The

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.

© 2013, Resident Staffing Solutions, Inc.

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

If deep or associated with trauma, order the following:

UA (With Micro/reflex culture)

CBC

CMP

CPKMB

TROPONIN

EKG

IV Saline Lock

- Consider -

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

Abdominal Burn

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

IV Saline Lock

- Consider -

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

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

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

Lactic Acid

CPK Total

IV Saline Lock

- Consider -

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

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 Crush Injury

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

Acute Abdominal Series

IV Saline Lock

- Consider -

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

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 Distension

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

IV Saline Lock

- Consider -

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

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 Pain

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

IV Saline Lock

- Consider -

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

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 Pain >50yo

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

IV Saline Lock

- Consider -

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

EKG (If Age 50 or Greater)

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

CPKMB and Troponin (If Age 50 or Greater)

Keep Patient NPO

Abdominal Pain Upper

CBC

CMP

UA (With Micro/reflex culture)

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

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 Recheck

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

Urine Drug Screen

EKG

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

CBC

CMP

ETOH Level

Urine Drug Screen

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

PT

PTT

IV Saline Lock

- Consider -

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

Alcohol Withdrawal

CBC

CMP

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

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

Allergic Reaction

AccuCheck Now

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA(With Micro/reflex culture)

Urine Drug Screen

EKG

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

CT Brain Without Contrast (with physician approval)

CPKMB and Troponin (if age 50 or greater)

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

IV Saline Lock

Altered Mental status

CBC

CMP

Type and Screen

IV Saline Lock

- Consider -

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

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

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Anxiety

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Aphasia

CBC

CMP

EKG

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)

CBC

CMP

Blood Cultures x 2

EKG

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

CBC

CMP

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

UA (With Micro/Reflex Culture)

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

CBC

CMP

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

UA (With Micro/Reflex Culture)

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 Pain

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

Pelvic Setup

Bartholin’s Cyst

CBC

CMP

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

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

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

CBC

CMP

PT

PTT

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)

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

Patient should be brought immediately to treatment area.

Black/Tarry Stools

CBC

CMP

PT

PTT

UA (With Micro/Reflex Culture)

IV Saline Lock

- Consider -

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

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

Bleeding Gums

CBC

CMP

UA (With Micro/Reflex Culture)

PT

PTT

IV Saline Lock

- Consider -

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

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

Blood in Catheter

CBC

CMP

UA (with Micro/Reflex Culture)

EKG

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)

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

Patient should be brought immediately to treatment area.

Blood Pressure Problem

Document Visual Acuity

Eye Kit to Bedside with Florescein

Tetracaine Solution (2%) Topical Once

Blurred Vision (Ophthalmologic)

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Blurred Vision (Possible Stroke)

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

Boil

CBC

CMP

CPKMB

Troponin

Magnesium Level

PT

PTT

EKG

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

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

Bradycardia

Chest PA and Lateral

- Consider -

CBC

CMP

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

Breast Lump

Chest PA and Lateral

- Consider -

CBC

CMP

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

Breast Problem

Chest PA and Lateral

- Consider -

CBC

CMP

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

Breast Injury

CBC

CMP

PT and PTT

EKG

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)

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

- Treatment -

Administer Tylenol or Motrin per Protocol

Breathing Difficulty

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Can’t Walk

CBC

CMP

UA

Urine Drug Screen

ETOH Level

Tylenol Level

Aspirin Level

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

EKG

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.

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

Carbon Monoxide Exposure

Identify Animal

Determine Rabies Status of Animal

Order xray of area for foreign body

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

CBC

CMP

CPKMB

Troponin

Magnesium Level

PT

PTT

EKG

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

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

Cardiac Arrest

CBC

CMP

PT

PTT

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

Contact Poison Control Center

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

Chemical Burn

CBC

CMP

PT

PTT

UA (With Micro/Reflex Culture)

EKG

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 -

Patient should be brought immediately to treatment area.

Notify Physician if patient is in extreme pain.

