ED life hacks

see also:

• Western Health ED main page
• Sunshine ED Fast Track

This is a quick reference guide to services in ED and how to make your shift run smoother. Topics are listed on the right side as a navigation aid. If you think of anything else you would like to add contact Gary.

• Screening for frequent flyers, NESB, domestic violence, D+A, homeless.
• 2 staff morning and 1 in the afternoon (weekend short – as covering wards) so maybe under the pump but always willing to advise.
• Crutches + zimmer knee – ask nurses
• CAM Boot + wedge – ACE can do but doctors should learn (see video link - https://vimeo.com/133944482)for an Achilles rupture just add 3 heel wedges to create an equinus position. Payment options = Nurses
• Functional review – vertigo/dizzy/mobility/elderly falls. Can do pre-assessment in ED if time available. Ref to post acute care, community based rehab, can do own f/u (physio, OT, SW – will occur in the next week).
• My aged care – will help increase services – respite/care facilities.
• Can do welfare checks.
• Dizzy patient (??dizzy day clinic – if the patient can afford). Referred to PAC, vestibular physio.
• Cognition and dementia service – used for anyone with out a diagnosis and has a 6 months decline in cognition, assessments.
• Care support – respite/funding/support
• Continence – “RDNS” can help (Bolton Clarke – new name RDNS)
• Wound management – ref to PAC 1st and then can out source to “RDNS”. Send 1st lot of dressings.
• HARP – resp/cardiac/complex needs/diabetes
• Pulmonary and cardiac rehab
• D+A – no longer in dept, can potentially be referred. Referral sheet behind ACE desk
• DHS/Domestic violence – crisis accommodation, safe steps – do assessment and work on a safety plan (info sheet at ACE desk).
• Staff support
• Bereavement

• Flag with ACE. Aged care liaison – IRCMAC, ref for IV abx.
• Leave notes for ACE team – they will follow up.
• Home needs discharge summary, IRCMAC and saline flushes. Need clear evidence of 1st dose.
• Where is the IRCMAC: see topic below.

CAM Boot + wedge – ACE can do but doctors should learn (see video link - https://vimeo.com/133944482)

• For an Achilles rupture just add 3 heel wedges to the CAM boot to create an equinus position. Ortho follow-up.

• Analgesia and ADT
• Cool the burn for 20mins with cool/tepid water (if burnt within the past 3 hours)
• Blisters <2.5cm leave unless over a joint, >2.5cm – de roof

• Epidermal/superficial = Dermeze / Vaseline
• Superficial dermal = Mepilex border, mepitel
• Mid/deep-dermal = Mepilex Ag
• Full thickness = Aquacel Ag + absorbent pad over the top

• Plastics vs with Ian Law (reviews most kids and minor adult burns) (Monday + Tuesday late shift and Thursday + Friday Day shift – send text 0416118953)

• Option 1: 1mg/kg BD + warfarin – Hith can help, need script for 1,2 and 5mg warfarin, anticoagulation form.
• Option 2 if DOACs / NOACs can be used then rivaroxaban 15mg BD for 3 weeks then 20mg OD – there is a PBS authority numbers for this dosing regimen
• see Mx of lower limb DVTfor more details

For a quick reference guide see Simon’s quick reference guide from PMH hospital for children in Perth: http://kidshealthwa.com/wp-content/uploads/2015/05/Fractureposter_version20150512.pdf

Alternatively here is a link for some paediatric plaster videos https://lifeinthefastlane.com/practical-guide-to-the-backslab/

• http://westerned.org/presentations/plastics-hand-injuries/
• Remember that despite the rise of technology, solid basic descriptions are still the bedrock of a good referral. Use appropriate and precise terminology eg. radial / ulnar. They love an AMPLE hx + hand dominance, occupation, smoking status and tetanus status.
• The hand examination includes motor, sensory and tendon function components
• Remove rings
• Abx = cephazolin / clindamycin or Tazocin (DM, immunosuppression, bites)
• ADT
• Xray
• NBM
• Early washout in ED may prevent later complications – consider using 500-1000mL bags of NaCl 0.9% on pump set with a drawing up needle to facilitate large volumes of fluid under good pressure
• Ensure your slabs are of appropriate weight so they do not fall apart before the first plastics clinic review
• The Plastics team are keen to see all hand fractures, even ones that will be managed conservatively, so that patients can have access to a hand therapist
• Nail bed injuries can be described by how proximal / distal to bone and nail bed, and if they are oblique

Call 56309 or switch Cellulitis + complex wound dressings

• 1st dose abx in ED. Drug chart needs abx + saline flush + PRN adrenaline.

