Tips and Tricks at EHC

Resident Contact List

2011-2012

A patient who comes in s/p I 131 treatment within a month of their treatment

Prostatic Implants

Get readings with the Geiger Counter and call radiation safety officer

How to use the Geiger Counter

Get the geiger counter from hospital police

Remove the red shield (do not discard)

Turn the on switch to x0.1

1. Turn off audio
2. Test the battery, when you press the button, the indicator should move to the battery test area of the display
3. Press reset
4. Make sure the f/s switch is turned to “f”
5. Take a background reading at least 15 feet from the patient
6. Now wand as close as possible to the affected area
7. Look at the mR/hr area of the display (the one in the middle of the 3 arcs), look at the number and divide by 10 (you have set the machine to the “x0.1″ setting so all readings need to be divided by 10)
8. Where the arrow settles is the reading
9. If the indicator moves all the way to the right, change the setting from x0.1 to x1
10. Retake the reading

What to do with the reading

Call or Page the radiation safety officer

Until they advise–

• < 2mr/ hr all children and pregnant staff need to stay 6 feet from patient.
• >2mr/ hr all staff need to stay 6 feet from the patient.
• If the patient is in extremis, treat the patient first as radiation emission is a secondary concern and brief exposure to implants will not cause a significant exposure to staff.  Pregnant staff should not treat the patient.

These patients should ALWAYS be admitted to surgery:

• Diverticulitis with and without abscess
• Cholecystitis
• Cholangitis (NOT MEDICINE)
• Choledocholithiasis (NOT MEDICINE)
• Liver abscess
• Post-operative complication within 30 days of surgery including DVT (go to the service that operated on the patient)
• Pancreatitis if caused by gallstones or if patient requires ICU admission (otherwise patient goes to medicine)
• Lower GI bleeds requiring admission
• Appendicitis
• Bowel Obstruction or Perforation
• Pneumoperitoneum
• Animals bites, frostbite, or burns below elbow go to service covering hand, otherwise to general surgery
• Acutely incarcerated hernia
• Spontaneous pneumothorax (unless requiring isolation for TB/HIV or acute exacerbation of COPD/Asthma requiring medical intervention, in which case they should be admitted to medicine)

Trauma Admissions

• Red Trauma-automatic admission to trauma service. If the initial work-up reveals no significant injury AND both the ED Attending and the Surgical Attending agree, these patients may be discharged (do not downgrade to yellow, discharge as red).

  In rare circumstances, a red trauma may have isolated injuries that are under the purview of another surgical sub-specialty. Admission to this service may only occur if the trauma service obtains the agreement of this sub-specialty; if there is any disagreement, the patient will be admitted to the trauma service. (In this circumstance, downgrade the patient to a yellow trauma).

• Yellow Trauma-If 2 or more organ systems are involved, the patient will be admitted to the trauma service. Isolated orthopedic injuries with stable hemodynamics may go to orthopedics. Unstable pelvic injuries will be admitted to the trauma service. Any patient requiring STICU admission will be admitted under the trauma service. Isolated traumatic intracranial bleeds may be admitted to neurosurgery or trauma service.
• Syncope with isolated intracranial bleed may be admitted to neurosurgery or the trauma service. These patients should only be admitted to the medicine service if they are at significant risk for cardiac dysrhythmia or cardiac ischemia as determined by the ED attending.
• Syncope with any significant trauma (facial fractures, rib fractures) will be admitted to the trauma service. This excludes minor lacerations, contusions, abrasions. These patients should only be admitted to the medicine service if they are at significant risk for cardiac dysrhythmia or cardiac ischemia as determined by the ED attending.
• Yellow trauma with isolated facial or ocular trauma requiring admission should be admitted to the service covering facial trauma at the time and date of patient arrival in the ED. If the patient has facial/ocular trauma with additional injuries, they should be admitted to the trauma service.
• Isolated genitourinary trauma requiring admission should go to the trauma service.
• ??? Upper extremity fracture requiring admission for pain should be admitted to the trauma service. ???
• Lower extremity fracture requiring admission: Orthopedics. If pelvic fracture is unstable or accompanied by significant blood loss, then the patient will be admitted to the trauma service
• Altered mental status or post-concussive syndrome (excluding syncope) after trauma goes to trauma service even with a negative trauma work-up.
• Rib fractures requiring admission goes to the trauma service.
• Vertebral fractures after trauma goes to the service covering spine.

Neurology/Neurosurgery Admissions

• TIA goes to neurology (Only if unstable atrial fibrillation should these patients go to medicine)
• Spontaneous Intra-parenchymal hemorrhage (ICH)-admit to neurology, do not call neurosurgery. Neurology will consult neurosurgery as appropriate. If these patients require operative intervention or EVD, they will go to the STICU under neurosurgery
• Spontaneous SAH-neurosurgery

Miscellaneous

• Cellulitis below elbow-Service covering hand
• Cellulitis in other locations-alternates between surgery/medicine. Call bedboard to see which service is next up.
• Upper GI bleeds go to medicine

Provider Directions for Positive rapid HIV Results

Additional Resources:

http://www.cdc.gov/hiv/topics/testing/resources/factsheets/rt_counseling.htm.

It includes information including the sensitivities and specificities of our rapid tests (appendix), allowing an educated discussion about what this test means with our patients.”

ID Clinic Who to send to the ID Clinic

Colored Trauma CT Scan Policy

If you want your scan done within an hour, unfortunately you have to send a
resident

2 T+H Specimens

You need two T+H specimens unless it is an emergency, in which case you’ll need to sign a waiver