wowza

Esme, I probably should have qualified my statement. RV infarcts can cause hypotension but are much easier to correct and usually much more benign than LV infarcts*So hypotension in an anterior MI means the pump failed. Hypotension in an RV infarct is often a pre-load issue that can quickly be corrected. Anterior infarcts causing hypotension can be corrected only with some pretty extreme interventions because the pump has failed- balloon pumps or inotropes until the initial stunning of the myocardium is corrected. Even then, often teh scarring is so severe you get an ischemic cardiomyopathy. It is rare to get an ischemic cardiomyopathy from an RV infarct unless a left dominant circulation with a massive infarct. Now the above is also dependent on the anatomy. If the patient is left dominant, the LCx will probably be the occluded vessel so it will be assocaited with inferior or lateral changes in addition to posterior changes. This means a large portion of myocardium will be involved and actually will involve portions of the LV, rather than just the RV. With regard to the bradycardia or heart block, these too are usually short lived and resolve with reperfusion of the AV node.

It depends on the type of heart attack (ie what part of the heart it affects). In most cases, the heart rate will increase. This is attenuated by the fact that most people who have an MI will also be on a beta blocker already. In terms of blood pressure, it depends on the area of the heart involved and how severe the MI is. A massive LAD or L main MI (anterior MI) will cause severe hypotension (cardiogenic shock). The treatment is quite different for RCA infarcts. Inferior or posterior MIs (RCA infarcts and sometimes infarcts of branches off of the LCx) can, but less often cause hypotension. However, these types of MIs are very, very sensitive to pre-load so any medications that either decrease cardiac output or change pre-load will cause hypotension. Less severe MIs will often be associated with hypertension. This is actually a pretty good prognostic sign as it shows that the pumping function of the heart is preserved.

OP, I had people in my class who started medical school at age 44. We had multiple people in their 40s and tons in their 30s. You will probably always wonder "what if" if you don't pull the trigger and go to medical school. From your post, it sounds like you wish you started that path in college. Don't waste more time. Know that the time commitment is extreme. You will probably need to do 2 years of undergraduate courses just to fullfil the pre-recs for medical school. The most common set of pre recs include: a year of each chem/biology/physics/organic chemistry + a year of lab for each, + a year of english (you probably have this) and a year of college level math (ie no less than calculus). Then you will have to take the MCAT. Add 4 years of medical school and at least 3 years of residency. So from here, it is at least 9 years. Know though, that life doesn't stop during the education. There are plenty of women who have kids in medical school and residency. Full disclosure: I am a doctor.

Minocycline treatment results in... [Allergy Asthma Proc. 2008 May-Jun] - PubMed - NCBI

Yeah, no there't not. This guy you posted is a chemist who has an appointment doing research for the medicine dept. Specifically he has a PhD in biochemistry (ie not in medicine).

Are you trying to say that 510 clinical hours is a lot? I think that is what some people are saying- the hours are insufficient especially when compared to what the DNP is trying to mimic.Let me give you an example: in a medical residency you would get more hours than all the hours in your "doctorate" in just 7 weeks- and medical clinical training lasts 5-12 years (thus somewhere between 40-75x more clinical hours).

First, wow, that was a very long post. Thank you for taking so much time to post your views. The difference here is that osteopathic education changed so that it now is IDENTICAL to allopathic education. They both have 2 years of basic science education, 2 years of clinical education and the exact same residencies. The improvement in education is why they are considered identical. It is not that MDs relaxed what they expected. It is that DO's stepped up their education. PhD's do not have a doctorate of medicine. They have doctorates in biology, biochemistry, or genetics or molecular engineering... well you get the idea. It is not a doctorate of medicine. There is no overlap there between MD and PhD. One is clinical, one is research based. Not to be snide but the dentist is the most knowledgable about the pathology of the mouth. MDs know much less about the mouth. What is the DNP the most knowlegable about? This is a serious question.

Actually I bet almost all of them would pass. Of course, we'll never have data to show one way or the other but for us, Step 3 of the USMLE is a really easy exam- by far the easiest of the 3 steps. Most interns don't even study for it much at all because of time constraints of internship, yet there is still a 95% pass rate. I have never seen a pharmacist or physcial therapist refer to themselves as doctors in the hospital and we work in very close multidisciplinary rounds. Dentist I don't have a problem with at all. Very often they are dual DMD/MDs and do Facialplastics or OMF. They really are the experts in the face/mouth so have earned the doctor titile.Optometrists really don't practice in hospitals so it's less of an issue. It is a bit misleading though in the clinic.Psychologists... again, I don't really care but have some minor issues with it. I think you touched on some of the issues. In my opinion, unlike every other practice/clincal doctorate there is no standardization of education. The other thing, it really hasn't stepped up the coursework, which it seems like many students are asking for. Finally, the title doctor in my opinion, should be reserved for the person with the most education in a given field.As above, this is why I think dentists deserve the designation- no other provider knows as much about the face and mouth. Same thing with pharmacists, podiatrists. This is also why I think optometrists probably shouldn't use the title- ophthalmologists have far more training. Similar to psychologists and psychiatrists. With regard to DNP and title of doctor- what the DNP is supposed to be the most knowledgable of and what the doctor is supposed to be the most knowledgable about are the exact same and I think everyone is on board with the differences in training. So, by this logic, it is misleading for a DNP to call themselves a doctor in a clinical setting. Outside, it makes no difference to me... although I think anyone who introduces themselves as Doctor X in any non-clinical setting is a bit of a tool.

