The best pearls of wisdom from PAs and NPs in 140 characters or less!
My go-to emergency medicine book is 1332 pages long and well, it’s so dry that it can cause the water bottle on my desk to run and hide behind my monitor.
So, what about good tips or pearls in an age of Twitter and TikTok? How about a collection of short-but-sweet tips that can come in handy in the urgent care arena? In that light I asked my online clinical discussion group of almost 5K clinicians to submit their best urgent care/emergency care tips in 140 characters or less.
Below is great wisdom packed into a small space, so enjoy these 30 brief but rock-solid tweet-worthy tips!
Never touch a rash you don’t want!
Most mothers should be believed when they say “my child isn’t his/her self”.
If skin is thin or there are multiple lacerations close to each other place Steri-strips parallel to the laceration and sew through them, the strips give skin extra strength and make closing easier – works great for skin tears in the elderly as well.
When trying to distinguish a stroke vs. Bell’s palsy, “if the patient can raise their eyebrows, then you should be raising yours (be worried that it’s a stroke).”
Another anecdote for Bell’s v stroke: Spare Beware – meaning, if it spares part of the affected side beware of stroke.
Removing small slivers or spines from a cactus is a breeze if you use Elmer’s glue and let it dry/peel it off or use the strips that are sold for removing black heads, works like a champ!
If you are collecting a culture for otitis externa and the patient is old enough, have them do it. They will usually get a better sample than you will.
Stand to the side while lancing, poking, prodding, swabbing anything.
Pain out of proportion to the injury or illness needs to be taken seriously, think compartment syndrome or worse!
Always do a GU exam on a male <18 yo c/o belly pain.
Remember that patients don’t get new onset migraines after age 50, consider an alternative Dx.
Trust your gut. If something isn’t adding up, ask more questions.
If you think about it twice, do it.
It’s ok to use lidocaine with epi in the fingers! (In fact, your patient will like the longer analgesia, and you’ll like having less blood in the wound).
In pediatrics, if you strongly suspect a fracture but have negative XRs, splint anyway and refer to ortho. You never be faulted for going the extra mile with pediatric trauma.
Always document N/V intact distal to an injury. Also, document compartments are all soft in a long bone injury. (As long as they really are) Bonus, check for proximal fibula head tenderness in ankle injuries.
I don’t let anything keep me up at night … if I’m going to think/worry about it after my urgent care shift, then I’m going to address it now.
I tell all my students that the most important thing they need to learn is to know what you don’t know.
Chest pain that is reproduced with chest wall palpation does not r/o ACS or PE.
Be able to explain abnormal vital signs. If they are tachycardic, there is usually a reason!
Never try to be the smartest person in the room (consult other PAs, docs, nursing staff if needed, specialists, etc.)
Trust experienced nurses. They know stuff.
I always check for TMJ tenderness in an ear pain complaint when I can’t find an infection present on Physical exam
If sending to ER from UC, either have someone drive them or call ambulance! Don’t have them drive themselves please!
Touch your patients. A temp of 98.6 in someone that looks sicker than their vital signs can be sepsis if the extremities are cold (and clammy).
Use Tegaderm over the closed eye to protect it when working on eyebrow laceration repairs. Peels off easily without pulling hair/lashes. Works great on kids when applying Dermabond.
Always ask about vaginal symptoms when there are “UTI” complaints. Half the time it’s the vagina.
Always lay someone down when doing a procedure. Even if they haven’t had VVS before.
If a woman comes in with a genital lesion and she is worried about an STD, it is rarely an STD. When a woman comes in for a genital lesion from a presumed bike seat injury, it is always herpes.
If someone has fatigue always look at their feet. Feet are far from the heart and can be a window giving you a peek at circulation or renal issues.
Interested in more tips and tricks? Check out our post-graduate training and education program, ThriveAP. Not only do we cover quick clinical pearls, but we take a deeper dive into primary care medicine. For more information, contact firstname.lastname@example.org.
Brian Bizik, MS, PA-C, is a Physician Assistant with 18 years of clinical experience. He is a frequent speaker for ThriveAP. Currently, Brian is the Respiratory Care Coordinator for the Terry Reilly Health Centers in Boise and Nampa, Idaho. Brian is also the current Conference Chair and Past President of the Association of Physician Assistants in Allergy, Asthma and Immunology and past member of the Idaho State Asthma Collaborative.