The Community - Provider Practice Essentials...Pregnancy Test Serum Qualitative (if patient is...

Community

Triage Companion

This triage companion is meant to serve as a guide for busy emergency departments utilizing advanced nursing

guidelines for throughput and screening purposes. It is not intended to be a replacement for physician

management, thought, and clinical decision-making, but to enhance the delivery of healthcare during periods

of high volume and slow patient throughput (surge).

It is the expectation of this institution that clinical reason be used for the initial assignment of chief complaint,

and that these advanced care protocols are initiated as part of a complete triage examination, and verification

of the patient’s true medical presentation to the Emergency Department.

These chief complaints and protocols have been optimized for the HMA Medhost database of patient

complaints. Deviation from these protocols is encouraged only in cases where there is an unclear selection of

which protocol to use, and physician involvement in this decision is suggested.

If superficial, cover in Silvadene lotion, wrap in dry dressing

If deep or associated with trauma, order the following:

UA (With Micro/reflex culture)

TROPONIN

IV Saline Lock

- Consider -

Pregnancy Test Serum Qualitative (If FEMALE Aged 10-50)

Abdominal Burn

AMYLASE

LIPASE

IV Saline Lock

- Consider -

EKG (If Age 50 or Greater)

PT, PTT (If patient has history of Cirrhosis, Liver Disease, or is taking Coumadin or other anticoagulants)

Keep Patient NPO

Abdominal Cramping

AMYLASE

LIPASE

Lactic Acid

CPK Total

IV Saline Lock

- Consider -

Keep Patient NPO

Abdominal Crush Injury

AMYLASE

LIPASE

Acute Abdominal Series

IV Saline Lock

- Consider -

Keep Patient NPO

Abdominal Distension

AMYLASE

LIPASE

IV Saline Lock

- Consider -

Keep Patient NPO

Abdominal Pain

AMYLASE

LIPASE

IV Saline Lock

- Consider -

Keep Patient NPO

Abdominal Pain >50yo

AMYLASE

LIPASE

IV Saline Lock

- Consider -

CPKMB and Troponin (If Age 50 or Greater)

Keep Patient NPO

Abdominal Pain Upper

Pregnancy Test Serum Qualitative (if Female, Aged 10-50)

- OR -

Beta HCG Quantitative (if known pregnant)

Type and Screen (If patient is pregnant and complaining of vaginal bleeding)

IV Saline Lock

- Consider -

US Pelvic Complete (with physician approval)

Abdominal Pain – Lower Female

Identify abnormal lab result and order the same test here (i.e. PT and PTT if INR is abnormal).

If not included, also order CBC and CMP

- Consider -

Pregnancy Test Serum Qualitative (if patient is FEMALE aged 10-50)

Type and Screen if anemia (low hemoglobin) is the abnormal result

EKG if electrolytes (such as potassium) are abnormal

Abnormal Lab Results

Clean Wound, Apply Antibacterial ointment, dress per protocol.

Abrasion(s)

I & D Kit to bedside

Sterile Gloves

Betadine Swabs

Chloraprep per physician preference

¼ or ½ inch iodoform or plan packing per physician preference

Wound Culture

Abscess

Sterile Gloves

Betadine Swabs

Wound Culture

Abscess Recheck

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

Urine Drug Screen

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Pregnancy Test Serum Qualitative (If patient is Female aged 10-50)

Accidental Overdose

ETOH Level

Urine Drug Screen

Tylenol Level

Aspirin Level

IV Saline Lock

- Consider -

Alcohol Withdrawal

IV Saline Lock

- Consider -

Accurate exposure history – Pesticides, poisons, chemicals

Chest 1 view (if respiratory difficulty)

If patient is complaining of worsening SOB, take immediately back to treatment area

Allergic Reaction

AccuCheck Now

Tylenol Level

Aspirin Level

UA(With Micro/reflex culture)

Urine Drug Screen

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

CT Brain Without Contrast (with physician approval)

CPKMB and Troponin (if age 50 or greater)

IV Saline Lock

Altered Mental status

Type and Screen

IV Saline Lock

- Consider -

PT and PTT (if patient is taking Coumadin or other anticoagulants)

Anemia

Identify Animal

Determine Rabies Status of Animal

Order xray of area for foreign body

Animal Bite

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Notify physician if patient is appropriate for medical clearance.

Anxiety

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Aphasia

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if patient has history of chest pain or age >50)

UA (With Micro/Reflex Culture) if patient complains of dysuria

Pregnancy Test Serum Qualitative (If patient is FEMALE Aged 10-50)

Arrythmia

Chest PA & Lateral (or Chest 1 View if patient obtunded)

Blood Cultures x 2

Peak Flow

IV Saline Lock

- Also Consider -

ABG (If history of COPD/Emyphysema)

CPKMB and Troponin (If Age 50 or greater)

PT and PTT (If patient is taking Warfarin or other anticoagulants or has hemoptysis)

BNP (if patient has history of congestive heart failure)

- Treatment -

If severe hypoxia requiring more than 2L NC, call Respiratory Therapy, notify Physician

Asthma Exacerbation

Lumbar Spine (per pain location)

Thoracic Spine (per pain location)

Cervical Spine (per pain location)

- Consider -

If symptoms include new weakness, inability to walk, or numbness, patient should be brought

immediately back to treatment area or evaluated by ED physician upon arrival.

Back Injury

Lumbar Spine (per pain location)

- Consider -

Back Pain

Sterile Gloves

Betadine Swabs

Wound Culture

Pelvic Setup

Bartholin’s Cyst

IV Saline Lock

- Consider -

Bee Sting

Identify penetrating versus blunt trauma

Use appropriate protocol

For Assaulted Trauma patients, ensure safety of department and consider complete department lockdown

with Security

Bicycle Vs Vehicle

Type and Screen

IV Saline Lock (2 large bore)

Cardiac Monitor

- Consider -

CPKMB and Troponin (if age >50 or history of coronary disease)

EKG (if Pulse is greater than 100)

Patient should be brought immediately to treatment area.