Chemical Exposure - Eye

Apply 100% NRB

ABG with Co-oximetry and Carbon Monoxide Level

CBC

CMP

Chest 1 view

Pulse Ox Continuous

Cardiac Monitor

IV Saline Lock

- Consider -

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

Chemical Inhalation

CBC

CMP

CPKMB

TROPONIN

PT

PTT

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

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

Amylase and Lipase is pain is epigastric in location

Urine Drug Screen and ETOH

Chest Pain (Adult)

CBC

CMP

UA (With Micro/reflex culture)

EKG

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

IV Saline Lock

- Consider -

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

Urine Drug Screen and ETOH

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

Chest Pain (Pediatric)

EKG

Chest PA and Lateral

- Consider -

Chest Pain Protocol if symptoms appear cardiac

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

Chest Pain from Injury

CBC

CMP

CPKMB

TROPONIN

PT

PTT

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

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

Amylase and Lipase is pain is epigastric in location

Urine Drug Screen and ETOH

Chest Pain, Possible Cardiac

CBC

CMP

CPKMB

TROPONIN

PT

PTT

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

Chest 1 View

- Consider -

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

Amylase and Lipase is pain is epigastric in location

Urine Drug Screen and ETOH

Chest Pressure

EKG

Chest PA and Lateral

- Consider -

Chest Pain Protocol if symptoms appear cardiac

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

Chest Wall Pain

Patient should be brought immediately to treatment area.

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:

CBC

CMP

PT

PTT

IV Saline Lock

EKG

Clavicle Injury

CT Brain Without Contrast (With Physician Approval)

- Consider -

CT Cervical Spine (if neck pain present)

Apply Cervical Collar (if neck pain present)

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

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

Closed Head Injury – Adult

- Consider -

CT Brain Without Contrast (With Physician Approval)

CT Cervical Spine (if neck pain present)

Apply Cervical Collar (if neck pain present)

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

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

Asymptomatic children without hematoma may be observed until provider evaluation.

Closed Head Injury – Infant - Pediatric

CBC

CMP

PT

PTT

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

Cold Exposure

CBC

CMP

UA (With Micro/Reflex Culture)

Chest PA and Lateral

- Consider -

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

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

CBC

CMP

UA (With Micro/Reflex Culture)

Chest PA and Lateral

- Consider -

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

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

Congestion

KUB

Constipation

- Consider -

PT and PTT if patient taking Coumadin

CBC

CMP

CT Brain without contrast (with physician approval)

Contusion

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

CBC

CMP

Blood Cultures x 2

EKG

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)

- Treatment -

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

COPD Exacerbation

Chest PA & Lateral

- If FEVER or SHORTNESS OF BREATH -

CBC

CMP

Blood Cultures x 2

EKG

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)

Cough

CBC

CMP

CPKMB

Troponin

Magnesium Level

PT

PTT

EKG

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

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

CPR

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.

Croup

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

CBC

CMP

PT

PTT

CPK Total and Lactic Acid (If crush injury Suspected)

IV Saline Lock

EKG

- 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

CT Chest With IV Contrast (With Physician Approval)

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

Crush Injury To Abdomen

CBC

CMP

PT

PTT

CPK Total and Lactic Acid (If crush injury Suspected)

IV Saline Lock

EKG

- 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

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 -

UA

CBC

CMP

Chest PA and Lateral

Crying

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

Cyst

UA

CBC

CMP

EKG

- Consider -

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

Decreased Appetite

AccuCheck Now

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA(With Micro/reflex culture)

Urine Drug Screen

EKG

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

CT Brain Without Contrast (with physician approval)

CPKMB and Troponin (if age 50 or greater)

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

IV Saline Lock

Decreased Level of Consciousness

Expose patient

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

CBC

CMP

PT

PTT

Blood Culture x 2

IV Saline Lock

- Consider -

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

Elevate extremity

Turn patient in bed every 2 hours

Decubitus

CBC

CMP

BNP

EKG

- Consider -

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

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

OR

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)

CBC

CMP

UA (With Micro/reflex culture)

EKG

IV Saline Lock

- Consider -

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

Dehydration

Accucheck Now

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

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:

CBC

CMP

PT

PTT

EKG

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:

CBC

CMP

PT

PTT

EKG

IV Saline Lock

Dialysis Shunt Problem

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

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

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

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

CBC

CMP

EKG

UA (With Micro/Reflex Culture)

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

CBC

CMP

UA

EKG

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)

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

CT Brain Without Contrast (With Physician Approval)

Doesn’t Feel Right

Identify Animal

Determine Rabies Status of Animal

Order xray of area for foreign body

Dog Bite

Wound Superficial with Gram Stain

Apply dressing to wound

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

Drainage

Wound Superficial with Gram Stain

Apply dressing to wound

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

Drainage from Breast

Wound Superficial with Gram Stain

Apply dressing to wound

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

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

- Consider -

Accucheck if patient is Diabetic

Drainage from Ear

Wound Superficial with Gram Stain

Apply dressing to wound

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

Drainage from Eye

CBC

CMP

EKG

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

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

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

IV Saline Lock

Drug Abuse

UA (With Micro/Reflex Culture)

