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Beginning today we will be getting coronary artery calcium (CAC) scores
on some of our CPU patients who consent to participate in a study. For
you, this means you may have a research assistant approach you and ask
that a CAC study be ordered on a given patient. This is a non-contrast
CT of the heart that involves minimal radiation or time. It can be
ordered in the “ED Attending Only” order section in IBEX.

Thanks up front for your help- any questions let me know.

Luke

1.      Log on to sinai central

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5.      enter your sinai central password again

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7.      On right side, after a second, your stub should appear.

Hi all,
 
Since FDNY is now following our post-arrest hypothermia cases, it is imperative that we provide optimal care. Four points have come up over the past few weeks:
 
Who does not need hypothermia:
Poor baseline status is a contraindication to induction of hypothermia. Generally if the patient is > 75 y/o, debilitated and/or chronically in a nursing home, they are not a good candidate for hypothermia. A patient with baseline dementia is also not a good candidate. If you cannot ascertain the patient’s baseline mental function and they are >75, it may be better to err on the side of not inducing. These patient groups will not benefit from the thearpy and when they never wake up their inclusion leads to demoralization of the care providers.
 
When we were writing the protocols for NYC, we strongly considered making age over 75, regardless of level of function, a contraindication. We left it out b/c of the rare circumstance of the 80 y/o that looks like they are 60 and have an absolutely prisitine level of function. These patients are rare and do not live in nursing homes, they don’t have contractures, and they don’t have indwelling catheters. I welcome any thoughts or dissenting views on this point.
 
Time of Induction:
In patients who will benefit from hypothermia, it is crucial that induction starts as soon as possible. Every minute wasted decreases the benefits. Get a rectal temp to establish a baseline and then start iced saline right away. Do not wait for a-lines, central access, or any other procedures.
 
Probe Location:
It is all about the esophageal probe. Rectal probe location should only be used if the patient cannot receive a tube down their esophagus.
 
How to get the form:
As soon as ANY post-arrest patient comes in, go to ehced.org under protocols and ENTER THE PATIENTS MEDICAL RECORD NUMBER. This will take you to the form. Do this every time, do not use an old form you had stashed away. Do not enter random numbers just b/c you don’t want to find the MRN> This is critically important, please, please enter the real MRN in order to get the hypothermia instructions form. When the form is filled out, scan it in and then give the original to the ICU resident.
 
tutorials, articles, and videos are up at hypothermia.emcrit.org

Scott Weingart

Just to be clear- blood cultures are NO LONGER NEEDED for core measure compliance in pneumonia patients.
 
This is consistent with available evidence so you are no longer faced with deciding between good medicine and core measure compliance.
 
Continue to order blood cultures on the patients you believe are septic (regardless of source) just please, please, please… no more blood cultures on the routine PNA admit.

One additional point:
 
If you order and draw blood cultures after antibiotics are given the case becomes a core measure outlier so please discourage your medicine colleagues from ordering late blood cultures on admitted pneumonia patients…
 
Thanks,
 
Luke

Until further notice, if you are unable to reach AMAC through the regular number, try 718-786-8279.

Good evening, just a reminder about needlestick patients – we are able to obtain the results of the rapid HIV tests done on the patient  – it is in EDR – see below for details
in EDR – put in pt name/mr

Resident Menu
Date/Time: select: ALL DATA
Format: select: SHOW DETAILS OF ALL TESTS
Select: PROTECTED  (last on the pull down menu)
Click Get Data

thank you
Meika

The TIMI Guided ACS Protocol is now available here as well as the MI Flowsheet.

1. there is a reference in copies
2. there  is  an H and P in copies that must be filled out and scanned into the chart
3. after 5pm, and on weekend please contact the ID fellow for needlestick from an HIV+ source pt

thank you
Meika

Whoever is on for peds surgery is on call all the time, 6 days a week.  The exception due to 405 rules is Saturday (their one calendar day off per week).  From Friday midnight through Saturday overnight the general surgery resident on consult (the same person the adult side calls) is on for pediatric E.D. consults as well.  There is a designated person up to midnight friday, at 12:01AM its the general surgery consult resident.

standard pink IV:
20 gauge (.8 mm) x 30 mm angiocath
max flow rate = 60 ml / minute

standard green IV:
18 gauge (1 mm) x 30 mm angiocath
max flow rate = 105 ml / minute

standard grey IV:
16 gauge (1.3 mm) x 30 mm angiocath
max flow rate = 220 ml/min

procedural IV:
18 gauge x 64 mm angiocath
max flow rate = 85 ml/min

medial (blue) & proximal (white) lumen of triple lumen catheter:
18 gauge x 190 / 180 mm
max flow rate = 26 ml/min

distal (brown) lumen of triple lumen catheter:
16 gauge x 200 mm
max flow rate = 52 ml/min

cordis / introducer:
8.5 french (2.8 mm) x 100 mm
max flow rate = 126 ml / minute
max flow rate with pressure bag @ 300 mmHg: 333 ml / minute

Patients with HIV who do not have primary care should be referred to the Jack Martin Fund Clinic.

NB from Andy: all needle sticks / body fluid exposures must have a body fluid form filled out and scanned into the record.  The forms can be located under copies > MD Forms > Needlestick H&P and Needlestick Reference.