All posts by pamoments

About pamoments

Im a mom, wife, daughter, friend, a DIYer and a PA.

FOOSH injury

FOOSH Fracture

These 2 images are from the same patient who had a FOOSH event. This patient Fell On Out Stretched Hands. A FOOSH event commonly results a Distal radius fracture. This is also known as a Colle’s Fracture. The image also shows angulation and a small ulnar styloid fracture. Obvious Deformity was observed. When evaluating these patients always ensure Cap refill and pulses are present as well as Range of Motion. This particular patient had cool fingertips with a delayed cap refill. Then I compared the temperature and cap refill to the other hand. It was the same. Always make sure to compare both extremities when evaluating a patient. The patient did have a strong pulse, but was just cold. Range of motion was obviously decreased but the patient did very well regardless of pain.


Reduce the deformity and splint via a sugar tong and sent to ortho the next day. Ortho might appreciate a heads up though. If you suspect a vascular injury or compromise – immediate ortho consult is required.

You can either perform a Hematoma block for pain with oral/ IV medication or you can chose Conscious sedation. I prefer a Hematoma block as it is relatively less invasive than sedation and an easy procedure to perform. Once the patients pain is under control you can manipulate (usually with your finger on the dorsal surface of the hand where you feel the step off) the injury back in place.

Prior to reduction make sure you have a tech or someone with you who has appropriately measured the length of the patients arm and all the splint supplies ready to be applied after you have reduced the injury. You will have to hold the reduction in place until the splint has been applied appropriately.

Some providers prefer to use finger traps to help with placement of the bones post hematoma block. This is a providers preference. I personally find it helps with the reduction and sometimes the break will reduce on its own without manipulation.


Popcorn Hack

So, I prefer my popcorn on the stove with oil. Don’t get me wrong the popcorn bags are DELICIOUS! However, they can be a big fatty and honestly COVID has added to my waistline. The best I can do, because I have tried, is maintain the added 10 lbs. Yes, I could get the low fat or Skinny version but it tastes funny to me. So I figured, the bagged popped corn is litterally in a BAG. So I decided to try it JUST in a BAG.

  1. Paper Sandwich bag.
  2. Popcorn
  3. Salt/sugar
  4. Microwave

YES! It worked!

I put 2-3 tablespoons of popcorn kernels in the bottom of the paper bag and folded the top of the bag.

Then I microwaved the bag for 2 1/2 minutes until the kernel slowed/stopped popping. I did stay by the microwave as I have never done this before and didn’t want to smell burnt popcorn or bag all day. But YES! it worked. It was a little bland of course due to the lack of salt, butter or sugar. But you can doll it up anyway you like. Enjoy!

Covid 19 and its effect on Physician Assistant Education and future.

Elizabeth Massey, PA-C

Corona virus 19 first entered the US via social media and its effects on Wuhan, China. As an emergency Medical Provider and PA school educator I first thought, “Uh, Wow! That sucks.” Never did I think the virus would spread to the states. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and decrease in food supply and the fear of leaving their homes. This was startling and surreal to me even though I was not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Surely, we the smart people of the United states would learn from the other countries in the fight against this virus.

As a full time, Physician Assistant Educator and a part-time PA in the ER, I had colleagues at the CDC who related how BIG this was and knew the shutdown was coming soon in the US.

But did the US really shut down? No. It was left to local government with different opinions on the severity of the issue. I digress.

The PA school where I was busting my hump went virtual about a week and a half before finals. My world changed in more than one way – as I’m sure it did for many others. I was now a virtual educator full time.  I chose to furlough my part time position in the ER. My ER colleagues needed all the hours they could get to help support their families. The full time ED employee hours were shortened to 10 hours a month. Other facilities and companies were reducing the hourly or salary pay and cutting hours. I commend the ER staffing company I was and am working for with how well they treated all their employees during this hardship.

Meanwhile, I was learning new online platforms like zoom, and trying to figure out HOW we could test students while still maintaining test integrity. Special testing was required and still is – and this costs schools money that was not previously used on testing.