Black/Tarry Stools

IV Saline Lock

- Consider -

Type and Screen (If vital signs are unstable or massive bleeding noted)

Bleeding Gums

IV Saline Lock

- Consider -

Type and Screen (if vital signs are unstable or massive bleeding noted)

Blood in Catheter

UA (with Micro/Reflex Culture)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Chest 1 View (if patient is short of breath or complaining of chest pain)

CT Brain Without Contrast (If patient has severe headache and with physician approval)

CPKMB and Troponin (if patient is short of breath or complaining of chest pain)

Blood Pressure Problem

Document Visual Acuity

Eye Kit to Bedside with Florescein

Tetracaine Solution (2%) Topical Once

Blurred Vision (Ophthalmologic)

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Blurred Vision (Possible Stroke)

Sterile Gloves

Betadine Swabs

Wound Culture

Troponin

Magnesium Level

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

Bradycardia

Chest PA and Lateral

- Consider -

Breast Lump

- Consider -

Breast Problem

- Consider -

Breast Injury

PT and PTT

Chest 1 View

Keep Patient NPO

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

CPKMB and Troponin (if Age >50 or history of CAD)

BNP (If history of CHF)

ABG (If history of COPD, Empysema, or unknown history)

- Treatment -

Administer Tylenol or Motrin per Protocol

Breathing Difficulty

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Can’t Walk

Urine Drug Screen

ETOH Level

Tylenol Level

Aspirin Level

ABG with Co-Oximetry and Carbon Monoxide Level (may need to contact RT)

Oxygen 100% NRB

IV Saline Lock

- Consider -

Patient should be brought immediately back to treatment area or receive oxygen.

Notify physician immediately of patient is obtunded or requires immediate attention.

Carbon Monoxide Exposure

Identify Animal

Cat Bite

Apply Cervical Collar

Maintain Cervical Spine precautions

Cervical Spine Series (AP, Lateral, and Odontoid)

- Consider -

If patient has head injury, order CT brain without contrast AND CT Cervical Spine without Contrast (with MD

permission)

Cervical Spine Injury

Troponin

Magnesium Level

Chest 1 View

IV Saline Lock

Cardiac Monitor

Cardiac Arrest

IV Saline Lock

Cardiac Monitor

Contact Poison Control Center

Decontaminate and/or irrigate patient with copious amounts of water.

Chemical Burn

IV Saline Lock

Cardiac Monitor

Contact Poison Control Center

Decontaminate and/or irrigate patient with copious amounts of water.

Chemical Exposure

Document name of offending agent.

Irrigate Eye with Morgan Lens, 1 Liter per eye.

Contact Poison Control Center for further information.

Document Tetanus Status and notify MD is not up to date.

- Consider -

Notify Physician if patient is in extreme pain.

Chemical Exposure - Eye

Apply 100% NRB

ABG with Co-oximetry and Carbon Monoxide Level

Chest 1 view

Pulse Ox Continuous

Cardiac Monitor

IV Saline Lock

- Consider -

Chemical Inhalation

TROPONIN

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

Amylase and Lipase is pain is epigastric in location

Urine Drug Screen and ETOH

Chest Pain (Adult)

Chest PA and Lateral (consider Chest 1 View if patient is unstable)

IV Saline Lock

- Consider -

CPKMB and Troponin if patient has history of congenital disease, known heart disease, recent cocaine use

Chest Pain (Pediatric)

- Consider -

Chest Pain Protocol if symptoms appear cardiac

Chest Pain from Injury

TROPONIN

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

Chest Pain, Possible Cardiac

TROPONIN

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

Chest Pressure

- Consider -

Chest Pain Protocol if symptoms appear cardiac

Chest Wall Pain

Notify Physician of potential airway compromise

Choked / Choking

Clavicle LEFT or RIGHT depending on location of pain

- Consider -

Chest 1 view if patient in extreme pain or SOB

If patient is unstable, bring immediately to treatment area and order:

IV Saline Lock

Clavicle Injury

CT Brain Without Contrast (With Physician Approval)

- Consider -

CT Cervical Spine (if neck pain present)

Apply Cervical Collar (if neck pain present)

If patient had syncope prior to fall, also use Syncope Protocol

Closed Head Injury – Adult

- Consider -

Asymptomatic children without hematoma may be observed until provider evaluation.

Closed Head Injury – Infant - Pediatric

IV Saline Lock

Cardiac Monitor

Cold Exposure

- Consider -

Flu A and B (If flu season or suspected exposure)

RSV (if infant)

Monospot (if patient <25 years of age and no history of mononucleosis)

IV Saline Lock

Cold Symptoms

- Consider -

RSV (if infant)

IV Saline Lock

Congestion

Constipation

- Consider -

PT and PTT if patient taking Coumadin

CT Brain without contrast (with physician approval)

Contusion

Blood Cultures x 2

IV Saline Lock

- Also Consider -

- Treatment -

COPD Exacerbation

Chest PA & Lateral

- If FEVER or SHORTNESS OF BREATH -

Blood Cultures x 2

IV Saline Lock

- Also Consider -

Troponin

Magnesium Level

Chest 1 View

IV Saline Lock

Cardiac Monitor

Chest AP and Lateral

- Consider -

CBC (if patient is febrile)

CMP (if patient is febrile)

Blood Cultures x 1 (If patient is febrile)

- Treatment -

Supplemental Oxygen

If patient has severe shortness of breath, bring directly to treatment area, call Respiratory Therapy, notify

Physician.

Order Appropriate Radiograph Studies

Nonspecific pain locations should have all studies ordered to include the joint above AND below the injury

Elevate effected Extremity

ICE injury if less than 48 hours old.