Ummm... the people who write those guidelines are clinicians AND the leaders in research who are CHOSEN to be part of the panels that write the guidelines. Almost none of them are from DC. Evidence based medicine is used because it is what has been PROVEN to work. These are what guidelines (usually) are based on

Since a nurse is part of the healthcare team, I am not sure it would be a HIPAA violation, but I could be wrong.I think most physicians are realistic about how much a given patient will be able to control their cardiovascular risk factors just by diet/exercise alone. That said, any doctor worth his salt, will give it a go for a few months until it is clear that it just isn't going to happen. Technically, you need multiple readings in a doctor's office to be hypertensive so most will do diet/exercise modification before the patient will meet the criteria for hypertension.

How bad is her asthma- how bad are her PFTs ? There is literature in COPD that daily Azithro decreased hospitalizations so if the FEV1 showed true obstruction you could make a bit of a logical leap to maybe suppor this.

No one works through medical school. There is no time. Almost every student takes out the full amount of loans to go to medical school. Very few people in my class had their parents paying for everything. So it makes no difference if you come from money or not. This is also why the average medical school debt is $160,000

Well this is just ridiculous. First, no one is forced to work through undergraduate education. Second, I know plenty of doctors who did work through undergrad.Finally, put your money where your mouth is if it is so easy to get into medical school. Get into medical school and then we can talk.

The distinction here is the difference in education. MD and DO education is equivalent and very standardized. It involves 2 years of classwork and roughly 4000 clinical hours during school and roughly 12-20K more clincal hours during residency. The the depth and breadth of the DNP does not even come close to what is in the MD and DO curricula whether you compare raw class hours, raw clinical hours, or the lack of "fluff" courses like research and nursing activism. Furthermore, the DNP suffers from multiple things: 1) It doesn't have a true identity. It is a mix between a MPH and a clinical degree yet is supposed to be a step up from the clinical degree 2) The students often have to set up their own clinicals and the clinicals are very variable in terms of quality 3) the coursework is a patchwork of fluff courses and true clinical course. Nursing activism, research, epidemiology do not have a place in a clinical doctorate unless they don't detract from the clincal courses. As it stands now, they take the place of extra clinical hours and more path/pharm/phys So despite the lobbying, the degrees arent equivalent despite what the nursing lobby would have you believe. Really, if you compare the MSN and the DNP curricula, the only changes are the extra fluff courses rather than more clinical courses. There seems to be a movement where the nursing students are asking for a more rigorous education and I applaud this. However until this happens, the 3 degrees won't be equivalent.

Yeah it was never about filling the void in primary care. It has always been about money and power. The DNP movement was 100% political

Seriously, why don't you all complain. That is really the only way you all are going to change anything in NP education. Lord knows the administrators aren't going to do it.

The negativity is directed at the NP lobby who is continually pushing for expanded practice rights despite doing nothing to improve the clinical education of NPs and the NPs who really think that they have the same knowledge base and preparation as a doctor. The negativity is not directed at NPs who know their place in the health care team.

The physiology of adding ipratropium is the same in COPD and astham; it adds extra bronchodilation. I agree though that a steroid burst should have been added for a flare.

I'll bite: Anticoagulants/antiplatelets: Heparin Lovenox Coumadin (warfarin) Bivalrudin Aspirin plavix (clopidogrel) Blood pressure: ACEi's- captopril, lisinopril, enalapril ARB's- losartan, valsartan Other heart meds Beta-blockers (olol)- labetolol, carvedilol, atenolol, propranolol Calcium channel blockers- verapamil, nifedepine, amlodipine, nicardipine, diltiazem Vadodilators- nitroglycerin, nitroprusside Pressors- Dopamine, dobutamine, norepinephrine Statins- atorvastatin, rosuvastatin Fibrates- finofibrate Cholesterol binders- ezetimbe, cholestyramine Lung meds Albuterol, salmeterol Ipratropium, tiotropium Advair (fluticasone/salmeterol combo) Symbicort (budesonide/formoterol combo) GI meds Anti-acids H2 blockers- ranitidine, famotidine Anti-acids PPIs- omeprazole, esomeprazole, lansoprazole Bowel preps- mag citrate, polyethylene glycol Constipation- docusate, senna, miralax, lactulose, enemas Diarrhea- loperamide antinausea- ondansetron, promethazine, prochlorperazine Kidney meds Diuretics- furosemide, hydrochlorothiazide, spironolactone, acetazolamide Endocrine Diabetes- metformin, insulin (lantus, aspart) Thyroid- levothyroxine Steroids (glucocorticoids)- prednisone dexamethasone, hydrocortisone, methylprednisone, GU meds antispasmodics- oxybutinin, tolteridine (detrol) solifenacin (vesicare) BPH meds- doxazosin, tamsulosin, finasteride ED meds- sildenafil, tadalafil Neuro Alzheimers- donepezil (aricept) Seizures- valproate, levetiracetame, phenytoin, topirimate Benzos- lorazepam, diazepam, Agitation- benzos (lorazepam, valium), haloperidol, Pain meds Opiates- oxycodone, hydrocodone, morphine, fentanyl NSAIDs- ibuprofen, ketorolac Other- trazodone, cyclobenzaprine, lidocaine patches Headaches- fiorocet, sumatriptan, metoclopramide Gout- allopurinol, colchicine Psych meds and antibiotics are too numerous to name