- 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

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

- Consider -

Notify Provider for examination of pain out of proportion to symptoms

CT Brain without contrast (with physician permission)

Ear Pain

CBC

CMP

BNP

EKG

Chest 1 View

- Consider -

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

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

Edema

UA (With Micro/reflex culture)

CBC

CMP

CPKMB

TROPONIN

EKG

IV Saline Lock

- Consider -

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

Electrical Burn

UA (With Micro/reflex culture)

CBC

CMP

CPKMB

TROPONIN

EKG

IV Saline Lock

- Consider -

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

Electrocution

CBC

CMP

PT

PTT

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

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

Environmental Exposure

CBC

CMP

AMYLASE

LIPASE

EKG

IV Saline Lock

- Consider -

Chest 1 View (if patient is complaining of SOB)

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

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

Epigastric Pain

CBC

CMP

PT

PTT

Epistaxis Kit to Bedside

IV Saline Lock

- Consider -

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

Type and Screen (If patient has unstable vital signs)

Epistaxis

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

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

IV Saline Lock

ETOH Abuse

Document Visual Acuity

Patch effected eye is trauma reported

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

Eye Injury

Document Visual Acuity

Patch effected eye is trauma reported

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

- Consider -

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

Patient should be taken immediately back to treatment area.

CBC

CMP

IV Saline Lock

CT Brain Without Contrast (With physician approval)

Eye Pain

Document Visual Acuity

Patch effected eye is trauma reported

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

- Consider -

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

Patient should be taken immediately back to treatment area.

CBC

CMP

IV Saline Lock

CT Brain Without Contrast (With physician approval)

Eye Problem

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Facial Droop

CBC

CMP

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

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

Facial Swelling

Accucheck Now

CBC

CMP

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

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

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

Foot LEFT or RIGHT if history of trauma.

OR

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

Feet Swelling

Accucheck

CBC

CMP

UA (With Micro/Reflex Culture)

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 -

Administer Tylenol or Motrin per Protocol

Fever, Infant <30 Days

Accucheck

CBC

CMP

UA (With Micro/Reflex Culture)

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 -

Administer Tylenol or Motrin per Protocol

Fever

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

Finger Injury

If superficial, wrap in dry dressing

If deep or associated with trauma, order the following:

UA (With Micro/reflex culture)

CBC

CMP

CPKMB

TROPONIN

EKG

IV Saline Lock

- Consider -

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

Flank Burn

UA (With Micro/Reflex Culture)

CBC

CMP

IV Saline Lock

- Consider -

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

CT Abdomen and Pelvis without Contrast (With physician permission)

Flank Pain

CBC

CMP

UA (With Micro/Reflex Culture)

Chest PA and Lateral

IV Saline Lock

- Consider -

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

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

Flu Symptoms

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

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 -

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

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

NPO

- 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.

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

Foreign Body

CBC

CMP

UA

Urine Drug Screen

ETOH Level

Tylenol Level

Aspirin Level

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

EKG

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.

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

Gas Exposure

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

EKG (if febrile, Pulse >100)

Gastroenteritis

CBC

CMP

UA (With Micro/Reflex Culture)

EKG

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

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Genital Injury (Male)

CBC

CMP

PT

PTT

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)

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

Patient should be brought immediately to treatment area.

GI Bleeding (Active)

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

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Groin Injury

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

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Groin Pain

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

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)

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

Gunshot Wound to Abdomen

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Back

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Buttock

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Chest

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Head

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Neck

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Gunshot Wound to Pelvis

Patient should be brought immediately to treatment area.

Check pulses in all extremities, including effected extremity.

Expose patient completely and place in gown.

Notify Physician immediately for examination.

Gunshot Wound to Extremity

Patient should be brought immediately to treatment area.

Check pulses in all extremities, including affected extremity.

Expose patient completely and place in gown.

Notify Physician immediately for examination.

IV Saline Lock

Gunshot Wound to Foot

Patient should be brought immediately to treatment area.

Check pulses in all extremities, including affected extremity.

Expose patient completely and place in gown.

Notify Physician immediately for examination.

IV Saline Lock

Gunshot Wound to Hand

Patient should be brought immediately to treatment area.

