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Archive for January, 2009

Dentistry / Dental Referrals

we have been trying to improve flow of dental patients up to dental and avoid keeping their charts open while they go for a consult
for bureaucratic reasons they can not simply be directed upstairs without first receiving a screening evaluation which currently can only be done by a pa or md (this will hopefully change)
between 8 am and 3 pm, patients with a dental complaint should receive an expedited screening evaluation, discharged from the ed and sent to dental.
between 8 am and 3 pm, patients with dental complaints should be quick registered, quick triaged, and seen by an md or pa who confirms that the problem is dental and stable.  minimal documentation is needed in ibex.  the patient is then discharged with an instruction sheet directing them to the dental clinic, annenberg, second floor.
please be proactive with these patients and help them through the system.
thanks
andy

Written by reuben

January 30th, 2009 at 5:57 pm

Coronary Calcium Scores

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

Written by phil

January 29th, 2009 at 12:49 am

Posted in Cardiology

Viewing Pay Stub

1.      Log on to sinai central

2.      Hit Home

3.      Hit employee self service

4.      Hit payroll on line

5.      enter your sinai central password again

6.      on left side- hit view

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

Written by phil

January 23rd, 2009 at 9:00 pm

Posted in Finance

Induced Hypothermia Update

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

Written by reuben

January 23rd, 2009 at 8:59 am

Posted in Hypothermia

No more blood cultures for PNA patients

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

Written by reuben

January 23rd, 2009 at 8:58 am

Posted in ID,JCAHO

AMAC 10 digit number

Written by reuben

January 20th, 2009 at 4:07 am

Posted in AMAC

HIV Test Results Access Through EDR

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

Written by reuben

January 17th, 2009 at 3:32 am

Posted in ID,Needlestick

Acute Coronary Syndrome (ACS) Guidelines

Written by phil

January 16th, 2009 at 9:34 pm

Posted in Cardiology

Reminders about Sinai workplace needlestick

Written by reuben

January 13th, 2009 at 2:21 am

Posted in Needlestick

Pediatric Surgery Consults: Saturday Night

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.

Written by reuben

January 7th, 2009 at 5:13 am

Posted in Consults,Peds

IV Flow Rates

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

Written by phil

January 7th, 2009 at 4:04 am

Posted in Pearls

Discharge of HIV patients

Written by phil

January 2nd, 2009 at 4:58 pm

Needlestick Procedures

Written by phil

January 2nd, 2009 at 4:57 pm

Posted in Needlestick