- Consider -

If involved extremity is cooler than the contralateral extremity or pulses are difficult to palpate, patient should

be taken immediately to the treatment area

IV Saline Lock, CBC, CMP, type and screen if surgical intervention suspected

CPK Total and Lactic Acid (If crush injury Suspected)

Crush Injury

IV Saline Lock

- Consider -

CT Chest With IV Contrast (With Physician Approval)

CT Abdomen and Pelvis with IV Contrast ONLY (With Physician Approval)

Crush Injury To Abdomen

IV Saline Lock

- Consider -

CT Chest With IV Contrast (With Physician Approval)

CT Abdomen and Pelvis with IV Contrast ONLY (With Physician Approval)

Crush Injury To Chest

Completely Expose Patient

Search for painful areas, bleeding, swelling, redness, or other physical abnormality

- Consider -

Crying

Sterile Gloves

Betadine Swabs

Wound Culture

- Consider -

Decreased Appetite

AccuCheck Now

Tylenol Level

Aspirin Level

Urine Drug Screen

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

IV Saline Lock

Decreased Level of Consciousness

Expose patient

Photograph Decubitus Ulcer per privacy guidelines and affix photo to chart.

Blood Culture x 2

IV Saline Lock

- Consider -

Elevate extremity

Turn patient in bed every 2 hours

Decubitus

- Consider -

D-Dimer (if 1 or none of the following criteria below are met)

Lower Extremity Duplex US if two or more of the following conditions are met:

1) History of DVT

2) Active Cancer

3) Bedridden recently >3 days or major surgery within 4 weeks

4) Calf Swelling >3cm compared to other leg

5) Collateral superficial veins present

6) Entire Leg Swollen

7) Localized tenderness along the deep venous system

8) Pitting Edema greater in the symptomatic leg

9) Paralysis, Paresis, or recent plaster immobilization of the lower extremity

Deep Venous Thrombosis (DVT)

IV Saline Lock

- Consider -

Dehydration

Accucheck Now

If Accucheck < 50mg/dl notify Physician

AMYLASE

LIPASE

Blood Cultures x 2 sets

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

Serum Acetone if BS >200 mg/dl

Diabetic

- Consider -

Is patient actively bleeding? If yes, apply pressure and bring back immediately to treatment area. Order

Below.

Is Catheter hemostatic and secured to its insertion site? If no, bring patient immediately to treatment area.

Did patient receive scheduled hemodialysis? If no, order below:

IV Saline Lock

Chest 1 View STAT for catheter location

Dialysis Catheter Problem

- Consider -

Is patient actively bleeding? If yes, apply pressure and bring back immediately to treatment area. Order

Below.

Does patient have palpable Thrill? If no, bring patient back immediately to treatment area.

Did patient receive scheduled hemodialysis? If no, order below:

IV Saline Lock

Dialysis Shunt Problem

Stool Culture

IV Saline Lock

- Consider -

EKG (if febrile, Pulse >100)

C Diff (If patient is elderly, lives in nursing home, recent antibiotic use, has history of C Diff, or known outbreak)

Diarrhea

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Difficulty Swallowing

Identify type of G-Tube and Size.

If patient is leaking gastric contents, bring to treatment area as soon as possible.

Notify MD for immediate examination and/or management.

Displaced G-Tube

IV Saline Lock

Orthostatic Vital signs

- Consider -

Urine Drug Screen (if drug use suspected)

ETOH (if alcohol intoxication suspected)

CT Brain Without Contrast (if age >70, sudden onset of symptoms, or severe headache)

PT and PTT (if patient is taking Warafarin or other anticoagulants)

Dizziness

Urine Drug Screen

ETOH Level

Tylenol Level

Aspirin Level IV Saline Lock

- Consider -

CPKMB and Troponin (Age >50 or Diabetic Age >40)

PT and PTT (If patient is taking Coumadin or other anticoagulants)

Drug Levels as appropriate (Digoxin, Dilantin, Valproic Acid, etc)

Doesn’t Feel Right

Identify Animal

Dog Bite

Wound Superficial with Gram Stain

Apply dressing to wound

If active or heavy bleeding, bring patient immediately to treatment area.

Drainage

Drainage from Breast

If clear discharge such as CSF, bring patient immediately to treatment area.

- Consider -

Accucheck if patient is Diabetic

Drainage from Ear

Drainage from Eye

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

Cervical Spine Injury – Apply Collar if patient has neck pain

ABG if prolonged down time or hypoxia

Drowning

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Notify New Visions or appropriate inpatient detox team of patient’s arrival.

IV Saline Lock

Drug Abuse

- Consider -

CBC and BMP (If history of renal failure, fever, or decreased urine output)

Blood Culture x 2 (if fever)

Pregnancy Test Urine (If patient is Female aged 10-50)

Dysuria

Identify object that caused puncture

Check pulses and capillary refill for effected extremity (where applicable)

If Active Bleeding, bring patient immediately to the treatment area.

- Consider -

CT Brain without contrast (with physician permission)

Ear Injury

Identify traumatic versus atraumatic pain

- Consider -

Notify Provider for examination of pain out of proportion to symptoms

Ear Pain

Chest 1 View

- Consider -

TROPONIN

IV Saline Lock

- Consider -

Electrical Burn

TROPONIN

IV Saline Lock

- Consider -

Electrocution

IV Saline Lock

Cardiac Monitor

Contact Poison Control Center (if ingestion or toxic exposure suspected)

Environmental Exposure

AMYLASE

LIPASE

IV Saline Lock

- Consider -

Chest 1 View (if patient is complaining of SOB)

CPKMB and Troponin (If patient is diabetic or age > 50)

Epigastric Pain

Epistaxis Kit to Bedside

IV Saline Lock

- Consider -

Type and Screen (If patient has unstable vital signs)

Epistaxis

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Notify New Visions or appropriate inpatient detox team of patient’s arrival.

IV Saline Lock

ETOH Abuse

Patch effected eye is trauma reported

If active bleeding or irregular appearance to pupil, notify ED physician immediately.