Check pulses in all extremities, including affected extremity.

Expose patient completely and place in gown.

Notify Physician immediately for examination.

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

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

Hand Injury

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.

Obtain and document radial pulse and capillary refill

- 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

Hand Pain

CBC

CMP

CRP

Sedimentation Rate

Hand LEFT or RIGHT

IV Saline Lock

Hand Swelling

CBC

CMP

UA (With Micro/Reflex Culture)

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

CT Brain Without Contrast (With Physician Approval)

CBC

CMP

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CT Cervical Spine (if neck pain present)

Apply Cervical Collar (if neck pain present)

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

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

Head Injury with LOC – Adult

CT Brain Without Contrast (With Physician Approval)

CBC

CMP

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CT Cervical Spine (if neck pain present)

Apply Cervical Collar (if neck pain present)

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

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

Head Injury with LOC – Pediatric

CBC

CMP

UA (with Micro/Reflex Culture)

EKG

CPKMB

Troponin

IV Saline Lock

Cardiac Monitor

- Consider -

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

Rectal Temperature (for core measurement)

Heat Exposure

CBC

CMP

UA (with Micro/Reflex Culture)

EKG

CPKMB

Troponin

IV Saline Lock

Cardiac Monitor

- Consider -

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

Rectal Temperature (for core measurement)

Heat Stroke

- Consider -

If active bleeding, order the following:

CBC

CMP

PT

PTT

If unstable vital Signs:

Type and Screen

Patient should be brought immediately to treatment area.

Hemorrhoids

Chest PA & Lateral

CBC

CMP

Blood Cultures x 2

EKG

IV Saline Lock

PT and PTT

- Also Consider -

ABG (If history of COPD/Emyphysema)

CPKMB and Troponin (If Age 50 or greater)

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

Hemoptysis

CBC

CMP

UA (with Micro/Reflex Culture)

EKG

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)

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

Patient should be brought immediately to treatment area.

High Blood Pressure (BP > 200/110)

CBC

CMP

PT

PTT

Beta HCG Quantitative

UA (With Micro/Reflex Culture)

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

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

Serum Acetone if BS >200 mg/dl

High Blood Sugar

Pelvis

Hip (RIGHT or LEFT)

- If obvious fracture is suspected -

Chest 1 View

CBC

CMP

PT

PTT

Type and Screen

EKG

Patient should be kept NPO

IV Saline Lock

- Consider -

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

Hip Injury

Pelvis

Hip (RIGHT or LEFT)

- If obvious fracture is suspected -

Chest 1 View

CBC

CMP

PT

PTT

Type and Screen

EKG

Patient should be kept NPO

IV Saline Lock

- Consider -

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

Hip Pain

CBC

CMP

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

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

Hives

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Homicidal Ideation

Determine Tetanus status of patient

Order xray of area for foreign body

Human Bite

Accucheck Now

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

Serum Acetone if BS >200 mg/dl

Hyperglycemia

CBC

CMP

UA (with Micro/Reflex Culture)

EKG

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)

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

Hypertensive Crisis (BP > 200/110)

CBC

CMP

PT

PTT

Beta HCG Quantitative

UA (With Micro/Reflex Culture)

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)

CBC

CMP

UA

IV Saline Lock

Chest 1 View

EKG

- Consider -

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

Apply Non-Rebreather without oxygen

Hyperventilation

Accucheck Now

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

- Treatment -

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

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

Hypoglycemia

CBC

CMP

Blood Cultures x 2

UA (With Micro/Reflex Culture)

Chest 1 View

Strep Group A Rapid

Flu A&B

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

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

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

*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:

CBC

CMP

IV Saline Lock

If Urine Output:

UA (With Micro/Reflex Culture)

Inability to Void

Wound Superficial with Gram Stain

Apply dressing to wound

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

Incisional Drainage

Wound Superficial with Gram Stain

Apply dressing to wound

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

Incisional Pain

Identify Site of Incision Problem

Identify Name of patient’s surgeon who made incision

- Consider -

If signs of infection or heavy bleeding:

CBC

CMP

Blood Culture x 2

Wound Culture

Patient should be brought back to treatment area immediately

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

Incision Problem

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

CBC

CMP

Blood Cultures x 2

EKG

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

Inhalational Injury

Use appropriate protocol per patient’s description of injury

Injury

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

Insect Bite

Accucheck Now

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

- Treatment -

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

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

Insulin Reaction

CBC

CMP

EKG

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)

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

CBC

CMP

AMYLASE

LIPASE

UA (With Micro/reflex culture)

- Consider -

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

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

IV Saline Lock

Jaundice

UA (With Micro/Reflex Culture)

CBC

CMP

IV Saline Lock

- Consider -

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

CT Abdomen and Pelvis without Contrast (With physician permission)

Kidney Stone

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

Knee Injury

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

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

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 to Arm

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 to Chin

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 to Foot

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.

