Harbor:RME Manual - Revision history

Jfang: Links to new/updated information as this page gets deprecated

2020-01-31T22:10:23Z

Links to new/updated information as this page gets deprecated

← Older revision		Revision as of 22:10, 31 January 2020
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	==RME Provider Manual==		==RME Provider Manual==
	~~***~~ Old material - combine with ~~harbor main~~ RME & ~~Triage~~		===Old material - combine with [[Harbor: Main]] and [[Harbor:RME & TRIAGE]]===

	===Patient Flow===		===Patient Flow===
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	==RME Rounds==		==RME Rounds==
	*Please post/edit after presenting to NP's at rounds		*Please post/edit after presenting to NP's at rounds


			[[Category: Admin]]

Bchap23: Replaced content with "==RME Provider Manual== *** Old material - combine with harbor main RME & Triage ===Patient Flow=== *Quick team huddle at beginning of shift **Physician, NP's, RME charge..."

2020-01-25T05:16:17Z

Replaced content with "==RME Provider Manual== *** Old material - combine with harbor main RME & Triage ===Patient Flow=== *Quick team huddle at beginning of shift **Physician, NP's, RME charge..."

Show changes

Bchap23: /* Vertigo */

2019-11-04T23:03:14Z

Vertigo

← Older revision		Revision as of 23:03, 4 November 2019
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	#Test of Skew - cover eye for 2 seconds then switch … eye up or down is central (bad)		#Test of Skew - cover eye for 2 seconds then switch … eye up or down is central (bad)
	## vertical dysconjugate gaze (can be overcome by fixation, so must alternately cover one eye to prevent fixation -- when uncovered, the misaligned eye will move back into alignment)		## vertical dysconjugate gaze (can be overcome by fixation, so must alternately cover one eye to prevent fixation -- when uncovered, the misaligned eye will move back into alignment)
	# Head Impulse Testing - should be positive (ie, peripheral vertigo if the patient is unable to keep their central focus on your nose)		# Head Impulse Testing - should be positive (ie, peripheral vertigo if the patient is unable to keep their central focus on your nose and eye moves to side with saccade back to the middle)
	## if intact (eyes stay fixed centrally), higher concern for central		## if intact (eyes stay fixed centrally), higher concern for central
	## record on phone, tilt head forward 20 degrees, thrust head side to side ~20 degrees slowly & rapidly, cannot focus on camera if peripheral (lose vestibule-occulcar reflex);		## record on phone, tilt head forward 20 degrees, thrust head side to side ~20 degrees slowly & rapidly, cannot focus on camera if peripheral (lose vestibule-occulcar reflex);

Bchap23: /* Pharmacology */

2019-07-15T19:35:31Z

Pharmacology

← Older revision		Revision as of 19:35, 15 July 2019
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	*Narcotic Equivalents		*Narcotic Equivalents
	**MS 10IV=30PO=100mcg fentanyl=dilaudid 1.5mg IV=8mgPO=oxycodone 30mg PO		**MS 10IV=30PO=100mcg fentanyl=dilaudid 1.5mg IV=8mgPO=oxycodone 30mg PO
	*~~Suboxone~~		*Narcotic Addiction
	**		** Methadone is a full agonist, buprenorphine partial; naloxone is antagonist
	**		**
	**		**

Bchap23: /* Random Neuro */

2019-07-15T19:23:24Z

Random Neuro

← Older revision		Revision as of 19:23, 15 July 2019
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	===Random Neuro===		===Random Neuro===
			* Addiction
			** Nucleus Accumbens: dopamine - positive reinforcement
			** Amygdala - fear/neg reinforcement

	* Bell's palsy: send lyme titer; steroids in 1st 72 hours		* Bell's palsy: send lyme titer; steroids in 1st 72 hours

Bchap23: /* Pharmacology */

2019-07-15T18:10:41Z

Pharmacology

← Older revision		Revision as of 18:10, 15 July 2019
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	*Narcotic Equivalents		*Narcotic Equivalents
	**MS 10IV=30PO=100mcg fentanyl=dilaudid 1.5mg IV=8mgPO=oxycodone 30mg PO		**MS 10IV=30PO=100mcg fentanyl=dilaudid 1.5mg IV=8mgPO=oxycodone 30mg PO
			*Suboxone
			**
			**
			**
			**

	==Psych==		==Psych==

Rossdonaldson1: Text replacement - "vancomycin " to "vancomycin "

