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By Guest Blogger Brian Bizik, PA-C

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!

  1. Never touch a rash you don’t want!
  2. Most mothers should be believed when they say “my child isn’t his/her self”.
  3. 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.
  4. 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).”
  5. Another anecdote for Bell’s v stroke: Spare Beware – meaning, if it spares part of the affected side beware of stroke.
  6. 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!
  7. 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.
  8. Stand to the side while lancing, poking, prodding, swabbing anything.
  9. Pain out of proportion to the injury or illness needs to be taken seriously, think compartment syndrome or worse!
  10. Always do a GU exam on a male <18 yo c/o belly pain.
  11. Remember that patients don’t get new onset migraines after age 50, consider an alternative Dx.
  12. Trust your gut. If something isn’t adding up, ask more questions.
  13. If you think about it twice, do it.
  14. 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).
  15. 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.
  16. 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.
  17. 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.
  18. I tell all my students that the most important thing they need to learn is to know what you don’t know.
  19. Chest pain that is reproduced with chest wall palpation does not r/o ACS or PE.
  20. Be able to explain abnormal vital signs. If they are tachycardic, there is usually a reason!
  21. Never try to be the smartest person in the room (consult other PAs, docs, nursing staff if needed, specialists, etc.)
  22. Trust experienced nurses. They know stuff.
  23. I always check for TMJ tenderness in an ear pain complaint when I can’t find an infection present on Physical exam
  24. If sending to ER from UC, either have someone drive them or call ambulance! Don’t have them drive themselves please!
  25. 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).
  26. 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.
  27. Always ask about vaginal symptoms when there are “UTI” complaints. Half the time it’s the vagina.
  28. Always lay someone down when doing a procedure. Even if they haven’t had VVS before.
  29. 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.
  30. 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 info@thriveap.com.

 

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.  

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6 thoughts on “Tweet-Worthy Urgent Care Tips!”

  • CIndy Anthony says:

    I can’t believe this. A great testimony that i must share to all HERPES patient in the world, i never believed that their could be a complete cure for HERPES or any cure for HERPES,i saw people’s testimony on blog sites and comment section about Dr.Kuje a herbal doctor and the efficiency of his herbal medicine.I had to give him a try because i myself have been suffering from the same virus, and i was not disappointed. It took just few weeks i started using it i started noticing changes. I was cured. You can also contact him on his email kujeherb @ gmail. com…

    • ELAINE JAMES says:

      I’m recommending Dr Okasi to everyone who have herpes simplex virus to get the cure from him. I was diagnose of genital herpes in 2019 and i have been searching and asking questions to see if i could get something to cure the disease because i did not believe what the doctors say that no cure is found yet. I came across a comment on Youtube and the person testify how she was cured from herpes and hpv after using Dr Okasi herbal medicine. I quickly contact Dr Okasi and explain my problem to him and he prepare the herbs and send it to me through UPS and gave me instructions on how to use it and tell me to go for checkup after usage which i did after two weeks of taken the herbal medicine and my result was NEGATIVE. I waited another month and retested the result was still NEGATIVE and my doctor told me that am completely free from herpes. Am so happy and grateful to Dr Okasi for what he has done for me and i will continue to share this for people out there to know that there is cure for herpes. You can contact Dr Okasi on email and website to get the cure from him. Email: okasiherbalsolution @ outlook. com and his website:okasisolutiontemple. webs. com.

    • I have been suffering from Herpes for the past 3 years and 8 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr Sayo on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i took according to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Herpes. My heart is so filled with joy. If you are suffering from Herpes or any other disease you can contact Dr Sayo today on this Email address: (sayoherbalhealer @ gmail. com) or WhatsApp him on this Tell.Number +2349012175679

  • Sandra Wills says:

    Don’t ignore, who will believe that herbs can cure 5 years HERPES in my body, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of Herpes cure, i decided to mail him, unknowingly to me that this will be the end of the HERPES disease in my body, he prepare the herbal medicine for me, and give me instruction on how to take it, at the end of the 2week, he told me to go to the hospital for a check up, and i went, surprisingly after the test the doctor confirm me negative, i thought it was a joke, i went to another hospital was also negative, then i took my friend who was also herpes positive to the Dr Akhere , after the treatment she was also confirm negative . He also have the herb to cure cancer and HIV virus and many diseases and virus. please i want every one with this virus to be free, that is why am dropping his email address, drakhereherbalhome017 @gmail. com.. do email him he is a great man. the government is also interested in this Dr Akhere, thank you for saving my life, and I promise I will always testify for your good work.

  • Tanya Rufer says:

    I have be dealing with herpes for the past 5 years until i got review online about Dr.Iyayi people testifies how they got cured with his herbal medicine. And i order the treatment, after taking it for 14 to 16 days i totally got cured with Dr Iyayi herbal Medicine. I’m recommending you diagnosed with herpes should get this Herbal Medicine and be cured because his herbal medicine is guaranteed and safe and there is no side effect as well. contact his email; doctoriyayiherbalhome.org @gmail. com and you can as well whatsapp or call him via +2348162352979. I want you to know that Dr Iyayi also cures all kids of infections and viruses, including HIV.

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