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

Laceration to Forehead

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 to Gums

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 to Hand

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

Leg Injury

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

OR

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

Leg Pain

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

OR

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

Leg Swelling

Verify Lice/Scabies by visual inspection

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

Lice

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:

CBC

CMP

CT Brain without contrast (with physician approval)

CT Maxillofacial (with physician approval)

Lip Injury

CBC

CMP

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

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

Lip Swelling

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

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)

Loose Stools

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Loss of Vision

CBC

CMP

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

UA (With Micro/Reflex Culture)

Lumbar Spine

- 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.

Low Back Pain

Accucheck Now

If Accucheck < 50mg/dl notify Physician

CBC

CMP

AMYLASE

LIPASE

Blood Cultures x 2 sets

UA (With Micro/Reflex Culture)

EKG

IV Saline Lock

Cardiac Monitor

- Consider -

CPKMB and Troponin (if Patient Age >40)

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

- Treatment -

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

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

Low Blood Sugar

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

OR

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

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

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Memory Loss

Maintain Cervical Spine Precautions

CBC

CMP

PT

PTT

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Brain without contrast (with physician approval)

CT Cervical without contrast (with physician approval)

CT Chest with IV 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

CBC

CMP

PT

PTT

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Brain without contrast (with physician approval)

CT Cervical without contrast (with physician approval)

CT Chest with IV contrast (with physician approval)

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

Obtain radiograph of injured extremity

Motor Vehicle Collision (MVC)

CBC

CMP

IV Saline Lock

- Consider -

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

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

treatment area.

Mouth Swelling

CBC

CMP

IV Saline Lock

- Consider -

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

EKG (if febrile, Pulse >100)

Nausea

CBC

CMP

IV Saline Lock

- Consider -

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

EKG (if febrile, Pulse >100)

Nausea, Vomiting

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

EKG (if febrile, Pulse >100)

Nausea, Vomiting, Diarrhea

CBC

CMP

EKG

Chest 1 View

IV Saline Lock

Cardiac Monitor

- Consider -

Cervical Spine Injury – Apply Collar if patient has neck pain

Near Drowning

Accucheck Now

CBC

CMP

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

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)

Near Syncope

CBC

CMP

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

UA (With Micro/Reflex Culture)

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.

Neck and Upper Back Pain

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)

Neck Injury

Cervical Spine Series (AP, Lateral, and Odontoid)

- Consider -

Associated headache or stiffness with fever may be meningitis.

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

CBC

CMP

CPKMB

TROPONIN

PT and PTT

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

EKG

CT Brain without contrast (with physician approval)

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

Neck Pain

Cervical Spine Series (AP, Lateral, and Odontoid)

- Consider -

Apply Cervical Collar if injury reported

Maintain Cervical Spine precautions

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

permission)

Neck Problem

CBC

CMP

IV Saline Lock

Neck Soft Tissue

- Consider -

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

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:

CBC

CMP

UA

IV Saline Lock

Needs Urinary Catheter

Accucheck

CBC

CMP

UA (With Micro/Reflex Culture)

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 -

Administer Tylenol or Motrin per Protocol

Neonatal Sepsis

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Nervous

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Neuro Deficit

Accucheck

CBC

CMP

UA (With Micro/Reflex Culture)

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 -

Administer Tylenol or Motrin per Protocol

Newborn Sepsis

Chest PA & Lateral

- If FEVER or SHORTNESS OF BREATH -

CBC

CMP

Blood Cultures x 2

EKG

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)

Non-Productive Cough

CBC

CMP

PT

PTT

Epistaxis Kit to Bedside

IV Saline Lock

- Consider -

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

Type and Screen (If patient has unstable vital signs)

Nose Bleed

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Arm

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Face

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Hand

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Lips

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Numbness of Mouth

Initiate precipitous delivery protocol for Active Labor.

OB Delivery/Emergent

CBC

CMP

Beta HCG Quantitative

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)

CBC

CMP

Beta HCG Quantitative

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)

Identify type of G-Tube and Size.

