, and how much of the job is communication rather than procedures. If you've only ever imagined yourself in the ER, this will either confirm it or save you some time.

What we cover:

• Whether virtual shadowing counts on your CASPA application
• Real ER cases and how she worked through them
• What a full patient evaluation looks like in emergency medicine
• Communication and teamwork when everything's moving fast
• What surprises people most about the ER
• How to get shadowing hours when nobody will let you in the building

Resources:

Free Resume Download: https://www.thepaplatform.com/services/free-resume-download

Free PA School Application Timeline: https://www.thepaplatform.com/services/free-application-timeline

Pre-PA Counseling: https://www.thepaplatform.com/services/pre-pa-counseling

Pre-PA Academy: https://prepaclub.thepaplatform.com/landing/academy

Mentioned in this episode:

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Welcome to the Prepa Club Podcast.

Today you're going to hear a recording of a recent virtual shadowing we did with Jordan from the PA Life on Instagram.

She is one of our amazing pre PA coaches and she is an emergency medicine pa.

I hope you enjoy hearing all about her job.

She has some case studies for you and a lot of great insights.

Hey guys, it is cast of season.

How is everyone?

I know it can be a little you're in the savannah away from.

Let's get to it.

Applications opening.

Yikes.

It's okay.

You will be fine.

It might be a little stressful for these next few months, but the good news is we are here to help you through it.

I've been answering lots of questions on Instagram.

My Instagram is the PA platform if you don't follow along there.

And we have been doing lots of webinars.

We have some coming up in May.

We did all of our April ones already in preparation for for CASPA opening.

And we will be just going through some general prepa counseling, looking at some applications, looking for strengths, weaknesses and evaluating some different types of applicants so that you can get a feel for what you should be doing when you are evaluating yourself.

And then later in this month we will have interview webinars.

We're gonna go ahead and start some interview prep and we'll have those throughout the summer.

So each of our webinars are $5.

Be on the lookout for links to sign up for that if you're not on our newsletter or email list.

If you go to the PA platform.com newsletter you can sign up for that and you won't miss out on anything.

I really liked this kind of smaller model.

I know we've done conferences in the past, but it was hard to really address everyone's questions and so I feel like with this smaller version we're able to do that a little bit better.

All right, so let's get into hearing From Jordan.

She is awesome.

I have been working with Jordan for many years now.

She is one of our essay editors.

She does prepay counseling.

She does mock interviews, and she's just so sweet.

So you're going to love hearing from her.

She is so positive and joyful and I always love when I get to sit down and talk with her.

Fun fact, we've never met in person, like many of my PA colleagues that I'm friends with.

So maybe one day.

But here we'll jump into our episode with Jordan and if you have any questions, feel free to reach out.

I will try to point you in the right direction best I can in this busy season.

Guys, I'm Savannah.

I am a dermatology pa. We are not talking about what I do tonight, but we were talking about what Jordan does.

Jordan is one of our pre PA coaches and she is an erpa and she's going to tell you all about that.

She has a little presentation prepared.

We're going to hear all about her job.

So a lot of the questions are, can we get credit for this?

Can we put on caspa?

That kind of stuff.

So just to go over virtual shine very briefly, in general, you can put whatever you want on caspa and so, yes, you can put it on caspa.

That being said, we don't have any way to verify or validate who's here those hours or anything like that.

And it would be impossible for there's 200 people here for us to do that as well.

So we cannot provide anything and won't provide anything to the schools to verify those hours.

But if you have a different virtual shadowing entry on your application, you want to include it.

You can some schools or accept virtual shadowing, some don't.

And just take that into consideration when you're planning this out too.

Jordan, I was telling them how you are one of our coaches and you're awesome.

Like counseling and essays and interviews and everything.

Awesome.

Well, thanks for having me.

I'm Jordan.

As my little thing says, I'm an erpa.

So.

So a little bit about me.

I actually.

Let's put on my little PowerPoint here.

A little bit about me.

So I have been in the emergency room for the last going on four years this upcoming summer, which time flies when you're having fun.

I initially graduated from UW Madison.

And then your presentation, are you sharing?

I tell you what, if you click.

Start at the bottom.

Try it now.

There you go.

You're good.

Okay, thank you.

Yeah.

I definitely went in pretty open minded just knowing that I had worked as a CNA beforehand, so I did not have like crazy extensive experience in a specific specialty or department.

I had worked in a nursing home, so I was open book when it came to specialty.

After graduation, I actually went into my ER rotation terrified.

I thought it was going to be the longest eight weeks of my life.

I was like, this is gonna be a lot.

And it ended up being my favorite eight weeks of the entirety of the year.

I went in and it was so much fun every single day.

I really enjoyed the variety of the day.

I enjoyed the people I worked with.

And then at the end of my eight week rotation, I was offered a job at the department and I've been there ever since.

I've been doing a lot of stuff with the PA platform.

So I started off doing mock interviews and I still do that.

I really enjoy those.

But I've also added on a mentoring, which is also really fun.

So I get it.

I was not a pre PA that long ago and it is.

It's a tough process to go through.

So I feel for all you guys and you guys are all rock stars.

And besides that too, I also have some fun on Instagram and TikTok.

I make a lot of corny videos.

So that's a little bit about me.

And I guess on a personal level, I also.

I am married to an interventional radiology resident and I have a one and a half year old daughter.

So I've now taken on wife duties and mom duties on the side, which is also a whole new realm as far as like my pre PA background.

So I graduated from Edgewood College, which is this tiny little private college in Madison, Wisconsin with a biology major and an ethnic studies minor.

And as far as my stats go, and that's.

I'm sorry guys, that's a rough estimate.

It's.

I could not access my CASPA application or my.

I couldn't remember my GRE scores either.

But that was a rough breakdown of what I was as a pre PA.

I had about 15, 200 hours as a CNA and I had started working.

I think it was my freshman year of college and I just worked during summer breaks and if I have a free weekend, I jump in and do that that was my GPA shadowing, just like it is right now.

It was a little scarce to get the shadowing hours back then too.

I was very lucky.

My dad's best friend was a pa, so I was able to get a couple shadowing hours in there and I did have a lot of volunteering.

That was something I had a lot of fun with and I, most of my hours came from working in a food bank.

Actually it wasn't anything medically, so as far as jumping back to the emergency room side of things.

So typically in days I'm more of a PM shift worker.

So I go to work at about 4pm sometimes.

I do a ton of our shifts.

I work from 2pm to midnight or 4pm until midnight.

They just in the last, I think since the pandemic started, we also started a 7pm to 2am shift and that's about as close as I get to overnights.

I in our department, nurse practitioners and PAs do not work overnights.

