Harbor:ED policy manual

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1.0 Abuse (Adult and Peds)

http://myladhs.lacounty.gov/polproc/Harbor%20Policies%20and%20Procedures/DEM%20Policy%20Manual/01.0%20Abuse.pdf

  • Peds
    • If <72 hours, contact Sheriff, DCFS, and SCAN Teams (8-5 M-F on-site at HUMC, otherwise USC or SART Center)
    • If >72 hours, contact SCAN team to determine appropriate evaluation and follow-up
  • Adult
    • Contact Sheriff who will determine appropriate SART center and either transport or escort the patient
    • HIV prophylaxis is not routinely given, but can be offered in conjunction with ID recommendations


3.0 Admissions and Consultations

21.3 Respiratory Isolation Patient Protocol[1]

All adult patients presenting to the DEM will be screened at the time of triage by a RN for risk factors, symptoms or complaints of respiratory/tuberculosis (TB) using the RIPT criteria in the EHR; five points or greater indicates the need for immediate initiation of the RIPT procedure.

  1. A mask will be placed on the patient and PA/Lateral chest x-ray will be ordered by the triage provider or nurse (with a DEM Attending on duty as ordering physician)
  2. The patient will be escorted to the radiology waiting area, and the triage nurse will hand off communication to the Area Charge Nurse (ACN).
  3. On completion of the chest x-ray, the ACN will follow-up with the R-3 or Attending Physician for interpretation of the chest x-ray. The decision to release the patient back to the waiting area or continue isolation in a designated isolation room will be made by the provider at that time.

<https://www.ncbi.nlm.nih.gov/pubmed/10736118>

<http://www.currytbcenter.ucsf.edu/sites/default/files/ic_book_2011.pdf>


15.1 Visitors in the ED

http://myladhs.lacounty.gov/polproc/Harbor%20Policies%20and%20Procedures/DEM%20Policy%20Manual/15.1%20Visitors%20in%20the%20ED.pdf

21.4 Care of Potential Myocardial Ischemia Patient in Triage

  • All adult patients presenting to the DEM triage area with a chief complaint suggestive of myocardial ischemia will be screened rapidly by the Router RN to determine the need for immediate intervention using the following criteria:
  1. Age >35 AND chest, arm, neck, jaw pain that is described as pressure, heaviness, or discomfort.
  2. Age >45 AND Shortness of Breath, weakness, or arm numbness, CONCERNING FOR A CARDIAC ETIOLOGY and without other explanation
  3. Age > 65 AND Nausea, lightheadedness, “indigestion”, or “dizziness" CONCERNING FOR A CARDIAC ETIOLOGY and without other explanation
  4. Clinical concern for myocardial ischemia exists despite absence of 1-3
  • If the patient meets the above criteria the Router RN will assign a triage priority of cardiac, order an EKG, and notify the triage RN via phone; the patient will be placed in RME1 for immediate EKG
  1. Once the ECG has been completed, the triage nurse will notify the RME provider who will review the ECG

Approved June 2015, Chappell 2/22/16

21.5 Medications in Triage: Standardized Procedure

  • Administration of medications in triage (MIT) is to provide timely treatment for patients arriving to the ED with pain, fever, dyspepsia, or nausea and vomiting at the time of triage/assessment and reassessment. Available medications include Acetaminophen, Ibuprofen, Maalox, or Ondansetron.
    • PAIN: All patients who arrive to the ED Triage area will have their level of pain assessed and documented in the EMR. The pain scales used are FLACC, Numeric, and Faces, depending upon the age of the patient.
    • FEVER: All patients who present to the ED Triage area will have their temperatures taken and documented in the electronic medical record. All patients who present with a temperature > 100.4º F (38º C) [can be axillary, rectal, or oral temperature] shall be offered acetaminophen or ibuprofen. If a previous antipyretic has been given (either at home or in triage), an alternate antipyretic will be given if temperature >100.4º F (38º C). Rectal temperatures must be obtained for all of the following pediatric patients: Infants less than 2 months old, Children less than 2 years old with the exception of children presenting with minor trauma, & Active seizure patients up to 3 years old
  • Assessment of the patient’s symptoms (pain, fever, gastritis symptoms, nausea and/or vomiting) should be reassessed within 1 hours of the medication given in triage.
    • Patients who after reassessment of pain (within one hour of receiving the 1st dose of acetaminophen or ibuprofen) continue to complain of pain and desire further analgesic treatment will then be offered acetaminophen or ibuprofen alternating from the previous medication administration.
    • Patients who continue to complain of pain and/or fever may have a repeat dose of acetaminophen 4 hours after the initial dose, and/or a repeat dose of ibuprofen 6 hours after the initial dose.
    • Patients who continue to complain of dyspepsia may have a repeat dose of aluminum hydroxide and magnesium hydroxide antacid (Mag-Al Plus) 6 hours after the initial dose.
  • A nurse practitioner or physician provider will be notified of any patient that:
    • The triage nurse assesses to require more analgesia than oral acetaminophen or ibuprofen or aluminum hydroxide and magnesium hydroxide antacid (Mag-Al Plus) can provide

Consent

  • PD Blood ETOH draws: patient must be registered, police sign written consent form
    • ED staff will draw samples if the patient submits to the test, but will NOT attempt to obtain blood if physical force is required (by staff or law enforcement) to obtain the test
    • persons under arrest are only deemed to have given implied consent if they are unconscious or cannot refuse a test for other reasons

Approved November 2015, Chappell 2/22/16

See Also

References

  1. Approved June 2015, Chappell 2/22/16