Harbor:Main: Difference between revisions
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==Admin Updates==
==Admin Updates==
* Frequently used resources  
* Frequently used resources  
** [[Harbor:Legal#Law_Enforcement_in_the_ED|Law Enforcement in the ED (ICE)]]
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/ER2VhQepG9xPocy4NEgdlhMBckJxJdcuwzCsgVLs9CZLsg?e=Clsfcb The Newsletter: Word Doc]
** [[Harbor:Infectious_Disease_Threats#Flu%2FILI|Avian Flu]]
** [https://gamma.app/docs/Harbor-UCLA-ED-Newsletter-April-15-2025-wjxduhltesj68t9?mode=doc#card-co5azk6nq11rx1u The Newsletter: Shorter + Mobile Friendly Version]
** [https://wikem.org/wiki/Harbor:QR_for_Staff QR Code:  ED Ops Issues, Equipment issues, Prehospital problems, Inappropriate Referrals for Specialty Care (OOP Patients), Med Student evals, Resident Shout-outs]
** [https://wikem.org/wiki/Harbor:QR_for_Staff QR Code:  ED Ops Issues, Equipment issues, Prehospital problems, Inappropriate Referrals for Specialty Care (OOP Patients), Med Student evals, Resident Shout-outs]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
*** [[Harbor:Direct_Admission_after_Hours|Direct Admissions and Admissions from Clinic How-to Guide]]
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
*** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true ED to Specialty Clinic DC - please check instructions for each specific clinic prior to making an appointment]
*** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true ED to Specialty Clinic DC - please check instructions for each specific clinic prior to making an appointment]
*** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic]
*** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic]
*** [[Harbor:Direct_Admission_after_Hours|Direct Admissions How-to Guide]]
*** [https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis Breast Abscess]
*** [https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis Breast Abscess]
*** [https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy Breast Mass]
*** [https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy Breast Mass]
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*** [https://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]
*** [https://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]
** [[Harbor:STAT_MRI|Ordering a MRI]]
** [[Harbor:STAT_MRI|Ordering a MRI]]
** [https://dhs.lacounty.gov/harbor-ucla-medical-center/work-or-partner-with-us/la-drop/ LA Drop (Prehospital Blood)]
** [[Harbor:Legal#Law_Enforcement_in_the_ED|Law Enforcement in the ED (ICE)]]
** [[Harbor:Infectious_Disease_Threats#Measles|Measles]]
** [[Harbor:Infectious_Disease_Threats#Flu%2FILI|Avian Flu]]
** [[Harbor:Replantation_Patients|July 4th - Higher level of Care Transfer (USC Burn or Replant)]]
** [[Harbor:Replantation_Patients|July 4th - Higher level of Care Transfer (USC Burn or Replant)]]
*** [[Harbor:ED_follow-up_options#BURN_CENTER_CLINIC|July 4th - Outpatient USC Burn Center Follow-up]]
*** [[Harbor:ED_follow-up_options#BURN_CENTER_CLINIC|July 4th - Outpatient USC Burn Center Follow-up]]
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*[[Harbor:Code STEMI|STEMI Activation]]
*[[Harbor:Code STEMI|STEMI Activation]]
*[[Harbor:Trauma activations|Trauma Activations]]
*[[Harbor:Trauma activations|Trauma Activations]]
===[[Harbor:PE Response Team|PE Response Team (PERT)]]===
*[[Harbor:PE Response Team|PE Response Team (PERT)]]


===[[Harbor:Social work|Social Work]]===
===[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]===
===[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]===
===[[Harbor:Stimulant Use Disorder Treatment]]===
===Crown Checks===
*Screening L & D patients:  If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push. 
** If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible.  We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up. 
** Caveats:
*** If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator. 
*** If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
*** Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly. 
*** Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator.  If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).
===[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]===
===[[Harbor: Reporting to DCFS|Reporting to DCFS]]===
===[[Harbor:Placement patients|'''Placement patients''']]===
===[[Harbor:Placement patients|'''Placement patients''']]===
===[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]===
===[[Harbor:Psych patients|Psych Patients, Code Gold, & Exodus]]===
===[[Harbor:Psych patients|Psych Patients, Code Gold, & Exodus]]===
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
 
==='''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''===
===[[Harbor:NFL Injured Player/Staff Protocol|NFL Injured Player/Staff Protocol]]===
 
 
===Sepsis===
*[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
===[[Harbor:Sepsis core measures|Sepsis core measures]]===
==='''[[Harbor:Occupational exposure|Occupational Exposure]]'''===
==='''[[Harbor:Occupational exposure|Occupational Exposure]]'''===
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
===[[Harbor Radiation Precautions|Harbor Radiation Precautions]]===
===[[Harbor Radiation Precautions|Harbor Radiation Precautions]]===
===[[Harbor:NFL Injured Player/Staff Protocol|NFL Injured Player/Staff Protocol]]===


==='''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''===
===Substance Use Disorder (SUD) Treatment Options===
*[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]
*[[Harbor:Stimulant Use Disorder Treatment]]
*[[Harbor:Cannabis_Abuse|Cannabis (THC) Use Disorder (CUD) Treatment Options and Resources]]


===[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]===
===[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]===
*[[Harbor:Sepsis core measures|Sepsis core measures]]
*[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]
===[[Harbor:Social work|Social Work]]===
*[[Harbor: Reporting to DCFS|Reporting to DCFS]]
*[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]
*[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]
===Crown Checks===
*Screening L & D patients:  If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push. 
** If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible.  We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up. 
** Caveats:
*** If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator. 
*** If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
*** Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly. 
*** Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator.  If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).