Attempt to flush G-Tube if intact.

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

Notify MD for immediate examination and/or management.

Obstructed G-tube

CBC

CMP

Beta HCG Quantitative

Type and Screen and RH Factor

US Obstetric (with MD approval)

US Abdomen (With MD approval)

IV Saline Lock

- Consider -

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

OB Trauma

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

Urine Drug Screen

EKG

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

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

Overdose

Chest PA & Lateral

- If FEVER or SHORTNESS OF BREATH -

CBC

CMP

Blood Cultures x 2

EKG

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)

Painful Cough

UA (With Micro/Reflex Culture)

- Consider -

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

Pain with Urination

CBC

CMP

EKG

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)

Palpitations

Accucheck Now

CBC

CMP

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

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)

Passed out Prior to Arrival

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

OR

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

Pedal Edema

CBC

CMP

UA (With Micro/reflex culture)

EKG

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

IV Saline Lock

- Consider -

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

Urine Drug Screen and ETOH

Pediatric Chest Pain

Accucheck

CBC

CMP

UA (With Micro/Reflex Culture)

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 -

Administer Tylenol or Motrin per Protocol

Pediatric Neonatal Sepsis

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

UA (With Micro/Reflex Culture)

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

Pelvic Pain

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

UA (With Micro/Reflex Culture)

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

Pelvic Problem

CBC

CMP

UA

GC Culture

Penile Bleeding

CBC

CMP

UA

GC Culture

Penile Discharge

CBC

CMP

UA

GC Culture

US Doppler Testicles (If testicles are painful)

Penile Injury

CBC

CMP

UA

GC Culture

US Doppler Testicles (If testicles are painful)

Penile Pain

CBC

CMP

UA

GC Culture

US Doppler Testicles (If testicles are painful)

Penile Problem

UA (With Micro/Reflex Culture)

CBC

CMP

IV Saline Lock

- Consider -

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

CT Abdomen and Pelvis without Contrast (With physician permission)

Possible Kidney Stone

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

Urine Drug Screen

EKG

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

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

Possible Overdose

CBC

CMP

PT

PTT

Type and Screen

Beta HCG Quantitative

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:

CBC

CMP

TYPE and SCREEN

PT

PTT

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:

CBC

CMP

TYPE and SCREEN

PT

PTT

Bring patient immediately to treatment area

IV Saline Lock

Post Surgical Pain

CBC

CMP

UA

Beta HCG Quantitative

IV Saline Lock

Pregnant

Initiate precipitous delivery protocol for Active Labor.

Preterm Labor

CBC

CMP

Magnesium

Accucheck Now

Patient should be NPO

EKG

UA (With Micro/Reflex Culture)

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)

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

Probable Seizure

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.

Problem with Feeding Tube

Attempt to Flush Foley Catheter

If unsucessful:

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:

CBC

CMP

UA

IV Saline Lock

Problem With Urinary Catheter

Chest PA & Lateral

- If FEVER or SHORTNESS OF BREATH -

CBC

CMP

Blood Cultures x 2

EKG

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)

Productive Cough

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Psychiatric

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Psych Problem

CBC

CMP

BNP

EKG

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

area.

Pulseless Extremity

Identify object that caused puncture

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

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

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

Puncture Wound

Identify object that caused puncture

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

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

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

Puncture Wound to Arm

Identify object that caused puncture

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

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

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

Puncture Wound to Back

Identify object that caused puncture

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

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

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

Puncture Wound to Chest

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)

Puncture Wound to Ear

Document Visual Acuity

Patch effected eye if trauma reported

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

Puncture Wound to Eye

Identify object that caused puncture

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

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

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

Puncture Wound to Face

Identify object that caused puncture

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

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

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

Puncture Wound to Foot

Identify object that caused puncture

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

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

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

Puncture Wound to Hand

Identify object that caused puncture

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

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

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

Puncture Wound to Head

Identify object that caused puncture

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

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

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

Puncture Wound to Leg

Identify object that caused puncture

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

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

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

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.

Rash

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

Rectal Abscess

CBC

CMP

PT

PTT

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)

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

Patient should be brought immediately to treatment area.

Rectal Bleeding

Identify type and location of foreign body

NPO

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.

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

Rectal Foreign Body

Document Visual Acuity

Patch effected eye is trauma reported

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

- Consider -

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

Patient should be taken immediately back to treatment area.