They just haven't found a need for it and I'm hoping it stays that way.

I don't really like working overnights.

I like my sleep a lot and over the weekends too.

So there's about, let's see, in my department, I think I just calculated this the other day.

There's I think 10 PAs and one nurse practitioner and about 12 doctors I work with.

So we have a pretty good group.

We've actually grown quite a bit since I started.

We've taken on like three or four new PAs and I think five new doctors since I started working.

So we're definitely growing and we're expanding our emergency room this year, which is exciting for us.

We're an 18 bed ER, but during the pandemic we've gotten pretty creative.

We actually opened up our, one of our emergency room bays.

We made 10 extra rooms in there.

So it's a little exciting.

So I definitely get my steps and getting jaunting out to, to the emergency room bay in order to see patients.

That's a little bit about my day in the emergency room as far as seeing patients.

So I know a pretty common thing across the board is I think people when they're in the emergency room as a PA or nurse practitioner worry about the acuity of patients.

And so for me, I actually get to see a variety of patients.

I see anywhere from like lower level trauma patients to walk in clinic visits or urgent care visits.

So I'm not really tiered into a fast track.

As an emergency room pa, I've been in on Codes I see strokes, heart attacks, like some pretty high acuity stuff.

The only ones I'm really not involved in are like our trauma reds or highest traumas just because emergency or emergency room physician as well as the trauma surgeon are typically involved in those.

So there's not there just be extra bodies in the room that are not necessarily needed.

So I'm not.

Unless they really need me, I'm not in on those.

And on a good day I probably see 15 to 20 patients roughly in that ballpark.

But probably the most I've seen is that we're like 35 to 40 patients in a shift, which can be a lot to get a lot of charts to do.

After that there's no.

That's the worst part of the job, I will say first and foremost, but that's typically my day.

And then as far as things go, I did come up with a couple case studies just to talk through different possible patient presentations that you might see in the emergency room.

So I try to pick some kind of classic ones that we see.

And I also try to make it a little tiered to Wisconsin, which is where I practice is in Wisconsin.

So this first case I have, a 33 year old female, presents to the emergency room with onset of nausea, vomiting and upper abdominal pain.

The discomfort started after eating biscuits and gravy at breakfast.

She has tried Tums and ibuprofen without any improvement.

So the question would be, what's our next steps with this patient?

You're looking at this lady sitting on your emergency room cot.

Where's your brain go to next?

We'll go to the next page here first, but I'd start probably in my mind when I walk into a patient's.

When I'm about to walk into a patient's room, typically what I will do is on my.

We have EPIC at our facility and so I'm able to sign up for a patient before I walk into the room and I am able to see their past medical history, review their vitals if they've had similar presentations where they've been in the emergency room or maybe at a walk in clinic before this prior imaging is a good thing I typically review especially if they come in with a certain complaint before I even walk into this patient room.

I know their vitals, their chief complaint.

Usually our triage nurses are fantastic at giving like a little synapse of like why they're there.

So it's all good things to walk in knowing before you're even laying eyes on the patient.

Okay, we've got Some good ideas here.

We have people saying ultrasound of gallbladder, CT abdomen, pregnancy test.

Those are ultrasound?

Yeah, Urinalysis, abdominal X ray, ua.

Okay.

Those are all.

I would say that is all really great ideas there.

So my next step with her, as I'm going here and hearing her history, taking her history, the next thing I do is a physical exam.

And then, like you guys are saying, that would be the next step there, is getting on to how we're going to evaluate this.

So I'm going in and laying hands on this patient.

Like I had said before, I know their vitals, walking in the room.

So for her, she's got a temperature of 100.4 degrees Fahrenheit.

She's breathing normally.

She's got a blood pressure 145 over 82, a heart rate of 104, and she's stating normally at room air on 100%.

So when I'm pushing on her belly and I.

You can see that picture there.

And these are all compliments of.

She's got most of pain in her upper quadrants.

You're pushing on her right upper quadrant.

She's got a lot of tenderness there.

And you look at this nice diagram here.

And you're looking, you see the liver, the gallbladder.

Biliary disease is common in that area.

But you can't say abdominal dams are greats, but there's a lot of contents in that area.

So you also want to keep in mind the pancreas is in close proximity.

The pancreas is there, too.

Those are all good things to keep in your mind.

Other things to note when you're pushing on her back or on her flank, you don't have a lot of tenderness there.

So you might think, okay, less likely that this is maybe a gu thing where it's a kidney stone or a urinary tract infection.

It's not off the table, but my mind's going somewhere else now, and no pain below, and she's looking dry.

So, as you guys very smartly said, the next step would be getting some labs and imaging.

So, typically, in our emergency room is nice.

We have a lot of protocols in place.

So even before I go in and put in my specific orders, a lot of the triage nurse will put in just like, settled labs.

We have one for, like, weakness, abdominal pain, chest pain.

So for her being a female of childbearing age, like you guys had mentioned, most definitely you'd want to get a pregnancy test.

That's a really good thing to know.

And down the way, if you are thinking that it's something that might need a surgical intervention.

It's a really good thing to have because your surgeon's going to be real angry if you didn't run that and it comes back positive.

So cdc, so that's looking to see like it's got your white blood cells on there, your red blood cells.

So that's going to tip you off.

If there's infection going on, anemia going on lipase, which is associated with the pancreas, you'll have a quite elevated pancreas or, sorry, lipase.

If you have got pancreatitis or if you've got like a gallbladder disease where you've got choleducolithiasis, which is basically a stone lodged in the wrong place, a ua.

So like I said, it's didn't have flank pain, but still good to rule out that there's any urinary issues there and the pregnancy test.

So with a patient like this that I'm walking into, most certainly you can start with an abdominal X ray.

That's not a bad thought at all.

But if you're thinking it's more going to be like gallbladder disease or along that lines, you want to get something a little bit more specific that's going to look at the tissue and penetrate it.

So it's going to be the right upper quadrant.

Ultrasound is typically what I order.

And that's what you can see the picture picture of here.

And this is a picture like if you're going to get it and she's got cholecystitis, which is inflammation and infection of that gallbladder, this is what you're going to see here is that thickened gallbladder wall, the per cystic fluid.

If for whatever reason, sometimes with patients that have higher BMIs, ultrasound is not as effective.

And so you can get a CT abnormal pelvis, which will.

It's not as specific, but certainly you will still get the information you need in order to talk to the surgeon.

And that would be the next step for this patient.

So if they're coming back, they're saying, hey, you've got acute cholecystitis.