I agree. You should immediately talk to your employee health. I (in a non-medical advice kind of way) would recommend considering prophylaxis if you think the body fluids may have actually gotten in your eye.

I'll give it a read. Again, this doesn't negate any of the other arguments put forth in this thread- a nice diversion but I'd love a response from some of the other arguments put forth.

1) You can label it whatever you want- whether nursing or medicine, but diagnosing and treating whether a nurse practitioner or an MD is the same job. You can call it "nursing practice" if you want to but it is the same job. Thus, the fact that I don't have a nursing degree is completely irrelevant. I have standing to comment. 2) Now as to dentists, podiatrists and pharmacists- each of these is the absolute expert in their domain. MDs do not have the extensive training dentists have for dealing with mouth pathology, the extensive training podiatrist have for foot pathology or the training in drug kinetics and interactions that pharacists have for drugs. So within those domains, they are the experts and I cede to their authority. Thus dentists are the doctors of the mouth, podiatrists the doctors of the foot and pharmacists the doctor of drugs. DNP's are the doctors of what exactly? An NPs domain is the exact same as an MDs, so they are NOT the masters of their domain. In fact, they claim to do the same job as MDs yet have a fraction of the knowledge and training. Here is the major difference between you and a dentist/podiatrist/pharmacist- they have the highest level of training possible in their field. NPs aren't even close; instead NPs have 800 clinical hours and more nursing leadership credits than pathophysiology credits. That is why there has been such an increase in autonomy of NPs; the students have been taught to advance their degree instead of how to better take care of patients (more pharm, more path, more phys etc). 3) So you really think it is doctors who are the ones who control how resources are distributed in our health care system? I wish we had that much power. Perhaps you should direct your anger at the bureaucrats in DC and those who run the insurance companies because we doctors would love to be able to treat everyone and have the power to do so. (Good try at mud slinging) 4) Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate. So, chuckle all you want. You are putting yourself and your profession above your patients and that is a pity for them.

Again, just because a politician gave you permission to have independent practice does not mean you have the skills or knowledge to do so. You are confusing the two. Whenever I bring up the chasm in knowledge between a real doctor and a nurse practitioner you like to side step the issue by bringing up the fact that politicians saw fit to expand practice rights. That has more to do with the nursing lobby than if you are fit to be an independent practitioner. Again, good for you that nurses have more rights- bad for the patients when you miss a diagnosis because of inexperience and lack of knowledge. The eyes cannot see what the brain does not know. That is why extensive training is necessary. Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate. So call yourself doctor if you want; the real doctors will just chuckle behind your back and hope you don't kill someone with your lack of training and knowledge.

ironic you allude to doctors as being the ones who are arrogant. now which group is it that is taking a short cut around tens of thousands of hours of clinical training, scores of hours of hard sciences and years of residency and then calls themselves equivalent? explain to me which group is arrogant- the people taking the short cuts or the ones calling them out on it. personally i think that nps should have closer supervision. i agree chart reviews days later does next to nothing; regulations should be tighter such that an np should have to present to an attending after each case just we had to do in during resident clinic.

I mean that's just funny. I have some pliers here if you need to remove the foot from your mouth. Well I actually went to medical school and I am now a doctor at the #1 hospital in the country so I don't know why I would take a step back. I have a few issues with DNP education 1) there are only about 80 credits you need to get a "clinical" doctorate, many of which are the actual clinical hours 2) Many programs require only 800-1000 clinical hours 3) Half of the didactic courses are non-clinical fluff (nursing education, nursing leadership, statistics) 4) There is almost no difference between a masters and a doctorate level NP in terms of clinical courses and clinical hours 5) The DNP was nothing more than a political ploy to give NPs more independence. Add the word doctorate and it doesn't matter if there is actually a change between a masters and a doctorate, the politicians will eat it up. I know that each class in medical school was useful. There was no room to remove anything clinically useful for things like "Nursing Leadership" without severely compromising education. At most DNP programs, more than half of all courses in DNP programs are not clinically useful. There is no change in education between an NP (masters) and a DNP curriculum with the exception of non-clinical fluff. I have compared the two in the past on this board. If needed, I will break it out again and it will make people think twice about calling you doctor.