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