Eye Injury

- Consider -

Sudden onset eye pain without trauma could represent acute glaucoma or ischemia:

Patient should be taken immediately back to treatment area.

IV Saline Lock

CT Brain Without Contrast (With physician approval)

Eye Pain

- Consider -

IV Saline Lock

Eye Problem

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Facial Droop

IV Saline Lock

- Consider -

Facial Swelling

Accucheck Now

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse-ox continuous

Orthostatic Vital Signs

- Consider -

CPKMB and Troponin (if age >50 and/or symptoms of chest pain or palpitations)

PT and PTT (if taking Warfarin or other anticoagulants)

Blood Cultures x 2 if febrile

CT Brain without contrast (if trauma or headache prior to syncope reported)

Fainting

Identify area of pain and injury – order appropriate protocol(s)

- Consider -

PT and PTT if patient has head injury and is taking warfarin or other anticoagulants

Syncope Protocol if patient does not remember falling or passed out prior to fall

Fall Injury

IV Saline Lock

- Consider -

Foot LEFT or RIGHT if history of trauma.

1) History of DVT

2) Active Cancer

Feet Swelling

Accucheck

Blood Culture x 1

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Neonatal Sepsis can cause the patient to rapidly deteriorate. Should be brought to treatment area

immediately.

- Treatment -

Fever, Infant <30 Days

Accucheck

Blood Culture x 1

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

immediately.

- Treatment -

- Consider -

IV Saline Lock, CBC, CMP, Type and Screen if surgical intervention suspected

Finger Injury

If superficial, wrap in dry dressing

If deep or associated with trauma, order the following:

TROPONIN

IV Saline Lock

- Consider -

Flank Burn

IV Saline Lock

- Consider -

CT Abdomen and Pelvis without Contrast (With physician permission)

Flank Pain

IV Saline Lock

- Consider -

RSV (if infant)

IV Saline Lock

Flu Symptoms

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Focal Neuro Deficit

If patient has order for study or test, order the appropriate study or test.

Contact ED Physician for approval.

- Consider -

CBC and CMP for studies that require IV contrast

IV Saline Lock

Follow Up X-Ray/CT

- Consider -

Foot LEFT or RIGHT

Ankle LEFT or RIGHT

Tibia and Fibula LEFT or RIGHT

Knee LEFT or RIGHT

Foot Injury

- Consider -

Foot LEFT or RIGHT

Ankle LEFT or RIGHT

Tibia and Fibula LEFT or RIGHT

Knee LEFT or RIGHT

Accucheck (if patient is diabetic)

Foot Pain

Identify type and location of foreign body

- Consider -

KUB (If Abdominal / Rectal Foreign Body)

Chest 1V and KUB (If Swallowed Foreign Body)

Order Appropriate Extremity x-ray (if patient has extremity foreign body)

Pelvic Setup (for vaginal foreign Body)

Pediatric SOB with Swallowed Foreign Body should be brought immediately to treatment area.

All patients with Foreign Body in throat should be brought immediately back to the treatment area.

Notify Physician of severe foreign body symptoms or unique location.

Foreign Body

Urine Drug Screen

ETOH Level

Tylenol Level

Aspirin Level

ABG with Co-Oximetry and Carbon Monoxide Level (may need to contact RT)

Oxygen 100% NRB

IV Saline Lock

- Consider -

Patient should be brought immediately back to treatment area or receive oxygen.

Notify physician immediately of patient is obtunded or requires immediate attention.

Gas Exposure

Stool Culture

IV Saline Lock

- Consider -

Gastroenteritis

IV Saline Lock

- Consider -

CPKMB and Troponin (if patient age >50 or history of cardiac disease)

PT and PTT (if patient has liver disease or is taking Warfarin or other anticoagulants)

CT Brain Without Contrast (if patient has head injury, focal weakness, or age >70 with physician agreement)

Chest 1 view (if patient has cough, shortness of breath, or pulmonary disease)

Blood Cultures x 2 (if patient has fever)

General Weakness

US Scrotum with Doppler Flow Imaging for Torsion

GC Culture

Keep Patient NPO

IV Saline Lock

Genital Injury (Male)

Type and Screen

Cardiac Monitor

- Consider -

GI Bleeding (Active)

US Scrotum with Doppler Flow Imaging for Torsion (if patient is Male)

GC Culture

Keep Patient NPO

IV Saline Lock

Groin Injury

US Scrotum with Doppler Flow Imaging for Torsion (if patient is Male)

GC Culture

Keep Patient NPO

IV Saline Lock

Groin Pain

Amylase

Lipase

Type and Screen

Urine Drug Screen

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Trauma Transfer Packet

Gunshot Wound

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Trauma Transfer Packet CT Abdomen and Pelvis with IV contrast only (with physician approval)

CT Chest with IV contrast (with physician approval)

Gunshot Wound to Abdomen

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Back

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Buttock

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Chest

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Head

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Neck

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Gunshot Wound to Pelvis

Check pulses in all extremities, including effected extremity.

Expose patient completely and place in gown.

Notify Physician immediately for examination.

Gunshot Wound to Extremity

Check pulses in all extremities, including affected extremity.

IV Saline Lock

Gunshot Wound to Foot

IV Saline Lock

Gunshot Wound to Hand

IV Saline Lock

Gunshot Wound to Leg

If superficial, cover with silvadene lotion, wrap in dry dressing

Notify Physician for thorough evaluation and referral to burn center as needed.

