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Archive for January, 2011

Donations to the Peds ED

Written by reuben

January 31st, 2011 at 10:09 pm

Posted in Peds

NG Tubes / OG Tubes

1.  Intubated patients should have OG tubes placed in preference to NG tubes when possible, as there is no benefit to NG tubes (except maybe easier to insert), but they have the potential to cause sinusitis, and other complications like bleeding are more likely.  Awake patients obviously can’t tolerate OG tubes.
 
2.  All OG/NG tubes in the ED should be salem sump tubes (two lumens, one of them is blue). see picture.  Single lumen tubes are really only good for feeding, which is generally not a priority in the ED.  We are more interested in sucking things out, and single lumen tubes must be in low intermittent suction to prevent ulcers, which is less efficient.
 
3.  The blue lumen should be capped with a one-way valve to prevent regurgitation of gastric contents (blue end goes in blue tube).  If you tie it off, it defeats the purpose of using the 2-lumen tube (release valve to prevent sucking onto the gastric mucosa and causing ulcers).  

Kit



Written by reuben

January 31st, 2011 at 3:39 pm

Posted in Resus / Crit Care

Peds Floor Admission Delays

If there are any unneccessary delays in sign out to the floor or issues with admissions to the floor, be it transfer or bed pending cleaning for a long period of time, please call the nurse managers from 8 a – 5p. For P4, Stacey: 646-385-1935. For P5, Richard 917-509-5894. Thay are eager to help, so use them…

Thanks
Sylvia

Written by reuben

January 19th, 2011 at 7:16 pm

Posted in Peds

MRI Checklist

Written by reuben

January 14th, 2011 at 7:07 pm

Posted in Radiology

Elmhurst Consults: 4-1111

Dear Colleagues,

We are trying to document how long it takes consultants to (1) respond to pages (2) come to evaluate patients in the ED and (3) submit their assessments. The next Rapid Improvement Event (RIE) begins January 24th and will deal with the issue of consultation delays. Before we start though we need to know the baseline times. After the first Consultation RIE, about 1 1/2 year ago, some services got cordless telephones which helped us contact them directly but prolonged waits continue. So, for the next couple of weeks the telecommunication department has assigned an operator to help us gather this information:

The Plan:

1) Call 4-1111 for all consults
2) Give the operator the pt’s name, MR#, your name, your phone number (NOT 3054) and consultant needed
3) She will call/page the service and connect them to you
4) Speak to consultant
5) Consultant calls the operator when they arrive in the ED from the RED PHONE on the wall in the A Area’s Nursing Station
6) We call back operator when consult is completed ( defined as: when the consultant’s input permits you to make a disposition or diagnostic decision)

Please help us with this effort because there are no easy ways of getting this information and we do better if we can quantify the problem more exactly.

Thanks,
Phil

Written by reuben

January 11th, 2011 at 10:28 pm

Posted in Elmhurst

RSV Admission Guidelines Jan 2010

After recent discussion as to where to admit RSV positive infants please see the final decision:

The following are guidelines regarding admissions for infants with RSV. They are based on evidence that an infant <6wks of age with RSV has the highest risk of apnea during their first 2days of illness. *RSV+ infants <6wks of age should be admitted to a monitored bed if they are in their 1st or 2nd day of illness *RSV+ infants of any age that are in their 3rd day of illness (or more) do NOT need to be admitted to a monitored bed (unless they require PICU support for another reason – respiratory support, etc) Since these are only guidelines, and NOT a formal policy, we encourage everyone to continue to assess patients on an individual basis – and to make a decision based on the clinical status of each patient.

Beth Goodman, MD

Pediatric Chief Resident

The Mount Sinai Kravis Children’s Hospital

Written by reuben

January 8th, 2011 at 9:37 pm

Posted in Peds

Resident Composite 2010-2011

Written by reuben

January 7th, 2011 at 5:20 am

Posted in Residents

Teaching Resident Pager

The teaching resident now carries a pager and is available from 8-4 for all your TR needs.

The pager number is 917.252.6624.

You can send a text page by pointing your web browser to

http://usamobility.com/send_a_message/

This information has been added to the “ED Numbers” spreadsheet that is posted at all physician workstation areas.

love,

peter, elaine, and reuben

Written by reuben

January 7th, 2011 at 5:04 am

Posted in Contacts