Some of the big things I'd want to know walking back in the room, last time they ate or drank, because the surgeon's also going to want to know that if they're on blood thinners is another good one to think about because they can't go to surgery if they're actually on blood thinners.

That's not going to be pretty so acute cholecystitis is the answer here.

So basically what that means is there's anger.

Your gallbladder is angry, it's inflamed, it's infected, there's a stone, whether they had gallstones in there, gallbladder at one point and all of a sudden it's dislodged.

Now it's in the cystic duct.

Now it's angry.

So sometimes we'll admit patients and just put them on IV antibiotics.

But ultimately these patients do need to go to surgery and get their gallbladder out typically.

So that's the first case presentation questions you guys have about that one at all.

Someone said, what's Murphy's sign?

The Murphy sign.

So when you're pushing on that upper quadrant, if you push in and they've got, it's like almost like a rebound tenderness where you push out.

It's just an acute tenderness in that area that is associated right over the gallbladder.

And that's what we say.

It's not specific enough where we can push on and be like, oh boy, it's the gallbladder.

And we have to call the surgeon.

At that point they're going to want some more, they're going to want confirmation.

But a lot of times on your ultrasound you will see the ultrasound technician will have that either a positive Murphy sign or a negative Murphy sign.

But that's a great question.

Yeah, sorry, I should explain that a little bit better.

So that's typically like tenderness we associate over that gallbladder region.

Great question.

All right, so the next one, you've got a patient, a 56 year old male that is coming in with chest tightness and a fluttering in his chest.

Last night he went to go play pool at the bar with his friends and he felt awesome.

He was having the best night, but then woke up this morning and said something's not right.

So he's got chest tightness effusely across his chest.

It's not reading anywhere.

He just feels it right across his chest.

He's also feeling a little more short of breath this morning.

So what would be the next steps we think about with this patient?

And I guess some of the things too, I would consider just walking to this room and I'd like I said too, I'd have his vitals and I'd be looking at this guy and wondering if he's got a past cardiac history.

Does he have any risk factors for like a coronary disease, such as is he a smoker, does he have a higher history of hypertension, diabetes, hyperlipidemia.

So all these are risk factors going into, like, if we're worried about a heart attack, if he's got a strong family history of it, that's an.

A good thing to tip you off.

Another thing, too is if patients are having.

They might not come in and have this, like, chest pain off the wall.

They might have symptoms leading up to this point.

So maybe they're getting more tired walking to the mailbox or walking up a flight of stairs.

So those are all good things to think about when you're thinking about this case in this specific patient experience, I'd be like, okay, at the bar, potentially drinking last night.

Is there anything that.

That could have got him tipped off that's going to cause some symptom that he's coming in with today?

Seems like the people want an EKG and some blood work.

You're on the right track.

Exactly.

Let's get an ekg.

And so my techs are getting this EKG on this patient.

We have him, we're hooking up to telemetry so that we can see his heart rate on a real life basis.

And this is what I'm looking at here.

I'm looking at this lead and I'm like, that's not normal.

What are we looking at here?

So some things I look at when I'm looking at an ekg, what is the rate of the ekg?

What is the rhythm of the ekg?

And is there.

Are we seeing the typical qrs?

Are there P waves?

In this case, we are not seeing P waves.

So this guy is an atrial fibrillation or irregular rhythm.

So you can see a normal one up top here, and then the bottom one is afib.

So when you're looking at EKGs, so what I'm talking about, you probably can't see my cursor, can you?

Can't see my cursor.

Okay, so sorry.

I'm gonna try and explain this the best way I can without using my pointer, which I usually use.

So in the top one you can see.

Oh, there we go.

No, I think I can use it.

Maybe not.

So in the top one you can see that there's more.

If you click the whiteboard, you can write on it.

I've never really used that, but if you want to.

Or that option.

Let's see.

Wow.

I'm learning new things every day too, guys.

Let's see.

Whiteboard.

Oh, there we go.

Okay, can you see me now?

Let's see.

Let's get a color on here.

Let's do red for ekg.

Okay.

So up here you can see that there's these two bumps.

Sorry, I'm gonna be a bad writer here.

But there's two bumps there.

So one of them, the one that's the smaller one closer to the peak there, is called a P wave.

And so when I'm looking at EKGs, I can see there's P waves.

They're usually regular.

There's.

They're not missing from any of those spikes.

Those are the QRS complex.

But you can see below there are a lot of little bumpies here, and that is not normal.

So that's what typically there's a.

There's a lot of things that go into it, but that's typically the first thing that tips me off.

I'm not seeing P waves regularly.

This person's in atrial fibrillation.

And I didn't put vitals on this guy, but for this guy, you can assume he's coming into the emergency room.

He's tachycardic, so he's maybe running anywhere from 100 to 170 beats per minute, which is pretty fast.

And that's why he's feeling short of breath as well.

So with afib, you can have just regular old afib.

They're normal, they're rate controlled, but you can have.

What we get more worried about is when they're in this rapid ventricular response, meaning they're going to well above 100 beats per minute.

So there's a lot of literature going back and forth whether you want to rate or rhythm control.

Typically, what I was preached on throughout my training and now currently in the emergency room is rate control.

So in this case, with him being like potentially dehydrated from drinking last night, probably my first step would actually to be give him some IV fluids, see if we can get him hydrated up, and then see if that helps with his heart rate at all.

Potentially that could be enough to drop him below 100 and we're in a better spot.

However, if this patient is still cooking along at like 120 to 100 and you know he's going fast, then we start thinking about IV medications.

So we got Cartism, metoprolol, it's another one we commonly use.

Or if they're really unstable where they've all sudden dropping their blood pressure to like, I don't know.

I've seen patients running even like 60 over 40, and we're, we're worried about them.

They're getting sweaty, like they're unstable.

Then we start thinking about cardioversion.

So especially if they're unstable, that's our next step.

A lot of times we won't even mess around with medications.

We'll just consent them and we'll give them a cardioversion.

I got an example of that on the next page.

Another thing too, with patients, if they are, if they're in a certain window, like we have certain patients that will come in that know they're in an afib and they're like, I've been in afib between this, like, I went in at 8am this morning and they're seeing us at 10am, you know, that morning too.

And they've been on anticoagulation.

We will typically cardiovert them too, if they're symptomatic with that because they're on blood thinners.

And that's the next point here I make is the anticoagulation once they're stabilized.

So this is a new onset problem for a patient.

There's a couple of things we go through just to see if they're a candidate for or for anticoagulation.

We don't automatically always put every patient on there, but the thought with putting them on anticoagulation is about stroke risk.

So with afib, basically the top two chambers of the heart and the bottom two chambers of the heart are not beating correctly.

Like, typically, it's like a love dub.

