NORTH WALES CRITICAL CARE NETWORK

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "NORTH WALES CRITICAL CARE NETWORK"

Transcription

1 NORTH WALES CRITICAL CARE NETWORK LEVELS OF CRITICAL CARE FOR ADULT PATIENTS Throughout the work of the North Wales Critical Care Network reference to Levels of Care for the critically ill are frequently required. Examples of such are, amongst others, when collecting data for the patient flow studies or undertaking unmet demand studies throughout the entire acute Trusts. Levels of Care are described in Designed for Life: Quality Requirements for Adult Critical Care in Wales (WHC ). However, the Network work groups have identified several difficulties with the interpretation of the definitions. This is partly because they are sometimes confused with English definitions and often because they are subjectively interpreted. Confusion is further compounded because the levels of care are précised in the Welsh Standards for Adult critical Care in Wales (2003) but additional definitive guidance is not provided. It is for these reasons therefore that the Network has enhanced the levels of care definitions by providing examples. Whilst it will be impossible to provide an example for all patient scenarios it is hoped that these will aid clinical practice and reduce the subjectivity in interpretations. The definitions for level of care in Wales are as follows (All Wales Critical Care Development Group 2003). Level 0 Level 1 Level 2 Level 3 Level 3T Suitable for patients whose needs can be met through normal ward care in an acute hospital. Suitable for patients at risk of their condition deteriorating, those recently relocated from higher levels of care, and those whose needs can be met on an acute ward with additional advice and from the critical care team. Suitable for hospitalised patients requiring more detailed observation or intervention, including for a single failing organ system, postoperative care and those stepping down from higher levels of care. Suitable for hospitalised patients requiring advanced respiratory in addition to the above, but the duration of multi-organ or ability to manage multiple patients might be limited by staffing or equipment constraints. Organ and monitoring for most body systems should be available at Level 3T and these facilities would normally be available to multiple patients simultaneously. This level is suitable for critically ill patients requiring prolonged for multi-organ failure. Such units would have a significant teaching and training role. 1

2 LEVEL 3 = LEVEL 2 = LEVEL 1= INCLUDE QUICK GUIDE TO LEVELS OF CRITICAL CARE FOR ADULT PATIENTS (FOR MORE DETAIL & DEFINITION PLEASE REFER TO FOLLOWING PAGES) 2 ORGAN SUPPORT (DUE TO ACUTE ILLNESS) ADVANCED RESPIRATORY SUPPORT 1 CHRONIC ORGAN SUPPORT + 1 ACUTE ORGAN SUPPORT: BASIC RESPIRATORY SUPPORT + RENAL SUPPORT = LEVEL 3 BASIC RESPIRATORY SUPPORT + NEURO SUPPORT = LEVEL 3 BASIC RESPIRATORY SUPPORT + DERMATOLOGICAL SUPPORT = LEVEL 3 BASIC CARDIOVASCULAR SUPPORT + RENAL SUPPORT = LEVEL 3 BASIC CARDIOVASCULAR SUPPORT + NEURO SUPPORT = LEVEL 3 BASIC CARDIOVASCULAR SUPPORT + DERMATOLOGICAL SUPPORT = LEVEL 3 ADVANCED CARDIOVASCULAR SUPPORT + BASIC RESPIRATORY SUPPORT = LEVEL 3 ADVANCED CARDIOVASCULAR SUPPORT + RENAL SUPPORT = LEVEL 3 ADVANCED CARDIOVASCULAR SUPPORT + NEURO SUPPORT = LEVEL 3 ADVANCED CARDIOVASCULAR SUPPORT + DERMATOLOGICAL SUPPORT = LEVEL 3 NB BASIC RESPIRATORY SUPPORT + BASIC CARDIOVASCULAR SUPPORT = LEVEL 2 1 ORGAN SUPPORT (DUE TO ACUTE ILLNESS) BASIC RESPIRATORY SUPPORT + BASIC CARDIOVASCULAR SUPPORT = LEVEL 2 PRE-SURGICAL OPTIMISATION REQUIRING INVASIVE MONITORING EXTENDED POST-OP CARE PATIENTS REQUIRING HIGH DEGREE MONITORING OR OBSERVATION PATIENT RECENTLY LEVEL 3 BUT NOT WELL ENOUGH FOR LEVEL 1 PATIENT WITH UNCORRECTED ABNORMAL PHYSIOLOGICAL VARIABLES EPIDURAL ANALGESIA RECENTLY DISCHARGED FROM HIGHER LEVEL OF CARE OUTREACH SUPPORT REQUIRED EXCLUDE GI SUPPORT BASIC RESPIRATORY SUPPORT + BASIC CARDIOVASCULAR SUPPORT = LEVEL 2 PRE-OP BED BLOCKING ROUTINE POST-OP PATIENTS DELAYED DISCHARGES LEVEL 0 NORMAL WARD CARE (See Appendix 1 for description of basic, advanced respiratory and cardiovascular etc ) 2

