View source for Kaiser WLA

==N==
<br />
to page: 2500 BBBB CCCC#

==Info==
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Req
* Acute stroke: .nihss & .telehealthconsent
* 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.
* If non-member, document whether you contacted PMD and/or POMD to sign death certificate.
* If member, leave message on PMD voicemail, generally will sign death certificate. 
<br />
Outpt
* Suture/abscess >13yo: follow up in UC, no appt needed.
* 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. 
* Abscess <13yo: FU in ED
* Pt call 18009548000 schedule routine FU with their PMD (take several weeks).
* Clerk schedule FU appt if needed <2wks.
* Education classes: asthma, dm, depression, stress, bp, chol, wt mng, smoking cess. Pt call 3232983300 to enroll.

==EPRP==
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Regional EPRP Direct IP Admit
* Intubated patients
* Bipap/Cpap
* Unstable patients transferred for HLC to ICU
* Sepsis
* DKA on insulin drips
* PE with hypoxemia
* Meningitis needing inpt abx
* Ischemic stroke w/ sig neuro def
* Hemorrhagic stroke not req Nsg intervent
* CAP - Class 5
* COPD exac req >6L O2 (over baseline)
* CHF exac in nonO2 dep pt (still hypoxic despite aggressive ED tx 4 hrs
* Chest pain where Kaiser CV CS req adm
* Nonsurg CT proven diverticlitis/febrile/ill/need inpt abx
* Acute MI ACS + enzyme / EKG changes transferred for HLC
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WLA "ED MD Fast Pass" (in ED)
* Chest pain w nml EKG and neg trop, low risk
* pain syldromes (ex migraines), except sickle cell
* PNA Curb 65 1-2 w/ nml labs and no O2 req
* Asthma
* Blood transfusion up to 2U
* Htn OOC no e/o end organ injury
* DM OOC not DKA
* weak and dizzy w/ nml work up and no longer sx
* Vomiting, resolved/persistent
* UTI in elderly, af, not confused, not septic
* Psych
* Abd pain w/ neg work up
* DVT
* Social
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WLA "MOD Fast Pass" (in ED)
* CVA, TIA
* syncope, cardiac or noncardiac
* hypogly on sulfonylurea
* any infxtn w/ ALOC, low BP, or elev lactate
* high risk CP with multiple risk
* PE without hypoxemia
* weak and dizzy with nml work up and still sx
* GI bleed
* uncontrolled afib (ex on a drip)
* SNF placement need apparent prior to transfer
* SOD takes all traumas
<br />
WLA "MOD Evaluation" (in ED)
* all else notlisted, pt sent to ED but MOD complete eval and decide adm vs tx/dc

==CV==
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Stress Test
* Same day ETT: if nml working hrs, order and wait to be completed as an inpt. 
* 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"
* 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.

==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

==Heme==
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DVT
* Call inpt pharm x (assist lovenox initiation), off hrs ED RN will instruct on lovenox injct. 
* Rx warfarin
* Leave msg coumadin clinic x to arrange Pt/INR FU

==ID==

==Nsg==
<br />
* Clerk page ETAP operator (Nsg at KSunset closest)
* TBI + nml CTH + GCS >13: may stay if obs needed
* TBI + nml CTH + GCS <13: txf Nsg center for eval by nsg

==Ophth==
* recheck of FB removal, deep corneal abrasion, minor "red eye" do not req on call CS.
* Pt call 3238571163 730-8a to schedule own same day FU appt for M-F.

==Ped==
<br />
* Newborn: LAMC Peds hospitalist for ?
* Urgent Newborn: NOD (inhouse overnight)
* ? and CS: POD 8a-9p M-F and 9a-7p Sat/Sun/Holid (LAMC peds hospitalist outside of these hours)
* Peds adm <14yo: call LAMC peds hospitalist
* Back-up peds: any CS req peds to come in to ED to eval. MOD assists initial adm any teen pt outside POD hrs (POD take over next morning)

==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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<br />
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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<br />
General<br />
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==

==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.