But with afib, these two atriums are like.

So the blood's not pumping correct correctly, which can lead to clotting and can lead to stroke risk.

So that's the reason we think about anticoagulation.

If this is a young patient who doesn't have a high risk for stroke, sometimes we'll just let them fly without anticoagulation or we'll a lot of times consult cardiology to get their take on things.

So the next step, which is the fun thing, is cardioversion.

So I'll see if.

I don't know, Savannah, if we can pull this video up.

I guess I wasn't thinking about that when I was doing this.

It's a video of cardioversion.

So, yeah, let's try.

You may just have to screen share.

Let's see here.

But hey, I can put a video URL in.

Let's do that.

I don't know how that works, but.

Hey, give it a go.

Let's see.

Okay.

We don't have to watch the entire you, but just it's a cool video to see what cardioversion is about.

So typically, what that means it's kind of an emergency room dramas.

You hear the clear shock.

They've got these paddles to shock them.

It's not quite that.

We put stickers on them and we will charge it up to like, like 200 joules and then we'll shock them back into rhythm.

So typically what it's thought is the electrical pattern will help shock their heart electricity back into what it needs to be.

And I'll see if this will go.

And if not, that's okay to you guys consider just working.

But hey, let me see if I can screen share with it.

I'm gonna say if it doesn't work, that's okay too.

You guys can just look at it and send it out too.

Yeah.

Yep.

It's just.

It's a good example of cardioversion.

Just so you guys have an idea of what typically we do.

Oh, it says the video isn't available anymore.

Oh, weird.

It's.

I think it was like, literally it was the first thing I like, I googled cardioversion.

It was the first video that came up and it was a really good one.

So just google cardioversion.

It's a cool thing.

It's a cool thing to do.

So typically with cardioversion, I will run that with my attending physician where we're both in the room.

But it's.

It's a procedure where we have respiratory therapy involved.

So we'll have please come down.

We'll have them monitor their breathing because we do sedate them.

We don't shock them while they're awake because that would be awful.

So we do give them a little bit of sedative medication.

They don't remember anything.

We've got nursing staff in the room.

We'll have, like I said, my attendings in the room with me and then we'll run the cardioversion, which is nice.

Okay.

Case three, I had to throw a dermot in because I was working with Savannah tonight.

And this is like classic Wisconsin.

If you guys are from Wisconsin or anywhere up in the Northwoods, like, like this is something you'll see every single summer, every single spring.

So 18 year old male presents with a rash that has developed over the last week.

He declines that there's been any new exposures, shampoos, lotions, or laundry detergent.

His only new activity over the past week is that he went camping with his friends.

And also afterwards he noted this rash start.

He's what the heck is up?

So I'm looking at this thing and you're hearing that history so what are some thoughts with this one as far as what could be the.

What could be causing this rash?

And I will say in the emergency room, like, rashes are like our worst enemy.

Yeah.

Is that an emergency?

No.

Yeah.

So lots of possible Lyme or something to do with ticks or a bite.

Yes.

Is coming through.

That is exactly it.

Yes.

So how would you describe this rash?

And Savannah's probably going to laugh at my descriptive words because I am most certainly not in dermatology and not even close.

But this is how in the emergency room we would.

We would categorize this rash.

So red erythematous is our fancy medical term for red.

It's dry, it's flat, meaning we're not seeing a lot of bumps or pustules like you would like acne or like a weeping wound.

It's target centered, as you can see in this picture, where it's got that red center.

It's got some clearing, and then it's got the round ring around it.

So target shaped.

So in this patient, typically they're just like.

It's there.

It's not really bugging them by any means.

It's not.

Not itchy.

It's not painful.

It's just what's up with this?

And it's.

Yes.

Lyme disease.

So this is caused by this little bugger here.

And actually, in our emergency room, we have competitions to see who can pull more ticks off people, because people do come into the emergency room if they can't dislodge a tick.

Like, we very common for that.

They come in all day.

Yeah, yeah.

Very commonly.

They kind of see me for it too.

Or what happens here actually is I'm just doing skin checks and then they happen to have one on them, and I'm like, oh, by the way, there's a tick on you.

Can I get that, please?

Yeah, yeah.

So this is a deer tick.

So Lyme is not carried by every single tick in the world.

It is carried by this one or the black.

I think it's like the black legged tick is the other name for this little guy.

And these things are so small.

You'd be amazed by how small these guys are.

Like, if you don't look closely, like, you're gonna miss it.

It's just a tiny little thing.

That's why people think they're a mole.

They think they're like, yes.

And actually, so I.

That happens to me all the time too, where they're coming in for a random complaint and all of a sudden, oh, this guy Yes, I actually should have.

I had a, it was a wood tick, so it's a bigger version of a tick.

But I had one that came in and it was the biggest thing I've ever seen in my life.

It was awful.

I like.

Oh, I'm not a big fan of tick.

All right, so Lyme disease, so it is caused and I am not great at pronunciation, I probably should have thought about this before I put this specific slide in here, but Boreala burger burgado fury, I believe is how you pronounce that very fancy word, which is the bacteria that causes lens disease, so transmitted through these deer ticks.

So typically in the acute setting you will see this rash, this target rash or erythema migrans is the fancy medical term for this one.

And typically they'll come in with this rash which like I said, it doesn't really hurt them.

It's not painful, it's not itchy, but they might have a fever and they might feel really run down or tired.

However, if you don't catch limes in the early process, you can get to other problems.

It can spread, it can get to your joints causing achy joints or arthrology, it can get to the heart.

So that's a common thing.

Actually when people come in with a third with a heart block in the emergency room, we always have to consider do they have Lyme's disease?

If they've been in a tick area, if that's the cause of things, if we're not seeing any other acute issues or that carditis or the nervous system, it can cause nervous problems too.

So how to diagnose and actually I will be honest, typically in our emergency room we run a tick panel and then we run a western blots.

So we jump right to it.

But there is at least is what I learned in PA school is that there's two different kinds of testings.

You can do the enzyme linked immunosorbent assays or ELISAs, and then the western blot, kind of a confirmed confirmatory western blot, but the elisa, so if that flags positive, that doesn't always mean they have Lyme's disease.

It means you need to look harder and look and do more testing.

So then the western blot is the like official one that if that's positive then you got limes and the treatment.

So these are called tick tornadoes.

Actually one of our emergency room physicians has these in her back locker.

And if we fun.

Yeah, you twist them like you twist up and it the which is the big thing when you're removing ticks is you want to make sure the head is out, and, yeah, you just need to twist it up.

So first and foremost, if that tick is still there, you want to remove the tick.

The second line, though, it's antibiotic therapy.

