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Archive for September, 2008

Spinal Cord Injury Protocol

We are the spinal injury receiving center for the Jets and the protocol has them coming thru the ED. I have attached a brief synopsis. Talk to Amish or Sigrid about this weekend experience and see Amish on You Tube towards the end of the recording.

Jets Spinal Injury Protocol.

MSH has a new protocol with the jets medical team through Dr Andrew Hecht of orthopedics (spine) to handle all Jets home game player spine injuries. Below is a summary.

On-Field Medical team:
Emergency Physician
Team doctor
Paramedics
Trainer

On Field Capabilities:
RSI Intubation
ACLS
Immobilization
Plain film imaging
Clear spinal injuries will have no imaging before transport

Transport by on-field medical team by ground:
BP control to prevent hypotension
High dose steroids (emcrit)
Hypothermia not part of protocol at this point.

Notification to MSH Upon transport from stadium:
MSH ED: ED Director, A Jagoda, and North attending
Dr. Andrew Hecht of spine ortho or designee
Neurosurgery
Radiology

Arrival at Mount Sinai ED
To be overseen by ED attending on duty
Will be a coordinated multidisciplinary attending driven effort.
There may be public and media attention
Jets PR people will handle all media relations

Written by phil

September 29th, 2008 at 8:33 pm

Posted in ED Guidelines,Trauma

ED EKGs

The south zone attending (the shift formerly known as E.s now ECG.s) needs to sign any unsigned ECGs, located in the red folder under the ECG bin on the specimen desk. There are usually about 10 a day that fall thru the cracks. These need to be signed so the ED can bill for them. You may date the ECG on your date of read, and if, rarely, you find something ominous, check the chart to make sure it was picked up.

Written by phil

September 29th, 2008 at 8:29 pm

Posted in ED Guidelines

ED Pharmacists

Written by phil

September 26th, 2008 at 4:05 pm

Posted in Pharmacy

ID Approval

You can find the list of meds needing ID approval from the intranet (it took me a while but it’s here). The formal approval process is also described, but summarized below:

From 9-5 if a drug needs approval, page 9407 for adults, 3737 for kids. After hours, fill out the form from IBEX and send it to the inpatient pharmacy, at tube station 39. Drugs that require waking up an ID specialist include amphotericin B, capsofungin, tigecycline, daptomycin, linezolid, and for peds: IV vanc and IV acyclovir.

Written by phil

September 26th, 2008 at 4:04 pm

Posted in ED Guidelines,ID

Emergency Resident Composites

Written by phil

September 24th, 2008 at 5:40 pm

Posted in Residents

Emergency Department Intubation Checklist

Written by reuben

September 16th, 2008 at 10:55 pm

Posted in Airway

MICU Admission Criteria

Written by reuben

September 16th, 2008 at 10:30 pm

Posted in ED Guidelines,ICU

Capnometry Guidelines

Written by reuben

September 16th, 2008 at 10:28 pm

Posted in Airway

Online Death Certificate

Reminder: When there is a death in the ED between 8a-5p, call Medical Records and they can send someone to help enter info into the online death certificate system.  After hours, try to use the system (tutorial below) and call administrator on duty if you need help.

How to complete the death certificate online:

0. Use Reuben’s excellent offline PDF Tutorial or…
1. Go to “Start” menu on rightmost computer facing RESUS
2. Select “DAVE” application
3. At login screen:

  • Username: mtsinai
  • Password: mtsinai

5. Select “EVERS”
6. Select”Life Event”
7. Select “Death”
8. Select Start/Edit New Case
9. Fill out pages in sequence:

  • Fill in Red Fields
  • Validate each page
  • Hit “next” after validation
  • Press F12 for current date
  • Do Not Abbreviate Cause Of Death

10. At biometric thumbprint entry, PUSH HARD (worked for me).

To print actual certificate:

  • Go to “Death”
  • Life Events
  • Locate Case
  • Enter Patient Name
  • Search
  • Click Patient Name
  • Go to Forms
  • Print Form (Nursing Administrators have special legal sized death certificate form which makes it official).

To obtain your password/thumbprint authentication – please call: Norfortiria Grant 49629 or Joshua Rochard 32505.

Written by reuben

September 16th, 2008 at 10:26 pm

Posted in Death

OB Policy

Written by reuben

September 16th, 2008 at 10:13 pm

Posted in ED Guidelines,OB/GYN

Pain Policy

Written by reuben

September 16th, 2008 at 10:09 pm

Stroke Protocol

Written by reuben

September 16th, 2008 at 10:04 pm

MS IV Students

Written by phil

September 16th, 2008 at 3:40 pm

Posted in Students

Nocturnal Angioedema

From Dr. Jagoda.

There is a patient with an interesting case of nocturnal angioedema whose allergist is at NYU but the patient lives around the corner and comes to Sinai with acute events. Her allergist has been unable to capture an underlying etiology and so has been trying to get a serum Tryptase and Complement level during the event. Twice the patient has presented to our ED and has given the note from her MD requesting these labs and both times was told we don’t do these tests in the ED . . . which is true but in this case there is a reason to do them.

Please send the tests requested if a patient with similar complaints presents in the near future.

Written by phil

September 15th, 2008 at 9:34 pm

Posted in Allergy

Trauma Policy

Written by reuben

September 11th, 2008 at 9:20 pm

Posted in ED Guidelines,Trauma

Rabies Vaccine Shortage

ID Consult now required for Rabies Vaccination.

From Ruben Olmedo:

The Antibiotic Monitoring Group / P&T committee asked me to forward the attached DOH alerts regarding the rabies vaccine shortage to the faculty. Because of this shortage (~20 doses left in the hospital) , they would like ID consult to be called on cases that may that need vaccination. And if it is used, they will need the password given by the DOH for replenishment of the vaccine to the hospital by Novartis.

Also – earlier email:

Notify Local Health Department if considering immunization/pep @ 212-788-9830 or 212-788-4160 or after hours @ 212-764-7667.

Written by phil

September 4th, 2008 at 2:27 pm

Posted in ID