Rapid potassium repletion in a pericoding patient with severely low K of 1.5 due to mismanaged DKA at outside hospital. How fast would you replete it? What is the fastest you have ever repleted K?

[u/Little_Blackberry588]

I repleted 40 meq via central line in less than an hour, bringing it up to 1.9. The pharmacist is reporting me for dangerously fast repletion. What I can tell you is the patient was able to breath much better shortly after the potassium was given. Pretty sure the potassium was so low he was losing function of his diaphragm. Any thoughts from docs or crit care who have experience with a similar case?

[u/pshaffer]

There must be a final decision maker - one who can weigh all factors, and make the best decision among difficult choices. That is the physician. Physicians are deeply trained precisely so that they CAN go beyond algorithms. Physicians MUST overrule the non-physicians who haven't seen, talked to, or examined the patient

NPs worship the Algorithms (AKA evidence based medicine) and when, as is inevitable, almost every patient at some point gets outside of the patient population described in the EBM paper, someone has to know what to do. And not be befuddled by the fact that their patient who has chest pain does not describe the chest pain precisely as angina is defined in the text books. Or be confused by the 28 year old with cardiac-like chest pain, who was told to go home because he couldn't be having a heart attack, he was too young. He was having post-viral pericarditis.

[u/ProcyonLotorMinoris → u/pshaffer]

Literally no one was talking about APPs. You sound like you frequent r/noctor

[u/pshaffer → u/ProcyonLotorMinoris]

the discussion was about non-physicians making medical judgements and criticizing physicians based on their limited view. I do oppose poorly trained people being allowed to practice medicine without supervision. A totally rational point of view. I also support NPs and PAs being used within the limits of their training, just like physicians practice within the limits of their training. You don't see oncologists physicians practicing as neonatologists, however, NPs are free to do so:

https://www.patientsatrisk.com/podcast/episode/7e7ae04d/my-newborn-baby-required-a-rapid-response-the-np-that-showed-up-had-just-rotated-with-me-on-the-adult-hemeonc-service

Your response implies you may support unlimited scope for non-physicias. I hope not.

[u/ProcyonLotorMinoris → u/pshaffer]

Oh wow, looking at your profile you are a literal lobbiest against APPs. Honestly gives some bot vibes too. Well, enjoy your agenda.

[u/pshaffer → u/ProcyonLotorMinoris]

BOT? seriously?

I am a citizen. A physician. I get no money - so not a lobbyist. I see patients being abused by NPs practicing outside their scope. I am heartsick over this. And I do something. Is a person who has experienced child abuse and speaks to legislators about stopping child abuse a "lobbyist"? What I am doing is no different.

ANd you didn't answer the question of whether you support unlimited scope for non-physicians. A significant omission

I looked at your profile also, and saw you were appropriately appalled at this situation:

"When I was in a light duty position for a few months after a surgery, I met another light duty nurse from postpartum. She was one of the dumbest nurses I have ever met. She has zero critical thinking and couldn't recognize lethal rhythms, yet after one year in nursing (most of which was light duty) she was in NP school. I said "Wow, that must be really difficult. How are you still working while doing that and having a baby at home?" She said "Oh no, it's super easy. It's all online and I don't even really listen to the zoom lectures." Sooooo I'll look her up in a few years and stay far, far away from wherever she is."

THIS IS PRECISELY WHAT I THINK SHOULD BE STOPPED. You can stay away from her, but there will be patients who think she is well trained, that is what the AANP propaganda puts out on their advertisements. These patients may consent to be treated by her, being totally unaware of her inabilities. Patients should have information and also should have a choice to be seen by the most expert person.

I am not the enemy here, You and I seem to agree that patients deserve good care. You can see the problem as well as I can.

And I will always stand by those statements and never be embarassed about advocating for patients.

(BTW - I know that about 95% of NP students hold a full time position during the time they are in school. 0% of medical students do. Who is more dedicated? Who will learn more? The answers are obvious)