So doxycycline is the gold standard for patients that are over eight or not pregnant.

If they are pregnant, you want to choose amoxicillin, or if they're under 8, you want to choose amoxicillin.

And that's with kids, it has to do a lot with dentition.

And with pregnant people, it can cause problems with their pregnancy if you're giving them diagnosis vaccine.

So that's the thought there.

Yeah.

That is very interesting.

So I'll tell you how we remove them, just in case.

And I learned this at my, like, very early on.

Like, one of my very first patients had a tick on him.

If you cover it with an alcohol swab or gauze, like, drenched in alcohol, and just leave it for a little bit, it lets go.

So I'll usually just put that on and leave it for a couple minutes and then take some tweezers and it, like, pops.

Yes.

I was gonna say.

That is my.

That's what I typically do before, like, she brought in, like, these bougie, like, these up.

They're on Amazon.

They can Google tick tornado.

And I, for my brother, because he was losing his mind, he had a tick on him.

I'm like, here, Jazz, for the next time, use this guy.

Yes.

But, yeah, I typically use.

When she's not working, I use alcohol, probably because it does.

It works like a charm.

Yeah.

Now, you guys all know.

What do you do with the ticks?

Do y' all test the ticks?

We throw them away.

We don't really.

You would not believe, too, in our emergency room people, if they come in, like, a lot of people don't have the actual rash, like, that target rash.

They just come in, like, worried about Lyme's disease, and they'll bring their ticks in with them.

Like, they have them in, like, little plastic baggies, and they want us to evaluate them and send them away.

I'm like, we don't do that.

Yeah.

And we don't always prophylactically treat for Lymes either, unless they're actually symptomatic.

We just try and be good about our antibiotic use, and a lot of times, it's not actually indicated to do the prophylactic version of it.

Let's see.

So favorite resources in the emergency room.

So quite Honestly, as a new grad, my favorite resource was most certainly my peers, whether they be the other PAs or Nurse Practitioners, plus the attending attendings.

I should say that's.

That was a big thing for me.

As far as going into a new job as a new grad is making sure you've got a really good support system around you.

Especially walking into the emergency room.

Because that's the beauty of the emergency room is you see everything.

I could be dealing with a cardiac problem, a GI problem, a rash, ear infection.

Like I could be balancing 10 to 11 patients that have separate complaints all at one time.

And it's.

It can be a lot to memorize.

So it's good to have that support system just because you're.

You're pulling a lot of information into your.

Besides my attendings, my Peers up to Date is one of my favorites.

It's a really great database for practitioners.

A lot of times you will actually have it available to you in practice through your system, your healthcare system.

We do Emerald antibiotics is always a good thing.

I just made a TikTok about this.

I was laughing.

I Dosing pediatrics for antibiotics is like my nemesis.

I hate it.

I can dose a kid amoxysillin like four times a day and I have to look it up every time because I just.

I don't know.

That's my thing.

I'm like, I can't remember and I don't want to dose the small humans wrong.

That's a nice resource to have.

Is that emorett antibiotics or even too.

If a lot of people come in with like penicillin allergy and you're looking for an alternative to get amoxicillin, that's a really good resource too.

Just to quickly look it up on your app, say, okay, we can do this one instead dose it, move on.

MD Calc is another one.

I like it.

For a lot of scoring systems.

A lot of times for a sodium.

Like if there's a patient that has a low sodium but has a high glucose, you have to correct that so you get an accurate sodium.

And so that's a nice thing.

I don't commit that calculation to memory.

I just.

I have other things to think about besides that.

So you plug it in.

It's really nice.

You plug it in.

It gives you the correct dose or the correct number of what they have for a sodium level.

So that's a really slick.

A lot of us in the emergency room use that, doctors included.

Pocrates is a nice one for checking interactions with medications.

Emrap I actually use that a lot on my commute to work.

It's a podcast.

It's pretty nice.

It has a lot of really up to date information regarding emergency response.

And then like I said, my attending and my pharmacist.

Oh my goodness.

I could speak for days about my pharmacist.

They are fantastic individuals and just wealth of knowledge.

I could not practice nearly as much as I do without them.

So big shout out to them.

They're my favorite.

And some final thoughts.

So I laugh at this one because we're notorious for scanning people.

We are.

So no matter what the patient's complaint is, it's always important to take a good history, evaluate their vital and do a thorough physical exam.

I feel like that is a resounding, a resounding thought I had through my clinical rotations.

I feel like physicians and PAs alike always said, really take a thorough history.

You can figure out half the problem in your history and physical exam before even ordering labs or CT scanning them.

And always remember ABCs.

I think that's most important in the emergency room is airway, breathing, circulation.

As long as they're.

You can stabilize them on that front, you're going to be able to figure out the rest of your workup later down.

As long as they're breathing and they've got a circular circulatory system in process, like you're going to be set.

So those are the big things.

And you can get really fancy in the emergency room with your scans.

But it all boils down to are they, do you have a pulse and are they breathing and make sure those are stable.

And you can do a lot of good things in the emergency room with that.

And that's that.

There's my daughter, There's PA Quinn.

She's so cute.

She's a lot bigger.

She lives about a year ago.

She's got a lot more hair now.

Yeah.

Running around.

She's moving a lot faster.

So yeah, so that is my little emergency room spiel here.

So I guess as far as like questions you guys have, I guess we can jump into that component of things if you guys have.

Okay, so I have some here and y' all can keep putting them in the chat and I will add them.

But so some of the questions, one of them.

Did you feel readily prepared to work in the ER following graduation?

That's a great question.

I think anyone coming out of PA school, I felt very confident in my education.

Like I felt prepared on just like a knowledge basis to do it.

But I think there's Always that difference between, like books and student life and then real life.

When you're feeling the pressure of you're truly doing this, you're the one prescribing the medications, you're the one evaluating the patient.

And I think that's a lot of responsibility too.

Just knowing they're coming in at a critical state to see you and a lot of their care is like hanging on what your decision making process is there.

Like, that's, that was a huge responsibility.

And it took me a while to get comfortable with that thought.

So I guess coming out of the, out of PA school, I had, there's a lot of training that I had a lot of, I don't want to say handholding, but there's a lot of oversight by my physicians to start things off just being in that specific specialty, which I think most PAs feel that way.

Coming out of PA school, they've got fairly good training and get trained by their attending physicians to practice how they like them.

And so I, I felt, I think it probably took me a good year and a half to two years to feel confident in my practice.

And I think that would have happened no matter what specialty I would have been in.

Just because you're just, you're figuring things out, you're feeling out your own practice flow what you like, what you don't like.

