Allan Platt

Can you recognize a patient at risk for a hypercoagulable state

&NA; EARN CATEGORY I CME CREDIT by reading this article and the article beginning on page 39 and successfully completing the posttest on page 44. Successful completion is defined as a cumulative score of at least 70% correct. This material has been reviewed and is approved for 1 hour of clinical Category I (Preapproved) CME credit by the AAPA. The term of approval is for 1 year from the publication date of December 2008. Describe the elements of the clotting system Review the workup of excessive clotting, with special focus on laboratory evaluation Outline the differential diagnosis of hypercoagulable states using “5 Ps Had Caused Clots” Know the treatment of hypercoagulability, including lifestyle modifications and medications A disrupted clotting system can lead to life‐threatening thrombosis. PAs can use a simple mnemonic to remember the differential diagnosis for hypercoagulable states.

Understanding and treating disorders of the clotting system.

&NA; PAs must have a working knowledge of the intricate and complex clotting cascade in order to successfully diagnose and treat common bleeding disorders.

Put a PDA in your practice for easy access to current medical information.

&NA; Rapidly growing medical knowledge demands that PAs and educators be familiar with the latest equipment and software and that students learn to use these tools early.

Have-a-Disease Workshop: Teaching Evidence-Based Medical Interviews Using PDAs

2006 Vol 17 No 3 | The Journal of Physician Assistant Education INTRODUCTION The best way for physician assistant (PA) and medical students to learn how to do the medical history is to practice with multiple patients with some observed supervision. The ideal learning environment would include trained standardized patients in mock clinical exam rooms with video camera capability. However, most medical programs do not have these expensive resources or an unlimited number of clinical patients with preceptor supervision. As a result, the parts of the medical history and techniques that facilitate good patient communication must be taught in the classroom. Students need to practice these skills in a controlled environment with feedback, so should be taught history skills very early in the curriculum to help them refine their techniques over time. To do an efficient patient interview, students require a quick reference to review the differential diagnosis of the presenting problem. Students also need to learn how to develop lifelong learning skills to keep up with the rapidly changing knowledge base of medical information, treatments, and guidelines. Textbooks can be obsolete and outdated as soon as they are printed. However, many electronic references can continually provide up-to-date information. There are many excellent electronic tools and services available to bring the latest treatment and study summary information to clinicians via the Internet—to PCs in the office or to personal digital assistants (PDAs) at the bedside. PDAs can store the equivalent of 100 large textbooks, for immediate reference. Most of these references are purchased as annual subscriptions with periodic automatic updates. Students and teachers alike need to become familiar with these new tools that will be their primary information sources in the years to come.

Developing Champagne Medical Multimedia on a Beer Budget

Feature Editor’s Note: Often our perception of technology is futuristic and specialized. Many faculty find today’s mainstream computer hardware and software can be useful for day to day teaching tasks, but they also find many advanced specialized applications too complicated. Allan Platt, PA-C, is the program coordinator of the Georgia Comprehensive Sickle Cell Center at the Grady Health System, and a clinical instructor at the Physician Assistant Program at Emory University School of Medicine in Atlanta, Georgia. He takes us back to computer technology basics in this article, where he explains in non-technical language how to approach using multimedia to enhance basic teaching.—Richard Dehn Allan Platt, PA-C Emory University School of Medicine, Atlanta, Georgia

Managing sickle-cell pain…and all that goes with it

Sterling Jackson, 21, who has a history of sickle-cell anemia, is admitted to the medical/surgical unit from the emergency department (ED). He developed severe pain in his chest, arms, legs, and back about 10 hours ago. After 4 hours receiving intravenous (I.V.) nalbuphine (Nubain), ketorolac (Toradol), and hydration in the ED, he still rates his pain as 6 on a visual analogue scale, and his blood work shows worsening anemia from his baseline level. The most common genetic disorder in the United States, sickle-cell disease affects about 70,000 people. Although most common in African-Americans, it also affects people whose ancestors came from parts of the world where malaria is endemic. Having one sickle-cell gene (known as sickle-cell trait) provides some protection against malaria, but having two causes sicklecell disease. Years ago, people with sickle-cell disease died in their teens. Today, with improved education and treatment, some live into their 60s, but they’re susceptible to sickle-cell crises all their lives. In this article, we’ll explain what’s causing Mr. Jackson’s problems and how you can help him through the crisis.