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| ==N==
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| to page: 2500 BBBB CCCC#
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| ==Info==
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| Req
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| * Acute stroke: .nihss & .telehealthconsent
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| * Pna: .curb65 & 72hr FU appt (ask clerk to sched appt)
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| Deaths
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| * Document whether or not "coroner's case", if yes you MUST contact the coroner.
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| * If non-member, document whether you contacted PMD and/or POMD to sign death certificate.
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| * If member, leave message on PMD voicemail, generally will sign death certificate.
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| Outpt
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| * Suture/[[abscess]] >13yo: follow up in UC, no appt needed.
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| * Suture <13yo: wound check and suture removal in peds clinic. Walk-in peds clinic 5-830. If parent calls before 7am they will get same day appt.
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| * Abscess <13yo: FU in ED
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| * Pt call 18009548000 schedule routine FU with their PMD (take several weeks).
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| * Clerk schedule FU appt if needed <2wks.
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| * Education classes: asthma, dm, depression, stress, bp, chol, wt mng, smoking cess. Pt call 3232983300 to enroll.
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| ==EPRP==
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| Regional EPRP Direct IP Admit
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| * Intubated patients
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| * Bipap/Cpap
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| * Unstable patients transferred for HLC to ICU
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| * Sepsis
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| * DKA on insulin drips
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| * PE with hypoxemia
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| * Meningitis needing inpt abx
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| * Ischemic stroke w/ sig neuro def
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| * Hemorrhagic stroke not req Nsg intervent
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| * CAP - Class 5
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| * COPD exac req >6L O2 (over baseline)
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| * CHF exac in nonO2 dep pt (still hypoxic despite aggressive ED tx 4 hrs
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| * Chest pain where Kaiser CV CS req adm
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| * Nonsurg CT proven diverticlitis/febrile/ill/need inpt abx
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| * Acute MI ACS + enzyme / EKG changes transferred for HLC
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| WLA "ED MD Fast Pass" (in ED)
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| * Chest pain w nml EKG and neg trop, low risk
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| * pain syldromes (ex migraines), except sickle cell
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| * PNA Curb 65 1-2 w/ nml labs and no O2 req
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| * Asthma
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| * Blood transfusion up to 2U
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| * Htn OOC no e/o end organ injury
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| * DM OOC not DKA
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| * weak and dizzy w/ nml work up and no longer sx
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| * Vomiting, resolved/persistent
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| * UTI in elderly, af, not confused, not septic
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| * Psych
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| * Abd pain w/ neg work up
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| * DVT
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| * Social
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| WLA "MOD Fast Pass" (in ED)
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| * CVA, TIA
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| * syncope, cardiac or noncardiac
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| * hypogly on sulfonylurea
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| * any infxtn w/ ALOC, low BP, or elev lactate
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| * high risk CP with multiple risk
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| * PE without hypoxemia
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| * weak and dizzy with nml work up and still sx
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| * GI bleed
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| * uncontrolled afib (ex on a drip)
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| * SNF placement need apparent prior to transfer
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| * SOD takes all traumas
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| WLA "MOD Evaluation" (in ED)
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| * all else notlisted, pt sent to ED but MOD complete eval and decide adm vs tx/dc
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| ==CV==
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| Stress Test
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| * Same day ETT: if nml working hrs, order and wait to be completed as an inpt.
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| * Next day outpt ETT: M-F, ask clerk fax treadmill req form and EKG to cards. Order "outpatient cardiology referral - treadmill - stat - comments low risk chest pain"
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| * Nuclear perfusion for low risk (baseline LBBB, cannot ambulate, etc.): ask clerk fax form. Dc order "PNL Lexi - stat - comment Low Risk Chest Pain Protocol". NM will contact pt to schedule.
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| ==Fx==
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| Ortho fx clinic M-Sat starting 830a. RN or clerk schedule FU 1-2d of ED.
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| Soft tissue: outpt referral order.
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| Nasal fractures: ENT
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| other Facial fractures (includ mandible): Plastics
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| ==Heme==
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| DVT
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| * Call inpt pharm x (assist lovenox initiation), off hrs ED RN will instruct on lovenox injct.
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| * Rx warfarin
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| * Leave msg coumadin clinic x to arrange Pt/INR FU
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| ==ID==
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| ==Nsg==
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| * Clerk page ETAP operator (Nsg at KSunset closest)
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| * TBI + nml CTH + GCS >13: may stay if obs needed
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| * TBI + nml CTH + GCS <13: txf Nsg center for eval by nsg
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| ==Ophth==
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| * recheck of FB removal, deep corneal abrasion, minor "red eye" do not req on call CS.
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| * Pt call 3238571163 730-8a to schedule own same day FU appt for M-F.
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| ==Ped==
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| * Newborn: LAMC Peds hospitalist for ?
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| * Urgent Newborn: NOD (inhouse overnight)
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| * Peds <14yo adm: call LAMC peds hospitalist
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| * Peds ? and CS:
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| ** POD from 8am-9pm M-F and 9am-7pm Sat/Sun/Holiday
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| ** LAMC ped hosp outside of these hours
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| * Back-up peds: any CS req peds to come in to ED to eval.
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| * Teen ? and CS :
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| ** Back-up peds for teen admissions (14-17yo) 9pm-8am on weeknights & 7pm-9am on weekends/holidays (all other hours POD is paged)
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| ** POD for teen admissions 8a-9p M-F & 9a-7p Sat/Sun/Holid
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| ** 11pm-3am peds may ask MOD to assist with admission (peds must call MOD) and peds assumes care in AM
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| ==Psych==
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| *SI must document "R45.851 - Suicidal Ideation/Suicidal Ideations" or "T14.91 - Attempted Suicide w Injury/Suicide Attempt" -> triggers list for care coordinator to contact pt
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| *
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| ==Urology==
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| Painless Hematuria
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| - CT urogram: In ED if active painless bleeding AND only if pt has gross hematuria, sig drop Hct, or anemic from bleeding.
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| - if not active bleeding -> outpatient CT urogram & outpt urology referral
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| - 20 F 3way cath for irrigation.
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| Kidney Stones
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| - CT KUB
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| - Uric acid stones cannot be seen on KUB, must use CT
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| - urine strainer for dc pt's, urology WANTS stone for analysis
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| - Tamulosin preferred agent, if already on hytrin then no just keep them on it
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| UTI
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| - Urine Culture all recurrent UTI. (Many times it is not a UTI and the culture helps them when seeing the patient in clinic)
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| General<br />
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| 1. Our standard foley catheters are 16 F coudet catheters. If the patient has a prior stricture, surgery, TURP then do not keep attempting to place a larger catheter. This will just cause trauma and bleeding. Call urology. In the case of BPH a LARGER catheter may pass more easily
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| 2. If a patient is post op, please do NOT have the RN's automatically place a foley in triage. This may be contraindicated after certain surgeries
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| 3. Please DO NOT tell patients to go to urology clinic without an appointment. Send a referral or direct book the patient. Later the same day or the next day may be too soon. For example, a kidney stone patient should be seen in 2-3 days to allow time for the stone to pass. They won't change management if seen later the same day or the next day.
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| ==External Links==
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| ==References==
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| <references/>
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| Information expressed here is not officially approved or endorsed by Kaiser or any associated groups. This is not official medical advice.
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| [[Category:Admin]]
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