But as far as, like, knowing the knowledge, yes, I felt confident that I knew the knowledge enough to be able to, you know, jump in, you know, feet first and start off.

I felt comfortable with that.

I know pretty commonly now that there's a lot of PAs that do fellowships after graduation.

And I probably would have considered doing one if I didn't get offered my job.

I think that was a big factor for me as I knew I was walking in the door with a strong support system.

If I didn't know that, I would have for sure thought about doing a fellowship and got that training.

But I knew I was walking in the door to physicians that were willing to train me, teach me, and I had seen them in and work for eight weeks during my rotation.

So I knew exactly who I was going to be working with.

It wasn't going to be any surprises that they were going to just leave me out to dry.

I knew it was going to be a good experience, so I did feel comfortable.

But it definitely took me a while to get to that point of feeling confident in my practice and there's still days, like four years in now.

There's still days where I'm like, I don't know.

You have to go and look things up or talk to, consult people, talk to my attendings, and my attendings are fantastic.

And that's why we're there.

We're a very collaborative group at our emergency room.

And I love that, that I never feel dumb or stupid for walking over and asking.

Asking the question, because ultimately it's the patient.

It's the patient's life.

I can put my.

My ego aside if I don't know something to go talk to my attending or call someone that knows the answer, that's okay.

It's someone's life that you're taking care of.

And you never feel stupid asking questions,.

Going off of that.

One of the questions was, do you feel that relationship has.

With your collaborating physicians has changed as you gain more experience?

Yeah, I think they.

It's a trust level.

I think that's the biggest thing.

Coming.

Walking out of PA school, I would.

Was 24, just turned 24 years old.

So I was this young little whippers walking out of graduation.

And I think they.

They definitely want to trust me, and that's a big thing in the emergency room.

You're dealing with critical patients, and they want to make sure that you have that knowledge base and you are able to deal under stress and those kinds of crisis situations and able to still take care of the patients and not panic.

Is maybe the right answer.

Or that you're effectively able to go with the flow of the emergency room.

Because even that in itself, besides, the knowledge base is just the flow of the emergency room too, is.

Can be pretty quick and fast, and you need to get things done.

And certainly our relationship has evolved where they are very marked.

They're much more trusting.

I think I. Hopefully at this point, I've gained their trust and they know that I can operate at that level.

Many of times I'm right there with my attending.

I.

Last week we had a respiratory arrest where I was sitting there begging with the patient or begging the patient as the physician was intubating.

So we're like, right there with each other, and we've got a very good relationship.

I walk into work and there's that one day I feel bad about working with any of the people in my emergency room.

We just have a really good relationship.

And I have a relationship with 12 attendings.

Like, there's 12 of them.

And so figuring out their practice style is a whole other thing too, because everyone practices differently but they are all phenomenal physicians, and I feel very comfortable walking into work every single day practicing with any of them.

Yeah, and we talked about.

We did a podcast episode fairly recently, so if you're asking, like more pre PA questions, we talked about that more, but we talked a lot just about that relationship and jobs and that kind of thing.

Some people ask was, is your hospital a rural hospital?

So we are.

We're a level two trauma center.

So we are.

We have a lot of rural locations around us, so a lot of times we will get traumas shipped to us from other rural hospitals.

But we're main trauma center in our area, so we get a lot of the trauma patients.

But yeah, so we.

We definitely have rural areas.

I would say ours, I think.

What's the popular.

I don't even know what our population is anymore around our area.

It's a little bit bigger.

There's a lot of surrounding, like, suburbs in our area, so it's definitely, definitely bigger.

I wouldn't consider us, like, specifically rural, but there's a lot of surrounding rural area.

Gotcha.

Okay, let's see.

We've covered that one.

A couple about specialties.

So would you feel comfortable switching specialties and if you had to choose another specialty, what would it be?

So I thought about this a lot, actually, and so I. I think I feel comfortable coming from emergency medicine just into a different specialty.

Certainly there is a lot more specifics to a specialty I might know, like surface level, just with emergency room knowledge.

Surface level of a certain issue, like ob, GYN or not even say dermatology, because I know once you refer to dermatology, that's probably the one I know the least about, quite honestly.

But, like, cardiac stuff, obviously I know the emergent cardiac stuff going on, but I.

As far as I. I think I'd feel comfortable switching to a different specialty just knowing the base knowledge.

But it would certainly take a little bit of work to get up just enough to where I need to be to practice, and that comes with any job as far as my next job.

So I. I really like the emergency room.

And actually I. I told Savannah this.

I.

So my husband is a radiology resident, and he just started working down at his job.

We're in Madison, Wisconsin, and so we moved down here last June.

But I still work in my department, which is two hours away.

So I really like the emergency minute.

I really.

So I.

It's been very nice.

My family lives in the area that I practice, so my daughter gets to go hang out with Gigi and papa and grandma and grandpa up there.

Both my husband's parents live up there too.

So it's been really great with childcare.

But I love emergency room.

I don't know, I think I might be there for a while.

But I would say I've definitely developed new interests since working the emergency room.

I would have never guessed I would have liked gynecology or ob.

Like throughout PA school I was like, absolutely not.

And then now working in the emergency room, those are my favorite patients.

I tend to gravitate towards is the OB patients and the gynecology.

But I still have an interest in plastic surgery.

That was one thing that I thought about during PA school was plastic surgery.

And I might eventually navigate my way back towards that realm of medicine.

But right now it's error.

Okay.

Since you dropped the two hour away bomb.

What?

Sorry, that's not normal at all.

Don't worry about that.

Some people, there were questions prior to that, like, how do you let me find them?

I have a list over here I'm keeping.

Do you feel like being a PA in the ER gives you a good work life balance?

They said, are your hours like really varied and is that harder than like the normal 9 to 5?

And what does your typical work week look like?

Yeah.

So right now.

So before, before my daughter was born, I definitely.

My work week was like a typical work week.

I would go to work maybe three, four times a week.

I'd be working usually I'd actually work the 10 hour shifts I work from 2pm to 12pm was my typical shift.

I'd work like three, four times a week and I would work a lot.

So before my daughter was born, I worked a lot.

I picked up extra hours just because my husband was busy with medical school.

So it made sense to pay off loans and also support my spending shopping.

I like that one.

Yeah.

Sorry, Sam.

And so I.

So it was definitely more of a classical.

Like I'd go 2pm to midnight and I'd get my hours in and then I have a couple days off or I'd pick up extra shifts.

However, since my daughter was born, life has changed significantly where obviously my focus is on my daughter and I do feel, I think that's the reason why I've stuck.

I've stuck with my job too, is I really do like the balance of things.

