Common ER Encounters - Revision history

JenniferH: /* Botulism */

2021-08-23T22:23:13Z

Botulism

← Older revision		Revision as of 22:23, 23 August 2021
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	All suspected cases of botulism MUST be reported immediately to State of Alaska section of epidemiology 907-269-8000 or 800-478-0084. The state of Alaska has a very nice booklet on botulism that outlines symptoms and case recognition and appropriate treatment that can be found on the following web site. There are also hard copies in the ED and on NW.		All suspected cases of botulism MUST be reported immediately to State of Alaska section of epidemiology 907-269-8000 or 800-478-0084. The state of Alaska has a very nice booklet on botulism that outlines symptoms and case recognition and appropriate treatment that can be found on the following web site. There are also hard copies in the ED and on NW.
	*Link to: [http://dhss.alaska.gov/dph/Epi/id/Pages/botulism/resources.aspx State of Alaska website on botulism]		*Link to: [http://dhss.alaska.gov/dph/Epi/id/Pages/botulism/resources.aspx State of Alaska website on botulism]
	*Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than ~~[[____~~% predicted or ~~a decreased in ____%]]~~, intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork '''MUST''' be completed and returned to the State of Alaska.		*Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than 80% predicted or diminishing over time, intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork '''MUST''' be completed and returned to the State of Alaska.

	==Acetaminophen overdose==		==Acetaminophen overdose==
	*This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.		*This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.

JenniferH: /* Dog Bites */

2020-11-20T15:46:56Z

Dog Bites

← Older revision		Revision as of 15:46, 20 November 2020
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	==Dog Bites==		==Dog Bites==
	*Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf\|rabies investigation report]” from our Office of Environmental Health (OEH) department must be completed on every patient with a dog bite.		*Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf\|rabies investigation report]]” from our Office of Environmental Health (OEH) department must be completed on every patient with a dog bite.
	*Rabies prophylaxis: if the dog can’t be found, the bite wasn’t provoked or if the dog was behaving strangely, rabies prophylaxis should be administered and the State of Alaska, section of epidemiology notified: 907-269-8000 or 800-478-0084.		*Rabies prophylaxis: if the dog can’t be found, the bite wasn’t provoked or if the dog was behaving strangely, rabies prophylaxis should be administered and the State of Alaska, section of epidemiology notified: 907-269-8000 or 800-478-0084.
	*The order for the rabies immune globulin and vaccination are in RAVEN and have attached references in the reference tab of the order.		*The order for the rabies immune globulin and vaccination are in RAVEN and have attached references in the reference tab of the order.

JenniferH: /* Acute Myocardial Infarction */

2020-11-20T10:41:41Z

Acute Myocardial Infarction

← Older revision		Revision as of 10:41, 20 November 2020
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	Use [[:Category:YKHC Guidelines\|YKHC published guidelines]] for all types of encounters, if a guideline is available. If you deviate from the guidelines, document in the chart why you didn't follow the guidelines.		Use [[:Category:YKHC Guidelines\|YKHC published guidelines]] for all types of encounters, if a guideline is available. If you deviate from the guidelines, document in the chart why you didn't follow the guidelines.

	==[[Myocardial Infarction – Acute\|Acute ~~Myocardial Infarction~~]]==		==[[Myocardial Infarction – Acute\|Acute Coronary Syndrome (ACS)]]==
	*~~Acute MI~~ has become increasingly common in our population and, as a result, our use of lytics has increased. If ~~acute MI~~ is suspected, the order set for chest pain will be initiated. Cardiology is usually available at ANMC to review your EKG if you wish before initiating lytics. Most acute MI patients will be medevac’d to ANMC – possible exceptions include the elderly with multiple co-morbid conditions who aren’t eligible for operative intervention.		*ACS has become increasingly common in our population and, as a result, our use of lytics has increased. If ACS is suspected, the order set for chest pain will be initiated. Cardiology is usually available at ANMC to review your EKG if you wish before initiating lytics. Most acute MI patients will be medevac’d to ANMC – possible exceptions include the elderly with multiple co-morbid conditions who aren’t eligible for operative intervention.
	*If you give lytics, the patient goes via medevac to ANMC.		*If you give lytics, the patient goes via medevac to ANMC.
	'''Resources:'''		'''Resources:'''

JenniferH: /* Injuries/Fractures */

2020-10-28T13:16:43Z

Injuries/Fractures

← Older revision		Revision as of 13:16, 28 October 2020
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	*This is another very common reason for a visit to the ED. Most of our patients do not have access to fresh fruits and vegetables and reliable safe drinking water and therefore constipation is very common. The nursing staff has standard orders for triage for this problem. We do not have surgeons in Bethel (except for OB related issues) and so all appys need to travel to Anchorage if the surgeon wants to take out the appendix. They can often travel in on a commercial flight if they are stable. If unstable, or if pain can’t be controlled, they will need a medevac.		*This is another very common reason for a visit to the ED. Most of our patients do not have access to fresh fruits and vegetables and reliable safe drinking water and therefore constipation is very common. The nursing staff has standard orders for triage for this problem. We do not have surgeons in Bethel (except for OB related issues) and so all appys need to travel to Anchorage if the surgeon wants to take out the appendix. They can often travel in on a commercial flight if they are stable. If unstable, or if pain can’t be controlled, they will need a medevac.