CBC

CMP

IV Saline Lock

CT Brain Without Contrast (With physician approval)

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

CBC

CMP

CPKMB

Troponin

Magnesium Level

PT

PTT

EKG

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

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

Respiratory Arrest

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

CBC

CMP

Blood Cultures x 2

EKG

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

Respiratory Distress

CBC

CMP

PT and PTT

EKG

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)

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

- Treatment -

Administer Tylenol or Motrin per Protocol

Respiratory Failure

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

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

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Scrotal Pain

CBC CMP

Magnesium

Accucheck Now

Patient should be NPO

EKG

UA (With Micro/Reflex Culture)

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)

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

Seizure

CBC

CMP

Magnesium

Accucheck Now

Patient should be NPO

EKG

UA (With Micro/Reflex Culture)

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)

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

Seizure Activity

CBC

CMP

PT

PTT

Lactic Acid

Blood Cultures x 2

UA (With Micro/Reflex Culture)

Chest 1 View

Strep Group A Rapid

Flu A and B

EKG

IV Saline Lock

Cardiac Monitor

Pulse-Ox Continuous

- Consider -

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

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

- Administer -

Tylenol or Motrin per Protocol

Sepsis (Pediatric or Adult)

CBC

CMP

PT and PTT

EKG

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)

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

- Treatment -

Administer Tylenol or Motrin per Protocol

Severe Shortness of Breath

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

CBC

CMP

Blood Cultures x 2

EKG

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

Shortness of Breath

Shoulder LEFT or Shoulder RIGHT

Sling

- 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

Sling

Chest PA and Lateral

- Consider -

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

Shoulder Pain

CBC

CMP

Reticulocyte Count

IV Saline Lock

Pulse-Ox Continuous

- Consider -

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

Blood Cultures x 2 (if patient has fever)

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

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

ETOH

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Slurred Speech

Apply 100% NRB

ABG with Co-oximetry and Carbon Monoxide Level

CBC

CMP

Chest 1 view

Pulse Ox Continuous

Cardiac Monitor

IV Saline Lock

- Consider -

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

Smoke Inhalation

CBC

CMP

PT

PTT

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:

CBC

CMP

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

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

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)

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

Stab Wound to Abdomen

CBC

CMP

PT

PTT

Type and Screen

Xray appropriate extremity for foreign body and fracture

IV Saline Lock

- Consider -

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

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

Stab Wound to Arm

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

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

CT Chest with IV contrast (with physician approval)

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

Stab Wound to Back

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

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

CT Chest with IV contrast (with physician approval)

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

Stab Wound to Chest

Identify object that caused Stab Wound

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

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

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

Stab Wound to Foot

Identify object that caused Stab Wound

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

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

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

Stab Wound to Head/Face

Identify object that caused Stab Wound

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

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

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

Stab Wound to Leg

Identify object that caused Stab Wound

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

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

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

Stab Wound to Neck

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Stab Wound to Pelvis

Identify object that caused Stab Wound

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

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

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

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

UA (With Micro/Reflex Culture)

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

For Males:

UA (With Micro/Reflex Culture)

GC/Chlamydia Probetec (urine culture)

STD Exposure

Cervical Spine Series (AP, Lateral, and Odontoid)

- Consider -

Associated headache or stiffness with fever may be meningitis.

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

CBC

CMP

CPKMB

TROPONIN

PT and PTT

Blood Cultures x 2 if febrile

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

EKG

CT Brain without contrast (with physician approval)

IV Saline Lock

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

Stiff Neck

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Stroke

Initiate Stroke Alert Protocol

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Stroke Alert

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA (With Micro/Reflex Culture)

Urine Drug Screen

EKG

Chest 1 View

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

- Consider -

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

Substance Ingestion

CBC

CMP

ETOH

UA (With Micro/Reflex Culture)

Urine Drug Screen

TYLENOL LEVEL

ASPIRIN LEVEL

- Consider -

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

Notify physician if patient is appropriate for medical clearance.

Suicidal Ideation

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

Suture Recheck

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

Suture Removal

Chest 1 View

KUB

CBC

CMP

IV Saline Lock

- Consider -

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

Swallowed Foreign Body

CBC

CMP

IV Saline Lock

- Consider -

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

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

treatment area.