So I don't really know what the childcare situation was, was prior to that.

I think it was a little bit more Stable where things weren't shutting down.

People were like trying to scramble to get childcare.

So that's another huge benefit of what I have going on right now is that my parents watch my daughter and I don't have to worry about.

And I think too as a first time mom I have a little bit anxiety.

So it's just, it's nice to have her with someone that I know and trust and same with my in laws, they're fantastic.

And so I really like that aspect of things.

So that's worked out really well.

But also the balance of things.

I think PMs most people are like oh versus like typical like 9 to 5.

But it works really well with our schedule because if I'm home by midnight, I'll wake up by the time I might sleep in a little bit.

Thanks mom.

She'll let me sleep in a little bit if it's been a late night.

But I get to see my daughter the majority of the day until she goes to bed.

And if I go to work at 4pm I'm only missing out on three hours of time with her.

So I really do that a lot.

That's been a really nice fit for my life.

But I guess I don't have anything to really compare it to the 9 to 5 because I never did a 9 to 5.

Let's see.

So yeah, I like the balance of things.

That's worked really well and it's worked really well being a mom and a PA at the same time.

I've definitely cut back my hours when I do this crazy two hours.

So I know that sounds crazy the two hours but I do a stretch.

So I go, I drive two hours up to my parents house, I work for five or six days in a row and then I'm off for a week and a half.

So it's a balance there.

I'm not going up every two hours every day.

Like it's not like put your shifts all together.

That would be a lot.

So my work has been really nice about letting me stay on and they've done that for me where they'll block my, my shifts together.

So I do stretch a stretch of work and then I go back home and I'm home for a week and a half, two weeks, weeks.

And so it's been, it's a good balance and that's why I've kept my job because I love them and I now love what it has for my life.

Yeah.

And when you have a good thing, it's hard to leave or try to Find something else.

Absolutely.

Okay, so let's see.

What else do we have here?

We have a few more minutes for questions.

How did you know you wanted to work in the er?

I didn't.

It found me.

I. I really didn't know that I was going to be in a. I was going to.

In emergency room medicine.

I just.

I really liked my rotation.

And two, like I was saying before I started PA School, I don't actually know.

I don't think I said that.

I.

So I started PA school right after undergrad.

I started.

And so I did not have this extensive healthcare experience before I started PA school.

And so emergency medicine really did work out well for me because I did not have.

I think it just solidified all the different areas of medicine.

Inform me a little bit better.

You get a great training in PA school, but it's nothing like real life practice.

So I definitely felt like seeing being in more of a specialty that you get that wide variety that's not so specialized off the bat really helped me solidify my knowledge moving forward.

So it ended up being a good fit.

I really liked the flow of things.

I mostly like the procedures, if I'm being honest.

I really like procedural incision and drainage and lacerations are my favorite.

And so that's.

It's been really great just moving forward and solidifying my knowledge.

So if I do want to switch specialties down the road, whether it be the best choice for my family or I just change my mind about what I want to do, like, it's nice that I. I can do that.

And I feel like I still have that base knowledge because that darn pannery or that recertification test does come up faster than one would think.

I'm due next year.

Yeah.

So I'm like, I still.

There's lots.

There's stuffing for me to.

Don't get me wrong, but I think that will help.

Just seeing a variety of things in my day will help me.

Me take that test a little more effectively.

Not that you should pick your specialty based on the pannery, but it is a perk.

It is a perk.

Yeah.

No, for sure.

Because.

Yeah, that did sneak up pretty quickly.

Yeah.

Okay, so this is a good question.

What would you consider to be some of the most important things that you learned when you first started as a PA in the ed?

What were one of the most important things.

Yeah, when you first started.

That's a good question.

Probably.

Honestly, this is probably.

It is sick versus not sick for a page patients.

And it seems like it's a pretty silly thing, but if you can effectively walk into a room and like within 10 seconds determine if they are sick, like if they're going to need the attending sooner rather than later and need me to do something, especially in my early practice, I go grab the attending.

And I still do, but I can at least feel a little more confident in my skills to stabilize them before the attending walks in.

So that's.

I'd say that's probably the biggest thing that I learned.

And that's a pretty critical skill to figure out because you don't want to waste time with patients that are sick because they can deteriorate really fast, and then you're in a whole new mood mess.

That's probably number one.

Other things I learned how to effectively consult patient or either the hospitalist team or specialists.

And you will figure out that flow.

That's a whole nother bear.

But that.

That took a little bit of time for me to really get my thoughts down effectively, like for myself.

And then to have to talk to someone to admit a patient was a whole nother thing for me.

PA School is great.

You'll figure it out.

But it's just.

It takes practice to get it down.

And some days I still feel like my thoughts are a little trying to get for the hospitalist and.

But that's another thing that I think was hard off the bat, but it's gotten better with practice over the last four years.

Those are like the two.

You know, that's a really good question.

I'd have to probably think about that one.

But that's a.

That's an awesome question.

But I think that sick was probably the biggest thing that I had to figure out that was the most critical to my patient care.

No, that's.

Those are great things.

I think those are very helpful.

Okay.

So do you ever get pushback from patients about being a pa?

No, actually, I really don't.

It's, you know, I. I get that.

And actually, that was a fear of mine.

I think walking into out of PA school was, are people gonna understand?

And I will say I'm not in a rural area, but I think there's definitely a lower health literacy and maybe literacy level.

And so a lot of patients just look at you like.

And I like, what are you Like, I get that a lot.

Like, who?

And I don't say that.

Like, they're like, I don't want to see you.

I might have to have to explain to them, like, who I am and what I do.

But quite honestly, patience, you just film with kindness.

That's the biggest thing I learned.

If you walk in and you are, like, energetic and spunky and, like, ready to roll, like, people don't care.

Like, they're just happy to have you in the room and take care of you.

Like, they're happy they can talk with you and you're not going to walk in.

Judging them, that's a pretty big thing.

So I honestly, I think of the two times.

I think there's been two times I can recall that patients were like.

And they did not like the physician either.

So I don't think it was me.

Didn't want to be there that day.

So someone said, how do you introduce yourself?

Which I feel like there's been some, like, talk about this in the PA community.

Interested?

Yeah, that's it.

Because the whole name change thing, and so that's in limbo with that right now.

We're.

Our profession has adopted that.

But our legislative is not officially made us the associates.

So I walk in and I say, hey, I'm Jordan.

I'm a pa.

I'm be taking care of you today.

I do about the same.

I'm like, hey, I'm Savannah.

I'm the pa.

I work with doctor.

I hear whatever's going on.

Actually, I. I'm so bad with cracking jokes.

I'm like, people are probably like, get me out this room, lady.