2019-07-04T03:51:28Z

Text replacement - "vancomycin " to "vancomycin "

Rossdonaldson1: Text replacement - "TBSA" to "TBSA"

2019-02-12T07:23:07Z

Text replacement - "TBSA" to "TBSA"

Rossdonaldson1: Text replacement - "Harbor:Operations manual" to "Harbor:Main"

2019-01-31T07:37:03Z

Text replacement - "Harbor:Operations manual" to "Harbor:Main"

← Older revision		Revision as of 07:37, 31 January 2019
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	==See Also==		==See Also==
	*[[Harbor:Main]]		*[[Harbor:Main]]
	*[[Harbor:~~Operations manual~~]]		*[[Harbor:Main]]

	[[Category:Admin]]		[[Category:Admin]]

Bchap23: /* Bleeding */

2018-12-17T23:43:07Z

Bleeding

← Older revision		Revision as of 23:43, 17 December 2018
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	**CBC, peripheral smear, retic count (normal=sequestration, low (<0.5%)=aplastic – likely parvo); LFTs, BCX		**CBC, peripheral smear, retic count (normal=sequestration, low (<0.5%)=aplastic – likely parvo); LFTs, BCX
	**TX: Hydrate, O2, toradol +/- morphine; hydroxyurea if chronic pain		**TX: Hydrate, O2, toradol +/- morphine; hydroxyurea if chronic pain
			** Abx if febrile and <5 y/o
	**Transfuse: sequestration with severe anemia (retic count <3%)		**Transfuse: sequestration with severe anemia (retic count <3%)
	**Exchange TFX to keep HbS<30%: CVI, ACS with O2<90%, priapism		**Exchange TFX to keep HbS<30%: CVI, ACS with O2<90%, priapism

← Older revision		Revision as of 03:51, 4 July 2019
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	o Endocarditis: 3 BCX, TEE		o Endocarditis: 3 BCX, TEE
	 native valve: nafcillin 2g q6 + ampicillin2g q4 + [[gentamicin]] 1mg/kg q8		 native valve: nafcillin 2g q6 + ampicillin2g q4 + [[gentamicin]] 1mg/kg q8
	 prosthetic valve: vancomycin + [[gentamicin]] q8 + rifampin 300 PO q8		 prosthetic valve: [[vancomycin]] + [[gentamicin]] q8 + rifampin 300 PO q8
	 IVDA: vanco; daptomycin 6mg/kg daily (can be used for penicillin allg)		 IVDA: vanco; daptomycin 6mg/kg daily (can be used for penicillin allg)
	 prophylaxis: amoxicillin 2g PO 2 hrs before procedure		 prophylaxis: amoxicillin 2g PO 2 hrs before procedure
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	*Open fracture: splint, reduce if nausea and vomiting compromise, irrigate and cover with NS gauze, ANCEF + Td (add gentamycin 7mk/kg if >5cm lac; add penicillin 4M units if farm wound)		*Open fracture: splint, reduce if nausea and vomiting compromise, irrigate and cover with NS gauze, ANCEF + Td (add gentamycin 7mk/kg if >5cm lac; add penicillin 4M units if farm wound)
	**Ancef 2g Ivq8; zosyn 4.5g q8 (or gent) if soil contamination		**Ancef 2g Ivq8; zosyn 4.5g q8 (or gent) if soil contamination
	*Osteomyelitis: vancomycin + rocephin 2g QD; with DM: vancomycin + zosyn 4.5g		*Osteomyelitis: [[vancomycin]] + rocephin 2g QD; with DM: [[vancomycin]] + zosyn 4.5g
	*Septic joint (arthritis): WBC >50k		*Septic joint (arthritis): WBC >50k
	**vancomycin + rocephin 2g; prosthesis: rifampin 600 PO + vanco		**[[vancomycin]] + rocephin 2g; prosthesis: rifampin 600 PO + vanco
	*Tendonitis: from repetitive muscle motion; RICE +/- splint		*Tendonitis: from repetitive muscle motion; RICE +/- splint

