Harbor:Main: Difference between revisions
 
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''This is the main page for Harbor-UCLA emergency department; See [[Harbor:Pediatric ED (main)|Pediatric ED]] for the main Harbor pediatric page.''
''This is the main page for Harbor-UCLA emergency department; See [[Harbor:Pediatric ED (main)|Pediatric ED]] for the main Harbor pediatric page.''
==Admin Updates==
==Admin Updates==
* Frequently used resources
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[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:/t/EDOperations-HUCLA/ES3s8sXJdKBLpukbDXsHZfoBwhQCS17ogqrR8mC2TVNvcQ?e=xp82nc Ortho Consult Criteria]
** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:STAT_MRI|Ordering a MRI]]
** [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://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]
** [https://wikem.org/wiki/Harbor:Psych_patients Psych:  OSA, Covid, & Exodus]
** [https://wikem.org/wiki/Harbor:Infectious_Disease_Threats#Treatment Covid Treatment Options]
** [https://wikem.org/wiki/Harbor:QR_for_Staff QR Code:  Equipment issues, Prehospital problems, Med Student evals, Resident Shout-outs]
** [[Harbor:Surge_plan|Surge Criteria/Plan]]
OLD TOPICS
* '''ED Request for Specialty Appointment''' order is live 7/25/2023!  No more black star in the depart menu. 
** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true Referral Guidance Summary Sheet]
** [[Harbor:ED_follow-up_options|Details for Specific Clinics ]]
** How to Make an Appointment:  [[:File:ED Request for Specialty Appointment Hot Sheet 7-25-2023.pdf]]
* Happy July 4th:  [[Harbor:Replantation_Patients|Hand Replant Transfers to LAG]]
* [[Harbor:ED_follow-up_options#ORTHO|Ortho Follow-up Guidelines (5-2023)]]
* '''QR Code Resources'''
** [[Harbor:QR_for_Staff|For Staff (Equipment, EMS, Med Student Evals)]]
** [[Harbor:QR_for_Patients|For Patients]]
* 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 [https://lacounty.sharepoint.com/:b:/s/dhs-eci/ESN8ppJYxPZGhUcV9ZGyWYMB8do8sVnRqmBWuNyKG5x-7A?e=RpdAsg one-page intro guide] are available on [https://lacounty.sharepoint.com/sites/dhs-eci/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Deci%2FShared%20Documents%2FRadiology%2FPACS%205%2E7%20Upgrade%2FGuides%2FQuick%20Start%20Tutorial&p=true&originalPath=aHR0cHM6Ly9sYWNvdW50eS5zaGFyZXBvaW 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.
* '''Harbor's COVID page''' [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
** Paxlovid, Remdesivir, etc ... [[Harbor:Infectious_Disease_Threats#Treatment|COVID Treatment Options]]
* '''Interqual criteria''' [[Harbor:Interqual_Criteria_Tips|Interqual Criteria Tips]]
* '''Monkeypox'''
** See [[Monkeypox]] for medical information  &  [[Harbor:Infectious_Disease_Threats#Monkeypox|Harbor Monkeypox Plan]]
** Educational Material
*** [http://publichealth.lacounty.gov/acd/Monkeypox.htm LA County Monkeypox]
*** [http://publichealth.lacounty.gov/media/monkeypox/docs/Monkeypox_IntimateContact.pdf LAC DPH Monkeypox]
*** http://publichealth.lacounty.gov/media/monkeypox/resources.htm#reduce
*** [https://www.cdc.gov/poxvirus/monkeypox/resources/print.html CDC Monkeypox]
* '''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==
==General Administrative==
*Pre-hospital
*Pre-hospital
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Incoming transfers|Incoming transfers]]
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
**Exodus Transfers
*Administrative duties
***Exodus should call Psych ED about transfer, not Med ED
***Med ED will do MSE
*DEM AOD [[Harbor:DEM_Admin_on_Duty_(AOD)|DEM Admin on Duty (AOD)]]
* [[Harbor:Resident responsibilities and transitions of responsibility|Resident Responsibilities]]
 
===[[Harbor:Screening EMS Patients|Ambulance (EMS) Triage]]===
 
===Administrative duties===
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
Line 12: Line 97:
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:5S|Pre-shift: 5S]]
**[[Harbor:5S|Pre-shift: 5S]]
*Administrative resources
**Airway Bag [[Harbor:Airway_management_team]]
 
===Administrative resources===
===[[Harbor:RME & TRIAGE|RME & triage]]===
**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:ED policy manual|Harbor ED policy manual]]
**[[Harbor:Crown Checks in PED|Crown Checks in PED]]
**[[Harbor:RME & TRIAGE|RME & triage]]
 
**[[Harbor:ED attending on call plan|ED attending on call plan]]
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
**[[Harbor:Legal|Harbor Legal]]
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
 
===[[Harbor:Legal|Harbor Legal]]===


==Managing your Patient==
==Managing your Patient==
===General===
===General===
====[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]====
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
 
