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Archive for November, 2008

Near Miss Form

Written by phil

November 25th, 2008 at 11:09 pm

Posted in Near Miss

Updates

East zone: the zone formerly known as UC, now changed in Ibex.  The bed numbers are a continuation of the AED bed numbers, i.e. 23, 24, 25…

Discharge Desk: The discharge desk for adult has now moved to the specimen desk from 12MN to 8AM.  No more trips to the hallway.

Stocking:  we have started a new electronic accountability program for stocking.  Please send me any stocking problems that you find, especially any critical inadequacies.

Thanks – Scot

Written by admin

November 25th, 2008 at 9:24 pm

LVAD Info

If a patient arrives with LVAD; Call Director on call 24/7-212-241-1000 immediately.

  • Plug in external battery pack into AC outlet
  • No chest compressions

Left Ventricular Assist Device

What is a left ventricular assist device (LVAD)?

The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. A left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that’s surgically implanted. It helps maintain the pumping ability of a heart that can’t effectively work on its own.

These devices are available in most heart transplant centers.

When is an LVAD used?

This device is sometimes called a “bridge to transplant.” People awaiting a heart transplant often must wait a long time before a suitable heart becomes available. During this wait, the patient’s already-weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can help a weak heart and “buy time” for the patient.

How does an LVAD work?

A common type of LVAD has a tube that pulls blood from the left ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively helps the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the abdominal wall to the outside of the body and attached to the pump’s battery and control system. LVADs are now portable and are often used for weeks to months. Patients with LVADs can be discharged from the hospital and have an acceptable quality of life while waiting for a donor heart to become available.

LVAD SetupLVAD Setup

Written by phil

November 21st, 2008 at 2:34 pm

Posted in Cardiology,JCAHO

HIV PEP – 2 options

with one comment

NB.There are two different packages of HIV PEP (Kaletra and Truvada) in the Pyxis—a 5 day supply and a 1 dose supply.

Use the single dose HIV PEP for needlesticks and body fluid exposures where the SOURCE

patient is known, consentable  and can have rapid HIV testing return within few hours, ie. Inpatient at Mount Sinai and patient or surrogate can give consent.

ALL other patients who have a significant exposure within the 36 hour time frame, unknown source or unavailable source—this would include sexual assault patients—should receive the 5 day starter HIV PEP and be referred to the appropriate area for follow up—EHS (employees

off for the weekend who cannot return until Monday), sexual assault survivors, etc go to Jack Martin Clinic or Adolescent Health depending upon age.

The reason for 2 different packaging methods is cost—the majority of needlesticks from inhospital known source can get rapid HIV testing (and this is usually negative and the rest of the 5 day course is wasted. If the employee is exposed to KNOWN positive patient, consider ID consult to see if this regimen is best and give 5 day course with referral to JMC.

Thanks for you attention!

Barbara Richardson

Written by reuben

November 17th, 2008 at 8:59 pm

Posted in ID,Needlestick

Ophthalmology Consults

Procedure- Emergency Department (ED).

Stable Patients
I. For the ED patient that is stable and presents with a chief complaint of an eye problem and will also be discharged. The following referral process must be followed:
i. The emergency department will contact the ophthalmology clinic on 8east of the Center for Advanced Medicine (CAM) at 212-824-7653 or 7655.
ii. The ED will provide the clinic physician with pertinent information related to (1) chief complaint and (2) any actions and/or interventions undertaken in the ED.
iii. The patient will be discharged from the ED and directed to the CAM building with a consult form.

Emergent Patients
II. For the ED patient that requires an ophthalmology evaluation in the ED (i.e. trauma or eye injury) or is unable to ambulate to CAM. The following process will be followed:
i. The ED will contact the ophthalmology resident via beeper # 917-641-1556 during the hours of 8:30-5p Monday, Tuesday, Thursday, Friday and 12:30p-5p Wednesday.
ii. After hours, weekends and holidays, the ED will contact the page operator for the on-call ophthalmology resident.
iii. The resident will come to the ED and provide the necessary ophthalmology evaluation and treatment.
iv. The ophthalmology resident will transport the patient to Annenberg 2 if needed and return the patient back to the ED.

Admitted Patients
III. For the patient that present to the ED and is admitted for a diagnosis unrelated to ophthalmology but has an eye condition that requires an eye consult (i.e. CVA). The following procedure is followed:
i. The admitting physician will order an ophthalmology consult during the admission process.
ii. The referral will follow the inpatient ophthalmology referral /consult process outlined below.

Written by reuben

November 17th, 2008 at 8:55 pm

Cardiology Update

1. there are no curbside consults to fellows for potential acute mi cases.  if there is any suspicion, any suspicion, call amac to activate the system, ie: 7 am to 10 pm m-f amac calls directly to the cath lab; after 10 pm amac calls the cath attending cell phone.
2. if you have a patient with an acute mi, call amac to activate the system, ie: 7 am to 10 pm m-f amac calls directly to the cath lab; after 10 pm amac calls the cath attending cell phone
3. if you want to directly call the cath lab, thats ok, but also let amac do their thing
4. for acute mi, conversation with the cath attending should be ed attending (preferred) or senior resident to the cath attending – no junior resident nor intern should be presenting to the cath attending – one more time – conversation with the cath attending should be ed attending (preferred) or senior resident to the cath attending – no junior resident or intern should be presenting to the cath attending
5. if you have a nonacute cardiac patient and need to discuss with eps ccu or cath fellow, call amac and be explicit exactly who you want – this is only for nonemergent patients.  if amac has not idea who is on, tell them to go to “amion” and on the far right click on “amion” and then password is “mscardio”
6. when you call an attending for an admission please make sure you have a clear concise assessment and plan

Written by admin

November 11th, 2008 at 2:34 pm

ICU Evaluation and Consultation

Written by phil

November 4th, 2008 at 3:09 pm

Posted in ICU