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	o Aspiration: clinda 600 q8 + avelox		o Aspiration: clinda 600 q8 + avelox
	o ICU: rocephin/aztreonam (2gq8) + avelelox/azithro		o ICU: rocephin/aztreonam (2gq8) + avelelox/azithro
	o ICU/Pseudomonas: zosyn(4.5gq6) (good GI, 95% pseudomonal) /fortaz/aztreonam/rocephin/merrem + (tobra7mg/kg&azithro/avelox OR cipro/levaquin/amikacin) + vancomycin 1g/zyvox(better)		o ICU/Pseudomonas: zosyn(4.5gq6) (good GI, 95% pseudomonal) /fortaz/aztreonam/rocephin/merrem + (tobra7mg/kg&azithro/avelox OR cipro/levaquin/amikacin) + [[vancomycin]] 1g/zyvox(better)
	 albuterol and steroids may reduce severity of pneumonia		 albuterol and steroids may reduce severity of pneumonia
	• Order Urine strep/legionella if: ICU, failed outpatient, ETOH, liver disease, asplenia, travel<2wks, pleural effusion, encephalopathic		• Order Urine strep/legionella if: ICU, failed outpatient, ETOH, liver disease, asplenia, travel<2wks, pleural effusion, encephalopathic
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	===UTI’s===		===UTI’s===
	o Uncomplicated: keflex 500 q6; bactrim DS q12		o Uncomplicated: keflex 500 q6; bactrim DS q12
	o Complicated: ampicillin 1g q6 (vancomycin 1g if pcn allg) + [[gentamicin]] 5mg/kg		o Complicated: ampicillin 1g q6 ([[vancomycin]] 1g if pcn allg) + [[gentamicin]] 5mg/kg
	o Pyelonephritis		o Pyelonephritis
	o		o

← Older revision		Revision as of 07:23, 12 February 2019
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	* Hydrofluoric Acid: concentration is important		* Hydrofluoric Acid: concentration is important
	o <10% concentration delayed up to 24 hrs; <5% TBSA or less than 30ml ok		o <10% concentration delayed up to 24 hrs; <5% [[TBSA]] or less than 30ml ok
	o >40% -- 1% TBSA can cause systemic toxicity– requires cardiac monitoring, ECG, serial Ca levels		o >40% -- 1% [[TBSA]] can cause systemic toxicity– requires cardiac monitoring, ECG, serial Ca levels
	o arrhythmia, dec SBP, hypocalcemia, met acidosis, dec mag, inc K, inc INR		o arrhythmia, dec SBP, hypocalcemia, met acidosis, dec mag, inc K, inc INR
	o If QT prolonged, give Ca 1gram over 20 min; Check Ca q30 for 3 hours		o If QT prolonged, give Ca 1gram over 20 min; Check Ca q30 for 3 hours
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	*Update Td, keep warm, protect airway (stridor, CO>10%, prone patient if too much IVF)		*Update Td, keep warm, protect airway (stridor, CO>10%, prone patient if too much IVF)

	*Parkland formula – only if >20% TBSA (use Lactated Ringers)		*Parkland formula – only if >20% [[TBSA]] (use Lactated Ringers)
	#2-4cc/kg *TBSA; half over 8 hours, half over 16		#2-4cc/kg *[[TBSA]]; half over 8 hours, half over 16
	#After 24 hrs, ~1.5x maintenance IVF; Titrate to urine of 0.5cc/kg/hr; decrease IVF when>1cc/kg/hr		#After 24 hrs, ~1.5x maintenance IVF; Titrate to urine of 0.5cc/kg/hr; decrease IVF when>1cc/kg/hr
	#Only add maintenance fluids to peds (if <20kg use D5LR @ 3ml/kg*TBSA; titrate to urine 1-1.5ml/kg/hr)		#Only add maintenance fluids to peds (if <20kg use D5LR @ 3ml/kg*[[TBSA]]; titrate to urine 1-1.5ml/kg/hr)
	#ARF – bicarb, mannitol, dopamine, CRRT		#ARF – bicarb, mannitol, dopamine, CRRT
	#Nebulized heparin for pulmonary burns 5,000 – 10,000 IU q4 hours x 7 days + MUCOMYST + albuterol•		#Nebulized heparin for pulmonary burns 5,000 – 10,000 IU q4 hours x 7 days + MUCOMYST + albuterol•
	*Burn center transfers:		*Burn center transfers:
	#Partial thickness >10% TBSA, any full thickness;		#Partial thickness >10% [[TBSA]], any full thickness;
	#face, hand/foot, genitals, joints;		#face, hand/foot, genitals, joints;
	#electrical, chemical, or inhalation		#electrical, chemical, or inhalation