====[[Harbor:Paging|Paging consultants]]====
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Ophtho abbreviation dictionary]]
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Forms|Forms]]====
====[[Harbor:Radiology directory|Radiology directory]]====


===Tests & Orders===
===Tests & Orders===
*[[Harbor:Labs|Labs]]
*[[Harbor:Labs|Labs]]
*Radiology
 
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
 
**Ultrasound
===Radiology===
***[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
====[[Radiology Hours]]====
***[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
[[https://wikem.org/wiki/Harbor:Radiology_directory#Radiology_Directory| Radiology Directory]]
***[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
 
**[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
====US & QPathE====
**CT
* [https://dhsqpath.qpath.cloud '''QPathE Login link''']
***[[Harbor:Ordering a CT|Ordering a CT]]
** Login using e# and associated password
***[[Harbor:ED Radiology Specs|CT Specs]]
** 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
 
 
*Ultrasound
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
**[[Endocavitary Probes]]
*[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*CT
**[[Harbor:Ordering a CT|Ordering a CT]]
**[[Harbor:ED Radiology Specs|CT Specs]]
 
====Contrast====
* [[Creatinine_screening_prior_to_IV_contrast|IV Contrast]]
** [https://lacounty.sharepoint.com/sites/dhs-harbor-pharm/PrePrinted%20Forms/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms%2FExtravasation%20Management%20Provider%20Order%20Form%20P294%20%2810%2E6%2E20%29%2Epdf&parent=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms| Hyaluronidase for IV Contrast Extravasation order Form]
* [[Oral contrast for abdominal and pelvic CT|Oral Contrast]]
 
==== [[Urgent Outpatient IR]] ====


====[[Harbor:STAT MRI|STAT MRI]]====
====[[Harbor:STAT MRI|STAT MRI]]====
***[[Harbor:ED Radiology Specs|MRI Specs]]
*[[Harbor:ED Radiology Specs|MRI Specs]]
*Other orders
**[[Harbor:Ordering Blood Products|Blood products]]
**Antibiotics
====[[Harbor:Antibiogram|Antibiogram]]====
***[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
****[[Harbor:Sepsis core measures|Sepsis core measures]]
**Buprenorphine/Opiate Withdrawal Treatment
***[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]


===Consults===
====Upload Outside Films to PACS====
*[[Harbor:Phone numbers|Phone numbers]]
*Get form from clerk
*[[Harbor:Paging|Paging consults]]
*Put patient sticker on Form
*[[Harbor:Social work|Social work]]
*Check "Import"
*[[Harbor:Whole person care|Whole person care]]
*Sign


===Finding Things===
==== Get Images on Disc (For DC or Transfer)====
*Equipment
*Same as upload EXCEPT
**[[Harbor:Equipment|Equipment (AED/RME)]]
**Check "Export"
**[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
**Write time frame on form you want studies from
**[[Harbor:DME|Durable Medical Equipment (DME)]]
 
===[[Harbor:Ordering Blood Products|Blood products]]===
 
===[[Harbor:Antibiogram|Antibiogram]]===
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
***[[Harbor:Sepsis core measures|Sepsis core measures]]
 
===Finding Equipment/DME===
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 
====[[Harbor:ED supplies A-Z|ED supplies A-Z]]====


===Procedures===
===Procedures===
Line 67: Line 186:


==Special patient types==
==Special patient types==
*Activations
===[[Harbor:Codes|Code Activations]]===
**[[Harbor:Codes|Code Activations]]
*[[Harbor:Involuntary holds|Involuntary Holds]]
***[[Harbor:Involuntary holds|Involuntary holds]]
*[[Harbor:Airway management team|Airway Management Team]]
**[[Harbor:Airway management team|Airway management team]]
*[[Harbor:Code stroke|Code Stroke]]
**[[Harbor:Code stroke|Code Stroke]]
*[[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]]===
*Sepsis
 
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
===[[Harbor:Social work|Social Work]]===
**[[Harbor:Sepsis core measures|Sepsis core measures]]
===[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]===
**Exposures
===[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]===
***[[Harbor:Occupational exposure|Occupational Exposure]]
===[[Harbor:Stimulant Use Disorder Treatment]]===
***[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
===[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]===
***[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure]]
===[[Harbor: Reporting to DCFS|Reporting to DCFS]]===
*Others
===[[Harbor:Placement patients|'''Placement patients''']]===
**[[Harbor:AVF/graft complications|AVF/graft complications]]
 
**[[Harbor:Respiratory isolation|Respiratory isolation]]
===[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]===
**[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
 
**[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
===[[Harbor:Psych patients|Psych Patients (& Exodus)]]===
***[[Harbor:Ebola|Suspected Ebola protocol]]
 
**[[Harbor:Replantation Patients|Replantation Patients]]
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
**[[Harbor:XRT|XRT transfers]]
 
===[[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:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
==='''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''===
 
===[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]===
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]


