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Archive for October, 2009

Laryngoscope Handles & Airway Box

EMFaculty, EMResidents:

When intubating using conventional laryngoscopy, all of the implements we use to intubate at Sinai are disposable, except one: the laryngoscope handle. The flow for the handle is as follows: after you use it, you clean it with a disinfectant wipe and put it back in the box. Note that the laryngoscope blades are disposable.
Of course after intubating, you also must replenish all the supplies in the airway box according to the label on the box lid, for the next intubation. All materials needed for the box are in the airway cart, upon which the boxes sit. Colorimetric capnometers are suboptimal for confirmation and should not be in the box; instead the in-line capnograph attachment should be stocked in the box and used. If continuous capnography isn’t working or is thought to be unreliable, colorimetric devices are available in the cart.
Yours,

reuben

Written by reuben

October 29th, 2009 at 5:36 pm

Posted in Airway

Bariatric Surgery Patients

If you encounter patients being admitted for weight loss bariatric surgery, all information regarding contact lists, pre-op work up, utilizing proper body mechanics, the surgery itself, complications and sensitivity to the patients can be found on the intra-net.
Go to home page- medical services-on left Surgery, then Bariatric Clinical Guidelines.
If you need a bariatric bed; ask your coordinator or go to Nursing P&P Bariatric
There will be a survey for the Bariatric Program Wed. Oct.28.

Written by phil

October 28th, 2009 at 7:13 pm

Posted in Admitting

NYCLIX Update

As mentioned in faculty meeting today, NYCLIX has fixed it’s consent model and there is now a flood of data available from outside our institution.  ~ 20% of the patients coming in our ED have data available from elsewhere, all you have to do is login and look for it.
 
Key Points:
 
1)Any patient who has been at any of the following sites in the last 8-12 months should have data available:
    -NYU
    -Saint Vincent’s
    -Saint Luke’s Roosevelt
    -BI
    -SUNY Downstate/UHB
    -VNS
    -Institute for Family Health (large federally qualified health clinic system)
 
2)The NYCLIX interface can be launched from the IBEX toolbar (mouse over the “all” and click “NYCLIX”)
 
3) Login IDs were created for those who were at the training session at our faculty meeting earlier this year.  Your NYCLIX login ID should be the same as your Sinai (msonsitehealth) login ID, but the NYCLIX password does not change.  If you need a password reset, please email me.
 
4)  If you didn’t go through the training earlier this year and need a login ID, please email me.  I will have an account created and we can schedule some time to go through the training and get you set up with a login.
 
5) If you use NYCLIX, please send me some feedback with the following points:
    a) Brief description of case
    b) What information was accessed in NYCLIX
    c) How did it affect your managment
    d) Any other compliments/complaints/comments
 
Finally, if you want any refreshers on using the system, or have any question, just grab me next time you see me, or shoot me an email.
 
Thanks,
-Jason

Written by phil

October 28th, 2009 at 4:39 pm

Mumps Alert

Today, the NYCDOHMH released an Alert describing an outbreak of mumps in Brooklyn.  Thus far, 57 confirmed cases of mumps, including cases among fully vaccinated persons, have been identified.  The full alert is attached and key points are noted below.  Please share this information with your colleagues and staff as appropriate.  This Health Alert will be posted on the Mount Sinai Infection Control website.

Thank you.

 

Key Points

1.      All suspected cases of mumps must be reported to the Bureau of Immunization (212) 676-2288 (212-764-7667 after hours).  [Mumps is characterized by acute onset of unilateral or bilateral tender swelling of the parotid or other salivary glands, lasting 2 or more days.  Complications can include orchitis, mastitis, oophoritis, deafness, and encephalitis.]
2.      In health care settings, patients with suspected mumps should be cared for using Standard and DROPLET PRECAUTIONS.
3.      Testing should be performed on all suspected cases.  Testing should include blood (for IgM and IgG antibodies to mumps) and a buccal swab for viral isolation.  [Please note that a negative IgM does not rule-out mumps.]  Notify the lab if sending a specimen for viral isolation if mumps is suspected.
4.      Suspected cases should be kept home for 5 days after the onset of parotitis.  Susceptible contacts should stay home for the incubation period (12 days to 25 days after exposure).
5.      It is recommended that healthcare workers born after 1957 receive 2 doses of mumps-containing vaccine (e.g., MMR) unless contraindicated.  Healthcare workers born before 1957 who do not have a history of mumps should receive 1 dose of mumps containing vaccine and, in an outbreak setting, a second dose of mumps containing vaccine should be considered.