For severe infection they will arrange a flucloxacillin baxter pump Can also arrange mid-line insertions

• Moderate infection Cephazolin 2g BD
• Mild infection probenecid 1g oral and cephazolin 2g
• Add clindamycin is strep cellulitis is considered (fever, rigors, pain first and then rash, any blisters or tracking)

• Full details + other services: http://westerned.org/modules/headspace-referrals/
• REFERRAL TO HEADSPACE SUNSHINE:(12-25yo, presenting with mild-moderate mental health difficulties)

Business Hours: Fax ED assessment/notes to headspace Access Team, followed up with phone call to confirm receipt of the assessment (if possible, patient can speak with Access Team to ‘fast-track’ intake process) Afterhours presentations: fax assessment, leave a voicemail including patients name and send the UR number via email to Alex.Pleban@mh.org.au Sunshine Hospital Assertive Linkage Service (EMH) to follow up during business hours

• FAX: 9312 1757
• PHONE:  9927 6222

• Young people aged 12 to 25yrs and presenting with mild-moderate difficulties can be referred
• There is no geographical catchment, however it is expected that potential clients are able to attend their preferred centre
• headspace Sunshine provides access to counselling, psychiatry, GP appointments, mental health nurse, vocational support and peer support as well as facilitating contact with various collocated providers (housing, AoD counselling and carer support)
• Requests for crisis support or management of severe/complex presentations should be directed to Orygen Youth Health Triage 1800 888 320, or RCH Triage 1800 445 511

• Any aged care facility pt – flag with ACE/IRS they will make sure aged care liaison is aware (this is an under utilised service which helps manage aged care patients and can help make sure antibiotics are given and additional medical help is established if required).
• Leave notes for ACE team – they will follow up.
• Aged care facility needs discharge summary, IRCMAC (drug chart for the nursing home) including saline flushes. Need clear evidence of 1st dose of antibiotics if given and a script.

How to fill out the IRCMAC: Select 'E' on the bossnet tab for your patient: Find the IRCMAC form (ED & After Hours IRCMAC AD61) - you need to print it before saving. If you have more than 3 drugs you will need to go through the whole process again. Only new changes need to be documented - not all the patients drugs:

Select 'P' on the bossnet tab for your patient: Then click on the red tab and fill in the details including the ISBAR section

• All staff phone the consultant in charge (or registrar if you are calling overnight) if you are taking personal leave.  The number to call is 83451599 (Sunshine).  
• Emails directly sent to Narelle/Lien may get missed. When you are feeling better send Narelle/Lien an email within that pay run notifying them of your personal leave and attach a certificate if you have one.

All patient's D/C into the community with an IDC need:

• Post Acute Care (PAC) form completed - fax to 8345 1134 and 9836 4933 (if after hours)
• Community Discharge / Take-home Pack including 3x drainage bags, 3x leg bags and 2x leg straps

• If TOV is required you will need to fill out an AD32 form - request for elective admission and fax it along with your GP discharge letter to 8345 6711 and detail specific D/C orders i.e. time frame for TOV.

• If the patient requires Urology outpatients (i.e. failed TOV before requiring TURP) ensure this plan is also stated on GP letter and the AD32 form and fax to urology OPD 8345 6856

• Microbiology 56878
• Medical Microbiologist 56294
• Blood Culture Results 92440231
• On-call Haematologist - contact via lab or via Dorevitch 9244 0450

• ED:
  • adult AO 51599; triage 51600; NIC 51595; consultant 50281;
  • SSU 50300/51407; ECATT 50443/51248; pager 493; care coordinator 50189;
  • fax 51607/51447
  • secretary 51268
• AHA: 51511 page 832
• path: 51485
• radiology:
  • radiology registrar after hours 57223
  • radiologist 51659
  • radiographer 51162
  • US 50351
• theatre: 51566
• ICU liason nurse 50039 pg 501
• diabetic educator 50729

• ED: AO 56393; NIC 56334/56335; triage 56643;
• AHA 56645 page 500
• ICU 56545 CCU 56546
• diabetic educator p508 or 56493