Hand Burn

- Consider -

Hand Injury

Obtain and document radial pulse and capillary refill

- Consider -

Hand Pain

Sedimentation Rate

Hand LEFT or RIGHT

IV Saline Lock

Hand Swelling

IV Saline Lock

- Consider -

CT Brain Without Contrast (if pain is sudden onset, involves the neck, or is atypical from previous symptoms,

with physician consent)

PT and PTT (if patient takes Warfarin or other anticoagulants)

Headache

IV Saline Lock

Cardiac Monitor

- Consider -

Head Injury with LOC – Adult

IV Saline Lock

Cardiac Monitor

- Consider -

Head Injury with LOC – Pediatric

Troponin

IV Saline Lock

Cardiac Monitor

- Consider -

Rectal Temperature (for core measurement)

Heat Exposure

Troponin

IV Saline Lock

Cardiac Monitor

- Consider -

Rectal Temperature (for core measurement)

Heat Stroke

- Consider -

If active bleeding, order the following:

If unstable vital Signs:

Type and Screen

Hemorrhoids

Chest PA & Lateral

Blood Cultures x 2

IV Saline Lock

PT and PTT

- Also Consider -

Type and Screen (If patient is actively coughing blood, unstable, or anticoagulated)

Hemoptysis

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

High Blood Pressure (BP > 200/110)

Beta HCG Quantitative

US Obstetric Transvaginal

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider ordering the following if any active bleeding -

D-Dimer

Fibrinogen

Type and Screen

High Blood Pressure and Pregnant (BP >140/90)

Accucheck Now

AMYLASE

LIPASE

IV Saline Lock

Cardiac Monitor

- Consider -

High Blood Sugar

Pelvis

Hip (RIGHT or LEFT)

- If obvious fracture is suspected -

Chest 1 View

Type and Screen

Patient should be kept NPO

IV Saline Lock

- Consider -

Hip Injury

Pelvis

Hip (RIGHT or LEFT)

- If obvious fracture is suspected -

Chest 1 View

Type and Screen

Patient should be kept NPO

IV Saline Lock

- Consider -

Hip Pain

IV Saline Lock

- Consider -

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Homicidal Ideation

Determine Tetanus status of patient

Human Bite

Accucheck Now

AMYLASE

LIPASE

IV Saline Lock

Cardiac Monitor

- Consider -

Hyperglycemia

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Hypertensive Crisis (BP > 200/110)

US Obstetric Transvaginal

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider ordering the following if any active bleeding -

D-Dimer

Fibrinogen

Type and Screen

Hypertensive Crisis and Pregnant (BP >140/90)

IV Saline Lock

Chest 1 View

- Consider -

Apply Non-Rebreather without oxygen

Hyperventilation

Accucheck Now

AMYLASE

LIPASE

IV Saline Lock

Cardiac Monitor

- Consider -

- Treatment -

Food box with juice if patient not obtunded and Glucose <60

Glucose Tablet PO or 1 amp D50 IV if Glucose <60

Hypoglycemia

Blood Cultures x 2

Chest 1 View

Strep Group A Rapid

Flu A&B

IV Saline Lock

Cardiac Monitor

- Consider -

Lactic Acid (If SBP <95 or MAP <65)

*Immunocompromised patients are those who are receiving Chemotherapy, Radiation, have HIV, Leukemia,

immune disorders, or are at extremes of age (newborn or age >70)

Immunocompromised with Fever and Weakness

- Treatment -

Notify Physician to insert Foley Catheter

- Consider -

If no urine output from catheter:

IV Saline Lock

If Urine Output:

Inability to Void

Incisional Drainage

Incisional Pain

Identify Site of Incision Problem

Identify Name of patient’s surgeon who made incision

- Consider -

If signs of infection or heavy bleeding:

Blood Culture x 2

Wound Culture

Patient should be brought back to treatment area immediately

Incision Problem

Blood Cultures x 2

IV Saline Lock

- Also Consider -

- Treatment -

Inhalational Injury

Use appropriate protocol per patient’s description of injury

Injury

Sterile Gloves

Betadine Swabs

Wound Culture

Insect Bite

Accucheck Now

AMYLASE

LIPASE

IV Saline Lock

Cardiac Monitor

- Consider -

- Treatment -

Insulin Reaction

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

Irregular Pulse

Inspect Location of Itching and consider abscess, rash, or allergic reaction protocol.

Itching

- Consider -

CT Maxillofacial without Contrast (with physician approval)

CT Brain without Contrast (with physician approval, if head injury or LOC reported)

Jaw Injury

AMYLASE

LIPASE

- Consider -

Keep Patient NPO

IV Saline Lock

Jaundice

IV Saline Lock

- Consider -

Kidney Stone

- Consider -

IV Saline Lock, cbc, cmp, type and screen if surgical intervention suspected

Knee Injury

- Consider -

Knee Pain

Apply Topical Anesthetic to wound (LET) wherever applicable

Suture Setup

- Consider -

X-Ray of open laceration for possible foreign body contamination

If patient is heavily/actively bleeding, bring back immediately to treatment area.

Laceration

Suture Setup

- Consider -

Laceration to Arm

Suture Setup

- Consider -

Laceration to Chin

Suture Setup

- Consider -

Laceration to Foot

Suture Setup

- Consider -

CT Brain without contrast if head trauma reported (with physician approval)

Laceration to Forehead

Suture Setup

- Consider -

Laceration to Gums

Suture Setup

- Consider -

Laceration to Hand

- Consider -

Leg Injury

IV Saline Lock

- Consider -

1) History of DVT

2) Active Cancer

Leg Pain

IV Saline Lock

- Consider -

1) History of DVT

2) Active Cancer

Leg Swelling

Verify Lice/Scabies by visual inspection

Isolate patient from patients in Waiting room – prefer examination in triage by physician / midlevel.

Consider method of injury

If active bleeding, patient should be brought immediately to treatment area.

If result of fall, use fall protocol.

If result of bite, use bite protocol.