	==Injuries/Fractures==		==[[Orthopedics/Telerad\|Injuries/Fractures]]==
	*Please send all x-rays with fractures diagnosed to ANMC orthopedic telerad. This is a paper form you must complete. That allows for non-urgent consultation to take place via the ambulatory clinic. If there is an urgent need, please call ANMC and speak to the on-call ortho doc. They can give you some advice over the phone and, during the day, look at your x-rays.		*Please send all x-rays with fractures diagnosed to ANMC orthopedic telerad. This is a paper form you must complete. That allows for non-urgent consultation to take place via the ambulatory clinic. If there is an urgent need, please call ANMC and speak to the on-call ortho doc. They can give you some advice over the phone and, during the day, look at your x-rays.
	*If the patient is a trauma victim, call ANMC surgeon on call. They handle all calls related to trauma, even if the primary injury is orthopedic.		*If the patient is a trauma victim, call ANMC surgeon on call. They handle all calls related to trauma, even if the primary injury is orthopedic.

JenniferH: /* Sexual assault/sexual abuse of a minor */

2020-10-28T13:11:00Z

Sexual assault/sexual abuse of a minor

← Older revision		Revision as of 13:11, 28 October 2020
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	==Sexual assault/sexual abuse of a minor==		==Sexual assault/sexual abuse of a minor==
	see [[SART]] page for detailed information		see [[SART]] page for detailed information

			[[:Category:Emergency Room\|Emergency Department Main Page]]

JenniferH: /* Acetaminophen overdose */

2020-10-21T21:24:16Z

Acetaminophen overdose

← Older revision		Revision as of 21:24, 21 October 2020
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	*Link to: [http://dhss.alaska.gov/dph/Epi/id/Pages/botulism/resources.aspx State of Alaska website on botulism]		*Link to: [http://dhss.alaska.gov/dph/Epi/id/Pages/botulism/resources.aspx State of Alaska website on botulism]
	*Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than [[____% predicted or a decreased in ____%]], intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork '''MUST''' be completed and returned to the State of Alaska.		*Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than [[____% predicted or a decreased in ____%]], intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork '''MUST''' be completed and returned to the State of Alaska.
	===Acetaminophen overdose===		==Acetaminophen overdose==
	*This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.		*This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.
	*Poison control number is 800-222-1222		*Poison control number is 800-222-1222

JenniferH at 21:23, 21 October 2020

2020-10-21T21:23:49Z

← Older revision		Revision as of 21:23, 21 October 2020
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	*Occasionally infants with jaundice will come to the Emergency Department from villages for the express purposes of checking a serum total and direct bilirubin. Since this lab test takes considerable time to return, a general recommendation is to sequester this child and mother in either the quiet room or in another area away from the general ED population while awaiting test results. If the child is ill appearing, or has other complaints such as fever, of course have them evaluated in the main ED per guideline.		*Occasionally infants with jaundice will come to the Emergency Department from villages for the express purposes of checking a serum total and direct bilirubin. Since this lab test takes considerable time to return, a general recommendation is to sequester this child and mother in either the quiet room or in another area away from the general ED population while awaiting test results. If the child is ill appearing, or has other complaints such as fever, of course have them evaluated in the main ED per guideline.
	*[[media:Jaundice_neonatal.pdf\|YKHC Guidelines for Neonatal Jaundice]]		*[[media:Jaundice_neonatal.pdf\|YKHC Guidelines for Neonatal Jaundice]]

			==Dog Bites==
			*Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf\|rabies investigation report]” from our Office of Environmental Health (OEH) department must be completed on every patient with a dog bite.
			*Rabies prophylaxis: if the dog can’t be found, the bite wasn’t provoked or if the dog was behaving strangely, rabies prophylaxis should be administered and the State of Alaska, section of epidemiology notified: 907-269-8000 or 800-478-0084.
			*The order for the rabies immune globulin and vaccination are in RAVEN and have attached references in the reference tab of the order.
			*Link to the web site from the State of Alaska: [http://dhss.alaska.gov/dph/Epi/id/Pages/rabies/default.aspx Rabies]
			*Link to the post-exposure prophylaxis [http://dhss.alaska.gov/dph/Epi/id/SiteAssets/Pages/Rabies/RabiesPostExposureTreatment.pdf recommendations from the State of Alaska]
			*[[media:Rabies.pdf\|YKHC Clinical Guideline for Rabies]]