In a medical program it is important to learn physical skills. Skills like how to properly examine a patient, or how to perform certain procedures. This became exceedingly difficult and time consuming. As if working 50-60hrs a week in a medical program was not enough.  Now there was the extra time factor of staggering 8 students at a time in a lab (masked and gloved). Once the students left all the equipment and the room was disinfected.  Do not forget to add the wait time so the disinfectant could dry. Repeat for the next set of students. This was done for every class that required a lab. Labs that usually took 2 hours for a group of 40 students now took almost 2 days to complete.  This took one instructor out of the mix for 2 days’ worth of normal teaching and preparing. One might say it was a big change for schools and students. But this was only the didactic troubles medical programs were having.

The Clinical aspect of learning medicine was impacted the most by Covid 19. At first, only ER rotations were affected. Before long Clinical sites all around the country were cancelling their rotations, and some schools were pulling students out of their rotations. There were national meetings on how to keep the students in their sites or how the student could still get their required patient care hours, so graduation time was not altered. Rotations were shortened, flipped, changed, and postponed. The hardest hit rotations were the rotations that occurred in hospitals: Emergency Medicine, Surgery, OBGYN, or any Inpatient rotation. Then there were facilities that were just concerned for lawsuits should the student become Ill. There were very few rotations that allowed PA students to rotate and many of those required a N-95 mask. As the country is aware, there was a PPE shortage. Honestly, there is still – As I have ONE N-95 in a brown paper bag that I use when I am on shift. There were preceptors who simply didn’t feel comfortable with a student now. Some of the prior preceptors were furloughed or relieved of their duties entirely. Now there were fewer preceptors employed in general, and Many willing preceptors found themselves at facilities that were not.

There was a point when our program only had around 10 students on rotation while the other students were to study or do CME until a rotation became available. How would we decide which student would be allowed to graduate on time and which would not?

A few months later some facilities gradually began letting medical students back into certain rotations only. Hospital rotations were still a problem, but then Physician Assistant students began to have another problem. Select facilities would only allow Medical students or Medical students and Nurse Practitioner students, but not Physician Assistant students. Physician Assistant students are trained via the same model as Medical students and not the nursing model.  Thankfully, schools have learned ways around these difficulties, but many providers are burned out from Covid 19.  As Physician Assistants graduate, they will have a difficult time finding jobs as the market is saturated due to the layoffs of Physician Assistants and Nurse Practitioners. Now many of the positions available are Covid related–precisely what many facilities were preventing these very students from learning.  Some employers chose to only interview Nurse practitioners because of the autonomy level they have in some states – they do not need a physician to independently practice.  Now, 7 months later, some facilities are keeping Physician Assistants students out and will until spring of 2021.

What does this mean for the future of Physician Assistants? New graduates will have a difficult time finding employment and may not be as ready as they could have been due to reduced patient contact. Previously employed PA’s will have a difficult time finding employment with the pay they previously had. Nurse practitioners will continue to have a better lobby for themselves then PA’s will – which will make employment easier for them -thus driving PA pay down with it. Again, I digress. Physician Assistants around the country need to join together and help the students and schools still struggling to find meaningful rotations and Physician Assistants need to join together with their local Chapters to help fight for a better PA lobby for our profession. Don’t forget we can PIVOT in any direction- good or bad. Let’s pivot up!

PA skills and motherhood at it finest

Today, my son needed his bulbasaur (Pokémon) stuffy sewn. I’d rather use a sewing machine but I’ll take a few stabs at it by using my suturing skills. The simple running stitch was used in this superficial repair. And since I didn’t have my forceps I decided not do a non traditional knot tie by burying the thread underneath and going backwards.

A cancerous lesion

Squamous Cell Carcinoma

The pictured wound is post biopsy. 
67 year old Female previously had an injury that healed. About a month later, this growth occurred. It itched with mild discomfort. Present for about 4-6 month prior to biopsy. 
Biopsy results: Squamous Cell Carcinoma.
Patient treated with the Mohs surgery and doing well. 
Squamous Cell Carcinoma (SCC) is an overgrowth of abnormal Squamous cells. Usually progresses quickly but curable with appropriate treatment. SCC can metastasize to other organs.

Good company in a journey makes the way seem shorter. — Izaak Walton