ABDOMINAL PAIN
All pts with Abd Pain should have:
- Pregnancy Status addressed (between age of 10-60, female)
- Location of Pain noted
- U/A
- GU exam for all w/ pain below umbilicus (female = pelvic; male = testicular)
- Clear DDx considered (cholecystitis, gastritis, pancreatitis, SBO/ileus, constipation, diverticulitis, appendicitis, ovarian torsion, testicular torsion, UTI/Pyelo, renal colic, mesenteric ischemia)
- Blood work (CBC, CMP, Lipase, and add CRP for pediatric patients )
- Ultrasound
- KUB X-Ray
All pts > 50 yo with Abd Pain should have:
- Same as above plus ---
- EKG
- Rectal Exam
- Comment on AAA/Mesenteric Ischemia/ACS in DDx.
Standard of Care - Chest pain
CHEST PAIN
All patients with CP over 12 yo should have:
- EKG
- CXR
- Clear Differential diagnosis (DDx) discussed
All patients with CP over 40 yo should have:
- Aspirin 325mg (chewable) if suspicion of cardiac event
- EKG
- CXR
- Bilat BP and Distal Pulses
- Risk Factors
- Clear DDx discussed (specifically, ACS, TAD, AAA, PE, Pneumothorax).
Standard of Care - Fever
FEVER
All pediatric patients with fever should have:
- Document general status – “non-toxic”, “not septic”
- Hydration status noted – wet diaper in last hour, using restroom, crying tears, ablity to tolerate PO fluids, etc.
- Presence or lack of meningeal signs
- Note activity level/playfulness at normal/below normal level
- Under 2 years old fever over 103 without focal infection requires septic work up
- Catheterization for UA for any untoilet trained kids
- Motrin or Tylenol
All patients >10 with fever should have:
- Document general status – “non-toxic”, “not septic”
- Presence or lack of meningeal signs
- Consideration of DDx / source in chart.
- All patients looking toxic need steptic work up including Chest X-ray
- Toradol Injection
- Consider IV Hydration.
Standard of Care - Head injury
HEAD INJURY
All patients with noted head/facial injury should have
- Thorough neuro exam (age appropriate)
- Mechanism noted (Infant fall >3 ft = trauma, Adult fall > 10 ft = trauma , call EMS)
- LOC status noted
- If on any anticoagulants or age >65 , CT indicated, refer to ER.
- Full HEENT and Eye exam noted
- Documentation of HI warnings given to patient/family
- See guidelines for more info.
Standard of Care - Headache
HEADACHE
All patients with headache as chief/major c/o should have following noted:
- h/o same in past noted? If noted “worst H/A ever”, needs ER eval
- Full neuro exam, including cerebellar, gait, eyes
- DDx considered – SAH, mass, meningitis
- See guidelines for head CT indication.
LA Prehospital Stroke Screen
Age over 45 years Y/N
No prior history of Seizure disorder Y/N
New onset of neurologic symptoms in last 24 hours Y/N
Patient was ambulatory at baseline (prior to event) Y/N
Blood Glucose in range 60 to 400 (Glucose: _____)
Unilateral asymmetry (one of categories below)
Facial droop
Grip weakness or absence
Arm weakness