==Patient Disposition==
==Patient Disposition==
===Discharge===
===Discharge===
====[[Harbor: ED Follow-Up Options|'''ED Follow-Up Options''']]====
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
 
**[https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
====[[DC with meds in ED]]====
====[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]====
* Eye drops (vanco & tobra) and STI prophylaxis for home
***[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
* HIV prophylaxis for sexual assault patients (raltegravir and Truvada)
***[[Harbor:Medical Legal Partnership|Medical Legal Partnership]]
 
***[[Harbor:Coumadin clinic|Coumadin clinic]]
 
***[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 
*'''[[Harbor:Forms| Paper Forms]]'''
 
*[[Harbor:Coumadin clinic|Coumadin clinic]]
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Home Health|Home Health]]
*[[Harbor:Home hospice from ED]]


===Admission, OBS, & CORE ===
====[[Transportation Needs]]====
 
 
====[[Social EM resources]]====
 
===Admission===
====[[Harbor:Admission and consultation guidelines|'''Admission Guidelines''']]====
*[[Harbor:Admitting a patient|Admitting a patient]]
*[[Harbor:Admitting a patient|Admitting a patient]]
====[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines (Who goes to what service; policy 312)]]====
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
***[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
====[[Harbor:Interqual Criteria Tips|Interqual Criteria Tips]]====
 
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
 
====[[Harbor:Right level of care|Right level of care]]====
====[[Harbor:Right level of care|Right level of care]]====
**[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
*Admitting to Medicine - use MS Teams (no more clipboard)
**[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
**[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
*OBS & CORE
 
**[[Harbor:Observation placement|Observation placement]]
===OBS & CORE===
**[[Harbor:CORE|CORE placement]]
*[[Harbor:Observation placement|Observation placement]]
*[[Harbor:CORE|CORE placement]]
 


===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
===Other Disposition===
===Other Disposition===
*[[Harbor:Deceased patients|Deceased patients]]
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
*[[Harbor:Transferring a patient|Transferring a patient]]
* [[Harbor:Deceased patients|Deceased patients]]
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
===[[Harbor:Transferring a patient|Transferring a patient]]===
**[[Harbor:XRT|XRT transfers]]
*[[Harbor:Transferring to psych ER|Transferring to psych ER]]
**[[Harbor:Replantation Patients|Replantation patient transfer]]
*[[Harbor:Exodus|Exodus Psych transfers]]
*[[Harbor:Transfer to L&D|Transfer to L&D]]
*[[Harbor:Transfer/Discharge to Specialty Clinic|Transfer/Discharge to Specialty Clinic]]
*[[Harbor:911 STEMI out|911 STEMI out]]
*[[Harbor:MAC Transfer Burn or Replant|MAC Transfer Burn or Replant]]
*[[Harbor:Replantation_Patients|Hand Replant]]
*[[Harbor:Transfer to Comprehensive Stroke Center|Transfer to Comprehensive Stroke Center]]
*[[Harbor:XRT|XRT transfers]]
*[[Harbor:_Hyperbaric_Transfers|Harbor: Hyperbaric Transfers]]


==Documentation==
==Documentation==
Line 128: Line 288:
*[[Harbor:Consenting a patient|Consenting a Patient]]
*[[Harbor:Consenting a patient|Consenting a Patient]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
===[[Harbor:Forms|Forms]]===


==Disaster & Surge==
==Disaster & Surge==
*[[Harbor:Disaster plan|Disaster plan]]
*[[Harbor:Disaster plan|Disaster plan]]
===[[Harbor:Surge plan|Surge plan]]===
*'''[[Harbor:Surge plan|Surge plan]]'''
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
* Environmental Exposure:
** Ask Hazmat Response team or Incident Commander what decon has occurred on scene
** [https://www.atsdr.cdc.gov/toxprofiledocs/index.html CDC Tox Profile Lookup]


==Resident Education==
==Resident Education==
Line 141: Line 303:
*[[Harbor:VA MICU rotation|VA MICU rotation]]
*[[Harbor:VA MICU rotation|VA MICU rotation]]
*[[Harbor:How to get started in research at Harbor|How to get started in research at Harbor]]
*[[Harbor:How to get started in research at Harbor|How to get started in research at Harbor]]
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]


==See Also==
==See Also==
*[[Harbor:RME Manual]]
{{Special:Prefixindex/Harbor |hideredirects=1}}


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

Latest revision as of 21:15, 11 April 2024

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

PE Response Team

Social Work

Opiate Withdrawal/MAT/BUP

Harbor:Alcohol Use Disorder/Withdrawal Treatment

Harbor:Stimulant Use Disorder Treatment

Baby Safe Surrender Program

Reporting to DCFS

Placement patients

Harbor: Identifying Jane/John Doe, finding next of kin tips

Psych Patients (& Exodus)

Scheduled dialysis patients in ED

NFL Injured Player/Staff Protocol

Sepsis

Sepsis core measures

Occupational Exposure

Sexual Assault/STI Exposure (SART)

Infectious Disease Threats

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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