No, I walk in, I say, hi, I'm Jordan.

I'm the pa.

I do say that I'm working with.

They're gonna have a whole crew in here.

Nice to meet you.

Sorry, it's here is usually my spiel.

There you go.

And they're probably like, yeah, yeah, exactly.

But some people, like, I know some PA guys will go by like, PA Perry or like pa, Whatever their last name is.

But that's like, part of what I.

Love is that people just call me my name.

Exactly.

I'm like, pretty chill.

I'm like, yeah, no.

And every once in a while you'll get.

I'm.

I've gotten that before.

Yeah, yeah.

Or I walk in, I'm like, hey, I'm Jordan.

And I'm really.

I'm not a white coat person.

Mostly because I don't wear my white coat either.

I'm.

I. I just don't.

I don't know.

It's got nice pockets for snacks.

That's about the.

The scrubs in my scrub jacket.

That's all I need.

Yeah, so that's exactly it.

I'm Usually decked out in a metal eater figs and I. Yeah, so I don't wear my white coat.

So a lot of times I get called the nurse too.

And I say, not cool enough to be the nurse.

This one's at.

Over there.

I'm happy to meet you and take care of you.

I actually had a patient one time.

He asked me who's in charge?

You were the nurse.

And I was like, if I'm smart, it's the nurse.

I make those assumptions.

But I think that's the beauty of it is just not.

And I think many of us feel that way too.

I didn't know about the PA profession for a good chunk of my, like growing up, my dad's best friend was a PA and I thought he was a doctor.

Like, I made that assumption pretty widely throughout my, my childhood.

And then I realized, oh, there's this other profession.

I think it's good to walk in not feeling like offended or like you're.

That this patient doesn't know who you are.

Like questioning who you are.

Because I didn't know what a PA was until I was like 17 and then I figured it out.

But yeah, so I try and just take it with a grain of salt.

This is a great opportunity for me to educate.

They're usually not trying to be offensive by it.

They just don't know all.

So I just, I try and take every moment that I can to educate them because that's really how we're going to get better with the PA profession, where patients aren't asking us who we are and what we're going to do with them.

Yeah.

And I do the same and I rarely get asked at this point as well.

Usually they either know or they have had time to reschedule if they don't want to see a pa.

Okay, why don't.

I hate to end on a negative note, but I feel like this is a good question.

We'll make this our last question so we actually end on time for once.

So what are the worst things you have to deal with in your day to day as a pa?

And I feel like your worst are probably like way more terrible than mine.

Oh yeah.

So we think of the classic things in our emergency room as far as there's people coming in and it's their, their worst fear.

I'm confirming that they have cancer and it really.

Or they're miscarrying.

That's another thing that really can be pretty heartbreaking to have to deliver that news.

So certain breaking bad news is probably I'd say the hardest thing I have to do or walking.

A lot of times I'll walk with a physician.

If we're quoting a patient or going to talk to that family member that we, you know, we lost them.

So those are, I would say, definitely, like top things that are probably the worst.

Obviously, working during the pandemic has been a whole new bear too.

That's been a whole, whole thing.

Just being understaffed and large quantities of patients coming into your emergency room, that can be overwhelming and just keeping morale up.

I think that's the big thing too, where we've got many, many sick COVID patients unfortunately live in an area that's fairly unvaccinated.

So I saw the worst of the pandemic, unfortunately, where we had a lot of patients come in critically ill. And having to work on those kinds of patients, that's been hard.

And so I'd say that's the hardest thing that for sure are the patients where you're walking in having that discussion.

And thankfully, I had my oncology rotation.

That was my first rotation I had during PA school, which was hard, but I learned a lot of really good things.

I had a fantastic attending physician who gave me a lot of really great advice about how to break bad news.

And you're trained on that during PA school, too.

But that was a really big component because you're.

I always remember that you're going to be forever ingrained in their minds as the person that is breaking that news to them.

And I take that with a lot of.

Not pride, but I just, I really try to be reverent about that, about walking and knowing that I'm the one delivering the news.

And a big thing I do, too.

Especially if I'm, you know, having a patient, that new cancer diagnosis, I talk to the specialist that they're going to see afterwards before I go tell them, because there's nothing worse than walking in and breaking this awful news to them and then not having a game plan about what the next steps are, because then if I'm walking out of the room to go talk to the specialist, walking back in.

So I really try to get a game plan in place for those patients that I'm going to, you know, break those.

That news to them what the next steps are going to be for them.

And same with a miscarriage.

I definitely talk to the OB and just say, hey, what's the next step?

If it's something that's going to need a procedure versus someone that's just going to follow up as an outpatient with, you know, anticipatory care.

So, yeah, I try and get a game plan together before I walk in and tell bad news, but that's definitely the hardest part of my job is the news part of it.

But there's also just been, like, daily inconveniences, like I said, like being short staffed and having large censuses.

But that's minor in the realm of everything.

I would say we get through our days.

We're all in it together.

That's the biggest thing.

Good days and bad days.

It happens.

Yep, exactly.

There's many good days.

I would say there's more good days in the emergency room than there are bad days.

Fridays.

Yeah.

No, that was great.

Thank you so much for your insights, Jordan, and your wonderful information.

I put Jordan's Instagram in the chat and I've actually tagged.

Every night.

Yeah, you, like, popped up on my TikTok and I was like, oh, Jordan has a tick tock.

Yes.

Yeah.

And I think, Savannah, you can definitely.

I use my.

I think it's.

What is it?

So if you guys have questions like, for sure, email me.

I'll get.

I'll for sure get to you guys.

Yeah, and then.

And we'll.

You'll get the replay.

We'll send all that out and then.

Yeah.

Thanks so much, Jordan.

Yeah, this was awesome.

Thank you guys for hanging out with us.

And hopefully you learned something.

But you guys, you're very smart.

Actually, I saw.

I have to say, I saw one that said, do you have a nose before PA school, please?

No, you don't have to know any of that.

Oh, yes.

I. Yeah, I meant to.

Call me on that.

Yeah.

You do not.

I feel like a lot of people commenting, like, probably have specific experience, like in these areas.

You guys just.

We went brief.

You will learn so much more in PA school beyond.

I just want.

I just want to give you a general case idea, but there's more information and you will learn in PA school.

The biggest thing you should do for PA schools, go on vacation, do something fun.

Don't open up any books.

Just enjoy your free time.

Yeah.

This is awesome.

Thank you guys for letting me come and chat with y'.

All.

Yes.

Bye, guys.

Have a good weekend.

Or almost a weekend.

Thanks for spending Thursday night with us.

Yes.

This is great.

Great.

Very good.