Moderator EMEDPA Posted July 1, 2013 Moderator Share Posted July 1, 2013 I am putting together a guidebook for PAs who work solo at a rural facility I cover. This is what I have in it so far: STEMI/Thrombolytic guidelines/contraindications/dosing Stroke scale/TPA for stroke Contact info for all stat specialty referrals/ems transfers/helicopters anything else that should be in there? Link to comment Share on other sites More sharing options...
rcdavis Posted July 1, 2013 Share Posted July 1, 2013 Maybe, as a quick, convienent place to have them: Normograms such as Tylenol overdose treatment decision rules, ( time versus levels, liver fxn levels and treatment) PE decision rules (PERC etc) State rape kit rules, and post rape pregnany and ID protocols Copy of local "occupational exposure to blood and potentially hazardous body secretions/ needle stick" protocol...what to draw, which HIV prophy treatments to offer, consents, etc) Local protocol for outpatient tx of DVT and low risk PE ( lmwh, factor Xa use, heparin--> Coumadin) The difficult airway management algorithm (the one which lists ketamine as treatment for status asthmaticus unresponsive to other treatments) Local transfusion guidelines Local FUO in immune compromised patients (chemo, DMRA etc) preferred abx combinations Detox centers numbers and admit criterion ( alcohol levels acceptable) A local trauma protocols ( who takes head injuries, minor ICH which are stable, neck fx, unstable back fx, etch and trauma, etc.. The answers to the ubiquitous "surgery versus hospitalist, neuro surg versus orthopedist, OB (in te case of pregger trauma pt) vs surgery versus hospitalist) ... Who comes in, when. Local ACS , non STEMI, protocols ,,, regarding which anticoagulant That is all I can think of at the moment for situations which I would want a quick and easy go to Link to comment Share on other sites More sharing options...
Leeg Posted July 1, 2013 Share Posted July 1, 2013 When you get it completed, publish a version of it and I'll buy it. Sounds like a great idea for any PA in emergency medicine. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 1, 2013 Author Moderator Share Posted July 1, 2013 Great ideas RC, thanks! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 2, 2013 Moderator Share Posted July 2, 2013 When you get it completed, publish a version of it and I'll buy it. Sounds like a great idea for any PA in emergency medicine. Agreed that it is- only problem is that something like that will be very facility-dependent. The orthopod who manages all spinal cases may not be the same neurosurgeon who will cry foul about any orthopod touching his/her spine cases at another facility; admit patterns are all different; etc. Link to comment Share on other sites More sharing options...
Leeg Posted July 2, 2013 Share Posted July 2, 2013 I agree. I was referring to the information that is not facility specific such as general info for Tylenol OD, tpa, PE protocols etc. Then I can fill in the blanks (so to speak) with the local/facility information as needed. A generic version will provide a place to keep the information handy. Link to comment Share on other sites More sharing options...
Just Steve Posted July 2, 2013 Share Posted July 2, 2013 Local resources for psych/counseling, planned parenthood, addiction/dependency, free/low pay/walk in dental resources. Places to direct the folks who have no PCP and come to the ER hoping you can cure their chronic issues. Pass that hot potato. Link to comment Share on other sites More sharing options...
kargiver Posted July 4, 2013 Share Posted July 4, 2013 What is EMTALA, how does it really apply to PAs, what constitutes a screening exam through stabilization, etc. CMS has recently changed the rules, particularly for rural environments, but the screening exam is a lot more involved than what people think. We are dealing with a CMS investigation right now and learning the hard way that what we are taught is not what CMS necessarily thinks is correct.... Add dental blocks, curing agents for fractured teeth, basic rules for common fractures (when to boot fibular fractures, that type of stuff) G Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 4, 2013 Author Moderator Share Posted July 4, 2013 all the pas working at this particular facility have 15+ yrs of dedicated em experience. all but one are prior paramedics. many of us have passed the caq and are disaster medical teams which have deployed to austere environments, etc so I don't think I need basic stuff in there just stuff you see in a solo environment that you don't see working with a doc in a big urban ctr because the docs take them(thus the tpa/tnk for stemi/cva type stuff). Link to comment Share on other sites More sharing options...
kargiver Posted July 4, 2013 Share Posted July 4, 2013 I'll write you offline with the rest Link to comment Share on other sites More sharing options...
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