 

 

David P. Calfee, MD, MS

Hospital Epidemiologist and Infection Control Officer

Mount Sinai School of Medicine

Box 1151

One Gustave L. Levy Place

New York, NY 10029

 

Phone: 212.659.9470

Fax: 212.849.2582

Pager: 917.457.0258

Email: David.Calfee@mountsinai.org

Written by reuben

October 23rd, 2009 at 12:27 am

Posted in ID

Respiratory Therapy Pagers

1. Respiratory Therapy has a designated emergency pager: 1112

Page 1112 first, at all times.

If that pager doesn’t get you the response you want, page the respiratory supervisor: 2244.

2. If you have any concerns about a respiratory therapist you’re working with, get his or her name and send me an email. I will bring it up with their leadership.

3. The hospital has approved two PB840 ventilators designated for the ED. These high end machines do mechanical ventilation and non-invasive ventilation well and are used in our ICUs. We are expecting to have the two-machine commitment deployed within the next month. When that happens, we will streamline our stocking so that all equipment in the ED will be for this machine and attachments for the half-dozen other machines you have seen floating around the department will be removed. This should greatly improve our stocking and facilitate emergency physician-initiated NIV and MV.

In the meantime, if you have any issues with respiratory stocking, email me.

reuben

Written by reuben

October 22nd, 2009 at 6:39 pm

2009-2010 Resident Composite

Written by reuben

October 21st, 2009 at 7:53 pm

Posted in Residents

Ultrasound Clarifications

Just to clarify some misconceptions:

1. Where are the ultrasound machines?

The machine labeled “Resus” should be kept near Resus, plugged in
The machine labeled “South 13” should be kept in South 13, plugged in
The same pattern is repeated for the machines labeled, “Peds 4” and “South 9”
Try to leave the vessel finder (the “S-Cath” machine) near Resus, or at least in some obvious, open location. When it is used in the back of a patient room for an IV and left there, the next user will have difficulty finding it.

2. Which gel should be used for the ultrasound machines?

“Ultrasound Gel” is for ultrasounds. It is optimized to conduct sound waves

“Electrode Gel” is for electrodes (like the defibrillator paddles). It is optimized to conduct electricity. When used with ultrasound it yields worse images, is hard to clean off the probes and patients, and often implies that somewhere there is a defibrillator without gel.

3. Who left the machine dirty?

We are actively investigating the “two guys” who leave the probes covered in gunk, unplug the machines, and hide them in the utility rooms while the rest of the ED staff are minding their own business. Until these perpetrators are apprehended, please be sure to leave the machine ready for the next person to use:

-Clean the probes with TranSeptic spray before and after each use
-Leave the machines in their proper location, plugged in
-Do not leave garbage, especially medical waste and sharps, on the machines

Thank you for your support,

Bret

Written by reuben

October 13th, 2009 at 9:47 pm

Posted in Ultrasound

Emergency Department Pharmacist Hotline

with one comment

EMFaculty, EMResidents:

An ED pharmacist is in the department Monday through Friday, 1p-9p.  Their primary responsibility is to make sure that long-stay patients get their most important medications, but they are available to assist you in a variety of other ways including medication questions and helping out in codes/thrombolysis/hypothermia/etc. A single phone number has been created that will reach the ED pharmacist on duty:

(347) 637-8476, that’s (347) 6-DRUGS-6.

You can also leave a voicemail that will be returned by the EDP at the next available opportunity.

Let me know if you have any questions or concerns.

reub

Written by reuben

October 13th, 2009 at 6:25 pm

Posted in Pharmacy

Discharging Patients

1. All pts must be discharged at the conclusion of their ED encounter. Peds pts at the peds desk, east at the east BA desk and adults at the specimen desk. (The south end of the desk).
2. All pts will be asked for co pay (if appropriate).
3. All uninsured pts will be asked for partial payment.
4. Please make sure yours pts have signed the dc receipt prior to arrival at the appropriate discharge area.
5. All pts should have documented follow up. –
6.  ima clinic will see all of our pts for first follow up visit if they have no other access to care.
Thanks
Kevin.

Written by phil

October 5th, 2009 at 4:52 pm

Discharge desk and co pays

Just a reminder about discharging patients:
1. All pts must be discharged at the conclusion of their ED encounter. Peds pts at the peds desk, east at the east BA desk and adults at the specimen desk. (The south end of the desk).
2. All pts will be asked for co pay (if appropriate).
3. All uninsured pts will be asked for partial payment.
4. Please make sure yours pts have signed the dc receipt prior to arrival at the appropriate discharge area.
5. All pts should have documented follow up. –
6.  ima clinic will see all of our pts for first follow up visit if they have no other access to care.
Thanks
Kevin

Written by reuben

October 5th, 2009 at 3:37 pm