==Patient Disposition==
==Patient Disposition==

Revision as of 01:31, 17 April 2025

This is the main page for Harbor-UCLA emergency department; See Pediatric ED for the main Harbor pediatric page.

Admin Updates


OLD TOPICS

  • Hyperbaric treatment for CO
    • Options - UCLA Westwood, Long Beach Memorial, UCSD, NOT MAC to Catalina (only for dive injuries)
    • UR coordinates the acceptance
    • Transfers: UR should help coordinate the transfer - ELTC/HLOC - needs to occur <1-2 hrs
      • Sending facility is supposed to arrange transfer
      • If UR not able to get transfer in a timely manner --> MAC (CDO) - must be approved by house supervisor & Joy; BLS/ALS/CC transport
        • Medics can call the radio for online base medical direction/orders


  • New Expedited Work up Clinic referral process: https://www.wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC)
  • New asthma guidelines
    • The preferred DHS controller medication is Symbicort (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone).
    • If seeing the patient in the ED for an asthma exacerbation, please be sure to refill their controller medication AND the albuterol (if needed). We fall out if they fill more albuterol Rx’s in a year than their controller medication, so we need to make sure they get both when seen in the ED. If prescribing albuterol, do not give refills (you get 200 puffs!).
  • Sepsis – remember to do the required components of the sepsis core measure w/in 3 hrs (30ml/kg, bcx, abx), document using the auto text (use “auto text copy utility” to get Brad Chappell’s “ .harsepsis” to go through the reminder guidance text and exclusions for IVF 30ml/kg. Communicate to the admitting team if they need to repeat the lactate and perform the sepsis reassessment exam with time stamp (w/in 6 hrs).
  • If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities.
  • Synapse got a new look. See link for details. A one-page intro guide are available on DHS SharePoint
    • Alt+C still works to compare studies.
    • Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
    • Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.
  • Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.


  • Active Threat in the ED
    • Situational awareness
      • Stand between door and patient
      • Ensure patient is gowned
      • Be aware of long stethoscope, lanyard, long hair, etc
      • Panic buttons at nursing stations/router
      • Run & scream for help
    • Hospital Codes
      • Gold x111 - combative/agitated patient
      • Gray x64450 - combative/agitated NON-patient
      • Silver x111 - weapon, active shooter, hostage

General Administrative

Ambulance (EMS) Triage

Administrative duties

Administrative resources

RME & triage

Harbor ED policy manual

ED attending on call plan

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders


Radiology

Radiology Hours

[Radiology Directory]

US & QPathE

  • QPathE Login link
    • Login using e# and associated password
    • Double-click the exam
    • Click "edit" at the top of the page
    • Enter MRN in the "patient ID" box
    • in "comments" enter trauma FAST
    • Click save at top of screen


Contrast

Urgent Outpatient IR

STAT MRI

Upload Outside Films to PACS

  • Get form from clerk
  • Put patient sticker on Form
  • Check "Import"
  • Sign

Get Images on Disc (For DC or Transfer)

  • Same as upload EXCEPT
    • Check "Export"
    • Write time frame on form you want studies from

Blood products

Antibiogram

Finding Equipment/DME

ED supplies A-Z

Procedures

Special patient types

Code Activations

Placement patients

Psych Patients, Code Gold, & Exodus

Scheduled dialysis patients in ED

Sexual Assault/STI Exposure (SART)

Occupational Exposure

Harbor Radiation Precautions

NFL Injured Player/Staff Protocol

Substance Use Disorder (SUD) Treatment Options

Infectious Disease Threats

Social Work

Crown Checks

  • Screening L & D patients: If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push.
    • If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible. We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up.
    • Caveats:
      • If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator.
      • If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
      • Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly.
      • Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator. If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).

Patient Disposition

Discharge

ED Follow-Up Options

DC with meds in ED

  • Eye drops (vanco & tobra) and STI prophylaxis for home
  • HIV prophylaxis for sexual assault patients (raltegravir and Truvada)


Transportation Needs

Social EM resources

Admission

Admission Guidelines

Interqual Criteria Tips

Interqual Override Notes

Right level of care

OBS & CORE


Dialysis in the ED

Other Disposition

Transferring a patient

Documentation

Disaster & Surge

Resident Education

See Also

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