If patient was assaulted, consider the following:

CT Maxillofacial (with physician approval)

Lip Injury

IV Saline Lock

- Consider -

Lip Swelling

Stool Culture

IV Saline Lock

- Consider -

Loose Stools

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Loss of Vision

Lumbar Spine

- Consider -

Low Back Pain

Accucheck Now

AMYLASE

LIPASE

IV Saline Lock

Cardiac Monitor

- Consider -

- Treatment -

Low Blood Sugar

IV Saline Lock

- Consider -

1) History of DVT

2) Active Cancer

Lower Extremity Swelling

Confirm Medication Refill needed by Patient

Confirm there are not other emergent symptoms or complaints

Inform Patient that Narcotic Refills will not be written

Notify Physician of medication refill needed

- Consider -

Order Drug Levels for appropriate medications needing refill (Coumadin, Digoxin, Dilantin, Etc.)

Medication Refill

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Memory Loss

Maintain Cervical Spine Precautions

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Cervical without contrast (with physician approval)

CT Abdomen and Pelvis with IV contrast Only (with physician approval)

Obtain radiograph of injured extremity

Motorcycle Collision

Maintain Cervical Spine Precautions

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Cervical without contrast (with physician approval)

CT Abdomen and Pelvis with IV contrast Only (with physician approval)

Obtain radiograph of injured extremity

Motor Vehicle Collision (MVC)

IV Saline Lock

- Consider -

If patient has any degree of airway compromise, they should be brought immediately to the

treatment area.

Mouth Swelling

IV Saline Lock

- Consider -

Nausea

IV Saline Lock

- Consider -

Nausea, Vomiting

Stool Culture

IV Saline Lock

- Consider -

Nausea, Vomiting, Diarrhea

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

Cervical Spine Injury – Apply Collar if patient has neck pain

Near Drowning

Accucheck Now

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse-ox continuous

- Consider -

Near Syncope

- Consider -

Neck and Upper Back Pain

Apply Cervical Collar

- Consider -

permission)

Neck Injury

- Consider -

Associated headache or stiffness with fever may be meningitis.

If present in elderly or diabetic may represent angina, stroke, aneurysm, or other emergency

TROPONIN

PT and PTT

Sudden neck pain without injury should be brought immediately to the treatment area.

Neck Pain

- Consider -

Apply Cervical Collar if injury reported

permission)

Neck Problem

IV Saline Lock

Neck Soft Tissue

- Consider -

If patient has fever, edema in anterior neck, or airway difficulties, patient should be brought

immediately back to treatment area.

Neck Swelling

Initiate hospital needle stick policy if patient is employee/associate of hospital.

Initiate alternate protocol if patient is not an employee/associate of hospital.

Needle Stick Exposure

Insert Foley Catheter

Notify Physician if unable to pass catheter.

If no urine output and catheter was easy to insert, notify physician and order the following tests:

IV Saline Lock

Needs Urinary Catheter

Accucheck

Blood Culture x 1

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

immediately.

- Treatment -

Neonatal Sepsis

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Nervous

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Neuro Deficit

Accucheck

Blood Culture x 1

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

immediately.

- Treatment -

Newborn Sepsis

Chest PA & Lateral

Blood Cultures x 2

IV Saline Lock

- Also Consider -

Non-Productive Cough

Epistaxis Kit to Bedside

IV Saline Lock

- Consider -

Type and Screen (If patient has unstable vital signs)

Nose Bleed

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Arm

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Face

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Hand

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Lips

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Mouth

Initiate precipitous delivery protocol for Active Labor.

OB Delivery/Emergent

Type and Screen and RH Factor

US Obstetric (with MD approval)

IV Saline Lock

- Consider -

PT and PTT (if patient has history of bleeding disorder or heavy bleeding)

OB Problem (<20 Weeks)

IV Saline Lock

- Consider -

OB Problem (>20 Weeks)

Attempt to flush G-Tube if intact.

Obstructed G-tube

US Abdomen (With MD approval)

IV Saline Lock

- Consider -

OB Trauma

Tylenol Level

Aspirin Level

Urine Drug Screen

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Overdose

Chest PA & Lateral

Blood Cultures x 2

IV Saline Lock

- Also Consider -

Painful Cough

- Consider -

Pain with Urination

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

Palpitations

Accucheck Now

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse-ox continuous

- Consider -

Passed out Prior to Arrival

IV Saline Lock

- Consider -

1) History of DVT

2) Active Cancer

Pedal Edema

Chest PA and Lateral (consider Chest 1 View if patient is unstable)

IV Saline Lock

- Consider -

Pediatric Chest Pain

Accucheck

Blood Culture x 1

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

immediately.

- Treatment -

Pediatric Neonatal Sepsis

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

Pelvic Pain

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

Pelvic Problem

GC Culture

Penile Bleeding

GC Culture

Penile Discharge

GC Culture

US Doppler Testicles (If testicles are painful)

Penile Injury

GC Culture

Penile Pain

GC Culture

Penile Problem

IV Saline Lock

- Consider -

Possible Kidney Stone

Tylenol Level

Aspirin Level

Urine Drug Screen

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Possible Overdose

Type and Screen

IV Saline Lock

- Consider -

US Pelvic Complete (if patient is bleeding heavily)

Post Partum Bleeding

- Consider -

Order the following tests if patient is actively bleeding and/or unstable:

TYPE and SCREEN

Bring patient immediately to treatment area

IV Saline Lock

Post Surgical Bleeding

- Consider -

Order the following tests if patient is actively bleeding and/or unstable:

TYPE and SCREEN

Bring patient immediately to treatment area

IV Saline Lock

Post Surgical Pain

IV Saline Lock

Pregnant

Preterm Labor

Magnesium

Accucheck Now

Patient should be NPO

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider the following levels based on patient’s history -

Dilantin (Phenytoin Level)

Depakote (Valproic Acid)

Tegretol (Carbamazepine)

**Keppra Levels take three days for result and should not be ordered

CT Brain Without Contrast (if trauma or neuro deficit is reported, with physician approval)

Probable Seizure

Problem with Feeding Tube

Attempt to Flush Foley Catheter

If unsucessful:

IV Saline Lock

Problem With Urinary Catheter

Chest PA & Lateral

Blood Cultures x 2

IV Saline Lock

- Also Consider -

Productive Cough

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Psychiatric

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Psych Problem

IV Saline Lock

- Consider -

Doppler pulses

If unable to find pulse, extremity is cold, and/or extremity is painful, patient should be brought immediately to treatment

Pulseless Extremity

Obtain appropriate x-ray to view the area under the puncture wound.

