 Hey guys, okay so I want you to pause this video right now and go directly to my comment section and write whatever question you may have about my first week as a trauma PA, general surgery PA because what I'm going to do this Sunday is go through this video's comments and all the other videos comments and look at all of your questions and do a quick Q&A for you guys on my Sunday video. So go do that right now and then come back to the video and I can absolutely answer one of your questions right now and that question was will I still be doing videos on my channel even though I'm no longer a PA student? Of course I am. Yes, I'm absolutely going to do those videos. I'm not only going to continue to do my Sunday videos but I'm also going to give you guys a weekly story time update of my journey as a trauma general surgery PA. So make sure that you subscribe right now for my channel because I will be doing more videos for you guys as I continue on this journey. What's up you guys and welcome back to my channel. So we are in day five this is the last day of my week of being a full-on trauma PA slash general surgery PA and so I just wanted to talk to you about what happened today. So one of the traumas that I got to see was actually pretty cool though because although the mechanism of the injury wasn't really super significant it was just like a fall from maybe like one stair or something like that like just very low height. The injury itself was actually like pretty interesting because when I was in PA school and we were learning about reading x-rays and looking at CT scans of orthopedic injuries one of the injuries that we talked about and like was trying to figure out and see okay what is this injury was a trimalleolar um trimalleolar fracture. So it's a fracture of all the malleolers um in your leg right in your by your ankle. So on your fibula um on the tibia the two different ends and this patient had that which was actually pretty cool to pick up on and see. So it was like something that you kind of hear about like a little like red robin I guess you could say or goose egg it's like oh okay like I've heard about this before but I've never really seen it in practice and now I have so that was cool to see it was like a really nice little thing and I was like oh yeah this is fractured it looks like a trimalleolar fracture and it's displaced and I was like oh once the reading came back I felt kind of good about myself because it's like all right yeah okay so you did learn some things there are some things that you are still retaining. Another thing that I got to see which was actually pretty cool and these are like the two interesting things that happened so that's why I wanted to tell you about it. If you do want to keep hearing about you know my time throughout like working as a PA in trauma and general surgery please go ahead and subscribe because I will be starting to make more videos about this as I continue on um in my PA journey and you can also like this video because that's going to help my channel out a lot but the other thing that happened to me um on this shift was that I got to see a medication used in a kind of like off-brand way so I know like if you've been following my channel you've seen my bubble maps that I make um and one of for pharmacology and one of the bubble maps that I made was like your um sympathomimetics and sympatho or parasympathomimetics parasympatholytics um so it was talking about uh your cholinergic and your anticholinergic drugs and so just learning the difference between those and basically like their side effects was something that we need to learn for PA school and just in life um and using these drugs and one of those drugs that I learned about was neostigmine and so neostigmine is typically used for my gravus because it is an anti acetylcholinesterase so inhibitor so it inhibits acetylcholinesterase at like the junction and so if you know anything about mycine agravus there's a lot of acetylcholin cholinesterase and so you need that inhibitor and learning about that we know that it also gives a side effect of sludge um so salivation, lacrimation, urinary retention, um what's the D diarrhea, GI upset, emesis so like vomiting and meiosis so that is what this particular drug does but it's used for mycine agravus but today we used it to help someone that could not go to the bathroom that was severely distended like stomach super firm tight um and gassy and impacted with the valve go to the bathroom and I was like what like I've never heard of this before but like the doctor just like pulled it out of the air this particular um surgeon I was like wow I mean I've never heard of using it as that I mean obviously this is my first week of being a PA but at the same time it's cool to see kind of these off-brand uses for these drugs so if you know anything about neostigmy it also causes bradycardia so it brings down the heart rate and it can cause like brazo um bronchospasms so it's important that you have the antidote which is atropine right so when we were giving this uh this particular patient the drug we have to like severely monitor their heart rate um and their blood pressure because uh it causes hypotension as well so I was just there like standing like looking at this person's heart rate and looking to see if it's dropping and you're just kind of like pushing it over time like because you don't want to like give a big push and then all of a sudden the heart rate just plummets and then you know you're in this really bad situation with this patient so we're just like pushing the drug over time but at the same time monitoring the heart rate which was cool um because you got to see the heart rate kind of like dip a little and then come back up and then dip a little and come back up this particular patient like maybe the bronchospasms were kind of kicking in and so like anxiety kind of hit a little and so we saw although the heart rate was still stable and all of their vital signs are stable like we felt like okay you know like they were kind of panicking a little and maybe at the same time like it it wouldn't have been a good outcome so we gave atropine um which calmed the patient down kind of took the edge off of the neosigmine a little but we still had more to give and so once we finished that like they were okay and they like defecated and it was great I mean like defecation in and of itself is not like this great to-da moment but like imagine the relief that this patient got because they were so distendent like their stomach was severely significantly different after the use of that drug so that is what um I learned and I saw today and I will never forget that anymore that hey we can use this drug um to you know have this effect but at the same time make sure that you're watching for the bradycardia so that was it today um you know interesting week that I've had uh hope you guys have enjoyed learning with me and recapping my week with me like I said I will continue to do at least one of these videos um you know weekly as I continue to work uh as a PA in trauma and general surgery and if you guys have any questions for me um please leave them in the comment section below I really appreciate each and every one of you thank you so much for watching I will talk to you guys next time