Special ED Situations/Protocols - Revision history

JenniferH: Redirected page to Common ER Encounters

2020-11-20T15:48:03Z

← Older revision		Revision as of 15:48, 20 November 2020
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			#REDIRECT [[Common ER Encounters]]

	===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.

JenniferH: /* Dog Bites */

2020-03-30T19:44:35Z

Dog Bites

← Older revision		Revision as of 19:44, 30 March 2020
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	*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 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]		*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===		===Botulism===

JenniferH: /* Acetaminophen overdose */

2020-03-30T19:43:51Z

Acetaminophen overdose

← Older revision		Revision as of 19:43, 30 March 2020
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	*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
	*[[Acetaminophen Overdose]]		*[[media:Acetaminophen_overdose.pdf\|YKHC Clinical Guideline for Acetaminophen Overdose]]

	===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

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

2019-10-16T22:36:43Z

Sexual assault/sexual abuse of a minor

← Older revision		Revision as of 22:36, 16 October 2019
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	===Sexual assault/sexual abuse of a minor===		===Sexual assault/sexual abuse of a minor===
	#This is an unfortunately common occurrence in our region as well. If the alleged abuse took place in a village, the state troopers must be called, if the alleged abuse occurred in Bethel, the Bethel Police Department must be called.		see [[SART]] page for detailed information
	~~#The Office of Children’s Services must also be notified in all cases.~~
	~~#The Alaska State Troopers arrange travel in from the villages.~~
	~~#If you have a strong suspicion for abuse that law enforcement has declined to investigate, please re-contact law enforcement, CAC and OCS.~~
	~~#The Tundra Women’s Coalition (TWC) has a Children’s Advocacy Center (CAC) who handles all these cases and must also be notified.~~
	~~#The children, unless medically unstable, are all interviewed first at the CAC which is located in Bethel at TWC. The CAC has trained bilingual forensic children’s interviewers.~~
	#Depending on what is disclosed at the interview, the child can either need an acute exam with evidence collection (this is very uncommon and occurs only a few times per year) or can have a well-child exam scheduled in the ambulatory clinic in Bethel. These special appointments are arranged between the CAC and the outpatient scheduling department.
	#[[~~Suspected Prepubescent Child Sexual Abuse Procedure~~]]

JenniferH: Created page with "===Dog Bites=== *Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf|rabies investigation report]” from our Office of Environmental Health (OEH) d..."

2019-09-19T07:30:20Z

Created page with "===Dog Bites=== *Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf|rabies investigation report]” from our Office of Environmental Health (OEH) d..."

New page

===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]

===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
*[[Acetaminophen Overdose]]

===Sexual assault/sexual abuse of a minor===
#This is an unfortunately common occurrence in our region as well. If the alleged abuse took place in a village, the state troopers must be called, if the alleged abuse occurred in Bethel, the Bethel Police Department must be called.
#The Office of Children’s Services must also be notified in all cases.
#The Alaska State Troopers arrange travel in from the villages.
#If you have a strong suspicion for abuse that law enforcement has declined to investigate, please re-contact law enforcement, CAC and OCS.
#The Tundra Women’s Coalition (TWC) has a Children’s Advocacy Center (CAC) who handles all these cases and must also be notified.
#The children, unless medically unstable, are all interviewed first at the CAC which is located in Bethel at TWC. The CAC has trained bilingual forensic children’s interviewers.
#Depending on what is disclosed at the interview, the child can either need an acute exam with evidence collection (this is very uncommon and occurs only a few times per year) or can have a well-child exam scheduled in the ambulatory clinic in Bethel. These special appointments are arranged between the CAC and the outpatient scheduling department.
#[[Suspected Prepubescent Child Sexual Abuse Procedure]]