Puncture Wound

Puncture Wound to Arm

Puncture Wound to Back

Puncture Wound to Chest

- Consider -

Puncture Wound to Ear

Patch effected eye if trauma reported

Puncture Wound to Eye

Puncture Wound to Face

Puncture Wound to Foot

Puncture Wound to Hand

Puncture Wound to Head

Puncture Wound to Leg

Puncture Wound to Shoulder

If patient has fever, or signs of allergic reaction with airway involvement, bring immediately to

treatment area and initiate the Allergic Reaction protocol.

Sterile Gloves

Betadine Swabs

Wound Culture

Rectal Abscess

Type and Screen

Cardiac Monitor

- Consider -

Rectal Bleeding

Identify type and location of foreign body

IV Saline Lock

- Consider -

KUB (If Abdominal / Rectal Foreign Body)

Chest 1V and KUB (If Swallowed Foreign Body)

Order Appropriate Extremity x-ray (if patient has extremity foreign body)

Pelvic Setup (for vaginal foreign Body)

Pediatric SOB with Swallowed Foreign Body should be brought immediately to treatment area.

All patients with Foreign Body in throat should be brought immediately back to the treatment area.

Notify Physician of severe foreign body symptoms or unique location.

Rectal Foreign Body

- Consider -

IV Saline Lock

Redness of Eye

Patient should be brought immediately to treatment area for physician examination.

Notify Police.

Brevard County Protocol requires patient be discharged within 60 minutes to be accepted to rape

crisis center.

If it is anticipated that patient will be in department for longer than 60 minutes, initiate SANE exam

per hospital policy.

Reported Sexual Assault

Troponin

Magnesium Level

Chest 1 View

IV Saline Lock

Cardiac Monitor

Respiratory Arrest

Blood Cultures x 2

IV Saline Lock

- Also Consider -

- Treatment -

Respiratory Distress

PT and PTT

Chest 1 View

Keep Patient NPO

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

- Treatment -

Respiratory Failure

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

S/S of Possible Stroke

Verify Lice/Scabies by visual inspection

Isolate patient from patients in Waiting room – prefer examination in triage by physician / midlevel.

Scabies

GC Culture

Keep Patient NPO

IV Saline Lock

Scrotal Pain

CBC CMP

Magnesium

Accucheck Now

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Seizure

Magnesium

Accucheck Now

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Seizure Activity

Lactic Acid

Blood Cultures x 2

Chest 1 View

Strep Group A Rapid

Flu A and B

IV Saline Lock

Cardiac Monitor

Pulse-Ox Continuous

- Consider -

CPKMB and Troponin (if patient complains of chest pain, or age >50)

- Administer -

Tylenol or Motrin per Protocol

Sepsis (Pediatric or Adult)

PT and PTT

Chest 1 View

Keep Patient NPO

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

- Treatment -

Severe Shortness of Breath

Blood Cultures x 2

IV Saline Lock

- Also Consider -

- Treatment -

Shortness of Breath

Shoulder LEFT or Shoulder RIGHT

- Consider -

Clavicle LEFT or RIGHT depending on location of pain

Humerus LEFT or RIGHT depending on location of pain

Shoulder Injury

Shoulder LEFT or Shoulder RIGHT

- Consider -

Atypical chest pain in age >40, diabetic patients. Consider ordering Chest Pain protocol

Shoulder Pain

Reticulocyte Count

IV Saline Lock

Pulse-Ox Continuous

- Consider -

Chest 1 view (if patient has cough, fever, or chest pain)

EKG (if patient has rapid heart rate)

Sickle Cell Crisis

If patient has fever, or signs of allergic reaction with airway involvement, bring immediately to

treatment area and initiate the Allergic Reaction protocol.

Skin Problem

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Slurred Speech

Apply 100% NRB

ABG with Co-oximetry and Carbon Monoxide Level

Chest 1 view

Pulse Ox Continuous

Cardiac Monitor

IV Saline Lock

- Consider -

Smoke Inhalation

Type and Screen

Urinalysis

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Identify type of Snake and contact Poison Contol Center

Contact Blood Bank / Pharmacy for Crofab availability

- Consider -

Fibrinogen (if active bleeding)

D-Dimer (if active bleeding)

Snake Bite

If fever (temp >100.4), order Strep Group A Rapid

If vital signs abnormal, order the following:

IV Saline Lock

If airway swollen or compromised, patient should be brought immediately to the treatment area.

Sore Throat

Follow Stab Wound Protocol for appropriate part of the body involved.

Stab Wound

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Stab Wound to Abdomen

Type and Screen

Xray appropriate extremity for foreign body and fracture

IV Saline Lock

- Consider -

If patient has active bleeding or loss of palpable pulses, being immediately to treatment area.

Stab Wound to Arm

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Stab Wound to Back

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Stab Wound to Chest

Identify object that caused Stab Wound

Order appropriate x-ray to view the area under the puncture wound.

Stab Wound to Foot

Stab Wound to Head/Face

Stab Wound to Leg

Stab Wound to Neck

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Stab Wound to Pelvis

Stab Wound to Shoulder

Notify provider for quick evaluation and remove sutures or staples as indicated.

Staple Removal

For Females:

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

For Males:

GC/Chlamydia Probetec (urine culture)

STD Exposure

- Consider -

Associated headache or stiffness with fever may be meningitis.

If present in elderly or diabetic may represent angina, stroke, aneurysm, or other emergency

TROPONIN

PT and PTT

IV Saline Lock

Sudden neck pain without injury should be brought immediately to the treatment area.