Swelling of Tongue

CBC

CMP

BNP

EKG

IV Saline Lock

- Consider -

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

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

OR

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

Swelling of Lower Extremity

CBC

CMP

Mono Test

Blood Culture X 2

IV Saline Lock

Swollen Glands

Accucheck Now

CBC

CMP

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

IV Saline Lock

Cardiac Monitor

Pulse-ox continuous

Orthostatis 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)

Syncope

CBC

CMP

CPKMB

Troponin

Magnesium Level

PT

PTT

EKG

Chest 1 View

IV Saline Lock

Defibrillator pads on patient

Cardiac Monitor

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

Tachycardia

Initiate precipitous delivery protocol for Active Labor.

Term Labor

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Testicular Lump

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Testicular Pain

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Testicular Problem

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex Culture)

Keep Patient NPO

IV Saline Lock

Testicular Swelling

US Scrotum with Doppler Flow Imaging for Torsion

CBC

CMP

GC Culture

UA (With Micro/Reflex 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 -

CBC

CMP

CPK Total

IV Saline Lock

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

Thigh Pain

Finger LEFT or RIGHT

Thumb Injury

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

TIA

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

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Trauma (Major)

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Tremor

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Trouble Talking

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:

CBC

CMP

UA

IV Saline Lock

Trouble Voiding

CBC

CMP

PT

PTT

EKG

CPKMB

Troponin

CT Brain Without Contrast (with Physician approval)

IV Saline Lock

Cardiac Monitor

Pulse-ox Continuous

NIHSS on arrival

Trouble Walking

CBC

CMP

CPKMB

Troponin

Accucheck Now

PT

PTT

ETOH

Tylenol Level

Aspirin Level

EKG

UA (With Micro/Reflex Culture)

Urine Drug Screen

IV Saline Lock

Cardiac Monitor

Pulse Ox Continuous

- Consider -

CT Brain Without Contrast (ask for physician approval)

Unconscious Patient

AccuCheck Now

CBC

CMP

ETOH

Tylenol Level

Aspirin Level

UA(With Micro/reflex culture)

Urine Drug Screen

EKG

Chest 1 View

Cardiac Monitor

Pulse-ox Continuous

-Consider -

CT Brain Without Contrast (with physician approval)

CPKMB and Troponin (if age 50 or greater)

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

IV Saline Lock

Unresponsive Patient

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

Upper Extremity Pain

UA (With Micro/Reflex Culture)

- 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)

Urinary Frequency

Insert Foley Catheter

Notify Physician if unable to pass catheter.

CBC

CMP

UA

IV Saline Lock

Urinary Incontinence

UA (With Micro/Reflex Culture)

- 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)

Urinary Problem

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:

CBC

CMP

UA

IV Saline Lock

Urinary Retention

UA (With Micro/Reflex Culture)

- 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)

Urinary Symptoms

UA (With Micro/Reflex Culture)

- 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)

Urinary Tract Infection

CBC

CMP

Beta HCG Quantitative

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)

Vaginal Bleeding (Pregnant)

CBC

CMP

UA (With Micro/Reflex Culture)

US Pelvic Complete

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

IV Saline Lock

Vaginal Bleeding (Pregnancy Unknown)

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

UA (With Micro/Reflex Culture)

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

Vaginal Discharge

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

UA (With Micro/Reflex Culture)

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

Vaginal Itching

Pelvic Setup

GC Culture

Wet Prep

Culture Skin

UA (With Micro/Reflex Culture)

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

Vaginal Pain

CBC

CMP

EKG

UA (With Micro/Reflex Culture)

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

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

EKG (if febrile, Pulse >100)

Vomiting

CBC

CMP

Stool Culture

IV Saline Lock

- Consider -

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

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)

Vomiting, Diarrhea

CBC

CMP

UA (With Micro/Reflex Culture)

EKG

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)

Weakness

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

CBC

CMP

Blood Cultures x 1

RSV

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

Wheezing < 1 Year Old

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

CBC

CMP

Blood Cultures x 2

EKG

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

Wheezing > 1 Year Old

CBC

CMP

UA

IV Saline Lock

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

Won’t Eat

CBC

CMP

Amylase

Lipase

PT

PTT

Type and Screen

UA (With Micro/Reflex Culture)

Urine Drug Screen

ETOH

EKG

C-Spine Stabilization and/or collar as needed

Patient should remain NPO

IV Saline Lock (2 large bore)

Cardiac Monitor

Pulse Ox Continuous

NPO

- Consider –

Trauma Transfer Packet

Wound to Buttock

- Consider -

CBC

CMP

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