			==Botulism==
			*Food borne botulism is very common in our region as the consumption of fermented traditional foods is very common. Bethel is one of the repositories of botulism anti-toxin from the CDC and we have several kits here that we can use to treat patients. Botulism should be suspected in any patient with a history of consuming traditional fermented foods and symptoms such as weakness, dry mouth, blurred vision, urinary retention, ileus, diarrhea or dyspnea (especially without gasping or rapid respiratory rate.)
			All suspected cases of botulism MUST be reported immediately to State of Alaska section of epidemiology 907-269-8000 or 800-478-0084. The state of Alaska has a very nice booklet on botulism that outlines symptoms and case recognition and appropriate treatment that can be found on the following web site. There are also hard copies in the ED and on NW.
			*Link to: [http://dhss.alaska.gov/dph/Epi/id/Pages/botulism/resources.aspx State of Alaska website on botulism]
			*Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than [[____% predicted or a decreased in ____%]], intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork '''MUST''' be completed and returned to the State of Alaska.
			===Acetaminophen overdose===
			*This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.
			*Poison control number is 800-222-1222
			*[[media:Acetaminophen_overdose.pdf\|YKHC Clinical Guideline for Acetaminophen Overdose]]

			==Sexual assault/sexual abuse of a minor==
			see [[SART]] page for detailed information

JenniferH: /* Skin and Soft Tissue Infection */

2020-09-25T03:44:04Z

Skin and Soft Tissue Infection

← Older revision		Revision as of 03:44, 25 September 2020
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	==[[Skin and Soft Tissue Infection]]==		==[[Skin and Soft Tissue Infection]]==
	*Community acquired MRSA is very common here and boils and cellulitis is a common reason for visits to the ED. Please follow our guideline on boils. Most of the MRSA is sensitive to Septra. We prefer the use of penrose drains if at all possible in our patients, especially in children		*Community acquired MRSA is very common here and boils and cellulitis is a common reason for visits to the ED. Please follow our guideline on boils. Most of the MRSA is sensitive to Septra. We prefer the use of penrose drains if at all possible in our patients, especially in children
	*Click [[Practicing Medicine in Bush Alaska—Some ABCs#Cellulitis -- Community acquired MRSA Abscesses\|here]] for more information about cellulitis in the Delta.
	*[[media:SSTI.pdf\|Skin and Soft Tissue Infection YKHC Clinical Guideline]]		*[[media:SSTI.pdf\|Skin and Soft Tissue Infection YKHC Clinical Guideline]]

JenniferH: /* Respiratory illnesses */

2020-09-25T03:43:06Z

Respiratory illnesses

← Older revision		Revision as of 03:43, 25 September 2020
Line 30:		Line 30:
	* [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis/Wheezing]] [[media:Bronchiolitis_wheezing.pdf\|(YKHC Clinical Guideline)]]		* [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis/Wheezing]] [[media:Bronchiolitis_wheezing.pdf\|(YKHC Clinical Guideline)]]
	* [[Croup/Stridor: Evaluation & Treatment\|Croup/Stridor]] [[media:Croup_stridor.pdf\|(YKHC Clinical Guideline)]]		* [[Croup/Stridor: Evaluation & Treatment\|Croup/Stridor]] [[media:Croup_stridor.pdf\|(YKHC Clinical Guideline)]]
	* [[Influenza]] [[media:Influenza.pdf~~\|Influenza (Adult and Pediatrics)~~\|(YKHC Clinical Guideline)]]		* [[Influenza]] [[media:Influenza.pdf\|(YKHC Clinical Guideline)]]

	==[[Skin and Soft Tissue Infection]]==		==[[Skin and Soft Tissue Infection]]==

JenniferH: /* Respiratory illnesses */

2020-09-25T03:42:44Z

Respiratory illnesses

← Older revision		Revision as of 03:42, 25 September 2020
Line 30:		Line 30:
	* [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis/Wheezing]] [[media:Bronchiolitis_wheezing.pdf\|(YKHC Clinical Guideline)]]		* [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis/Wheezing]] [[media:Bronchiolitis_wheezing.pdf\|(YKHC Clinical Guideline)]]
	* [[Croup/Stridor: Evaluation & Treatment\|Croup/Stridor]] [[media:Croup_stridor.pdf\|(YKHC Clinical Guideline)]]		* [[Croup/Stridor: Evaluation & Treatment\|Croup/Stridor]] [[media:Croup_stridor.pdf\|(YKHC Clinical Guideline)]]
	* [[Influenza]]		* [[Influenza]] [[media:Influenza.pdf\|Influenza (Adult and Pediatrics)\|(YKHC Clinical Guideline)]]

	==[[Skin and Soft Tissue Infection]]==		==[[Skin and Soft Tissue Infection]]==