Stiff Neck

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Stroke

Initiate Stroke Alert Protocol

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Stroke Alert

Tylenol Level

Aspirin Level

Urine Drug Screen

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

Substance Ingestion

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

Suicidal Ideation

Suture Recheck

Suture Removal

Chest 1 View

IV Saline Lock

- Consider -

Swallowed Foreign Body

IV Saline Lock

- Consider -

If patient has any degree of airway compromise, they should be brought immediately to the

treatment area.

Swelling of Tongue

IV Saline Lock

- Consider -

1) History of DVT

2) Active Cancer

Swelling of Lower Extremity

Mono Test

Blood Culture X 2

IV Saline Lock

Swollen Glands

Accucheck Now

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse-ox continuous

Orthostatis Vital Signs

- Consider -

Syncope

Troponin

Magnesium Level

Chest 1 View

IV Saline Lock

Cardiac Monitor

Tachycardia

Term Labor

GC Culture

Keep Patient NPO

IV Saline Lock

Testicular Lump

GC Culture

Keep Patient NPO

IV Saline Lock

Testicular Pain

GC Culture

Keep Patient NPO

IV Saline Lock

Testicular Problem

GC Culture

Keep Patient NPO

IV Saline Lock

Testicular Swelling

GC Culture

Keep Patient NPO

IV Saline Lock

Testicular Torsion

If superficial, cover with silvadene, wrap in dry dressing

Notify Physician for thorough evaluation and referral to burn center as needed.

Thermal Burn

Hip Left or Right

Femur Left or Right

Thigh Injury

Hip Left or Right

Femur Left or Right

- Consider -

CPK Total

IV Saline Lock

Thigh Pain

Finger LEFT or RIGHT

Thumb Injury

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Toe(s) LEFT or RIGHT

Toe Injury

Identify penetrating (Stab, Gunshot, etc.) versus blunt trauma (fall, Assault, Motor Vehicle Collision, etc)

Use appropriate protocol

For Assaulted Trauma patients, ensure safety of department and consider complete department lockdown

with Security

Trauma Complaint

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Trauma (Major)

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Tremor

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Trouble Talking

IV Saline Lock

Trouble Voiding

Troponin

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Trouble Walking

Troponin

Accucheck Now

Tylenol Level

Aspirin Level

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Brain Without Contrast (ask for physician approval)

Unconscious Patient

AccuCheck Now

Tylenol Level

Aspirin Level

Urine Drug Screen

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

IV Saline Lock

Unresponsive Patient

- Consider -

Upper Extremity Pain

- Consider -

Urinary Frequency

IV Saline Lock

Urinary Incontinence

- Consider -

Urinary Problem

IV Saline Lock

Urinary Retention

- Consider -

Urinary Symptoms

- Consider -

Urinary Tract Infection

IV Saline Lock

- Consider -

Vaginal Bleeding (Pregnant)

US Pelvic Complete

IV Saline Lock

Vaginal Bleeding (Pregnancy Unknown)

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

Vaginal Discharge

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

Vaginal Itching

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

Vaginal Pain

IV Saline Lock

Orthostatic Vital signs

- Consider -

Urine Drug Screen (if drug use suspected)

ETOH (if alcohol intoxication suspected)

CT Brain Without Contrast (if age >70, sudden onset of symptoms, or severe headache)

PT and PTT (if patient is taking Warafarin or other anticoagulants)

Vertigo

Stool Culture

IV Saline Lock

- Consider -

Vomiting

Stool Culture

IV Saline Lock

- Consider -

Vomiting, Diarrhea

IV Saline Lock

- Consider -

CPKMB and Troponin (if patient age >50 or history of cardiac disease)

PT and PTT (if patient has liver disease or is taking Warfarin or other anticoagulants)

CT Brain Without Contrast (if patient has head injury, focal weakness, or age >70 with physician agreement)

Chest 1 view (if patient has cough, shortness of breath, or pulmonary disease)

Weakness

Blood Cultures x 1

IV Saline Lock

- Also Consider -

- Treatment -

Wheezing < 1 Year Old

Blood Cultures x 2

Peak Flow

IV Saline Lock

- Also Consider -

- Treatment -

Wheezing > 1 Year Old

IV Saline Lock

Won’t Eat

Amylase

Lipase

Type and Screen

Urine Drug Screen

Cardiac Monitor

Pulse Ox Continuous

- Consider –

Wound to Buttock

- Consider -

Wound Superficial w Gram Stain

IV Saline Lock

Wound Infection

Wrist LEFT or RIGHT

- Consider -

Hand LEFT or RIGHT (If pain involves hand)

FOREARM LEFT or RIGHT (If pain involved forearm)

Elbow LEFT or RIGHT (If pediatric patient, poor history, or pain in elbow)

Wrist Injury

Wrist LEFT or RIGHT

- Consider -

Hand LEFT or RIGHT (If pain involves hand)

FOREARM LEFT or RIGHT (If pain involved forearm)

Elbow LEFT or RIGHT (If pediatric patient, poor history, or pain in elbow)

Wrist Pain

The following complaints may qualify for MSE Screening depending on their severity and

presentation:

Abrasions

Anxiety without other complaint, vital sign abnormality, or suicidal/homicidal thoughts

Body Fluid Exposure not involving mucous membrane exposure or puncture

Drug Abuse without suicidal/homicidal thoughts, unstable vital signs, and refused by New Visions

Follow Up X-Ray/CT if not ordered by physician to return to ED

Bee Sting if no history of allergy or acute symptoms

Medical Clearance

Medical Complaint without clear symptoms

Employee Health Related

Chronic Pain

Recheck not referred by physician to return to ED

Mouth Problem without injury, bleeding, dysphagia, or other complaints

Sinus Congestion

Sinus Pain

Sneezing

Toothache

Wound Check is not referred by physician to ED

MSE Complaints

The Community - Provider Practice Essentials...Pregnancy Test Serum Qualitative (if patient is...

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