3 Level of Care Definitions (See Appendix 1 for description of basic, advanced respiratory and cardiovascular etc ) Level 3 Criteria Examples Include Exclude Advanced respiratory Respiratory failure from any cause that requires invasive, ventilatory. Examples may include patients with: Mechanical ventilatory Neurological depression o GCS <8 o Neuromuscular failure BIPAP / CPAP via ET tube Mask BIPAP Respiratory failure o Acute or chronic lung problems requiring ventilation e.g. COPD, ARDS, pneumonia, pulmonary oedema etc Extracorporeal respiratory CPAP via trache Non-invasive mask ventilation Severe Cardiovascular instability o E.g. Shock sepsis, cardiogenic etc See page 6 for algorithm Monitoring and Support of two or more organs due to an acute illness (one of which may be basic or advanced respiratory ). Chronic dysfunction of one or more organs sufficient to restrict daily activities and who receive monitoring and for one other organ due to an acute illness Acute dysfunction of two or more organs. Examples may include patients with: Respiratory and cardiovascular failure o Invasive ventilation and intravenous vasoactive drugs Respiratory and renal failure o Invasive ventilation and heamofiltration Respiratory and neurological dysfunction 1 o Airway protection for GCS< 8 Major surgery who require advanced respiratory (above) and monitoring / of other organs Continuous IV medication to control seizures and supplementary oxygen/airway monitoring Severe ischaemic heart disease and major perioperative haemorrhage COPD requiring home oxygen presenting with sepsis related to immunosuppression Angina on mild exercise and pneumonia requiring CPAP Basic respiratory and renal, neurological or dermatological Basic cardiovascular and renal, neurological or dermatological Advanced cardiovascular and basic respiratory or renal or neurological or dermatological 3 Gastrointestinal Basic cardiovascular plus basic respiratory = Level 2 Gastrointestinal Basic cardiovascular plus basic respiratory = Level 2

4 (See Appendix 1 for description of basic, advanced respiratory and cardiovascular etc ) Level 2 Criteria Examples Include Exclude Admissions receiving monitoring and for one organ due to an acute illness Basic cardiovascular and basic respiratory = one organ dysfunction = Level Gastrointestinal 2 Respiratory o >50% inspired oxygen 2 o A tracheostomy inserted in the last 24 hours o NIV or mask CPAP o The requirement for physiotherapy or suctioning at least every 2 hours Cardiovascular o Cardiovascular instability requiring continuous ECG and invasive pressure monitoring o Haemodynamic instability due to hypovolaemia/haemorrhage/sepsis o Haemodynamic instability requiring balloon pump o A single infusion of vasoactive drug requiring appropriate monitoring 4 Central nervous system o CNS depression sufficient to compromise airway and protective reflexes Acute impairment of renal, electrolyte or metabolic function o Renal replacement therapy o DKA o Profound hypothermia Renal Neurological Dermatological Step down (relevant when no other ticked no longer needs ITU care but requires greater monitoring / observations than could be provided on a general ward) NIV- long standing or established care Invasive lines in for convenience e.g. taking blood or IV access for drugs that could be given peripherally 3 Admissions receiving presurgical optimisation requiring invasive monitoring and treatment to improve organ function Examples may include patients requiring: Haemodynamic/respiratory resuscitation or optimisation. Elective major surgery but pre-optimisation Emergency surgery but resuscitation Insertion of invasive monitoring Pre-operative admissions to reserve the critical care bed Admissions receiving extended post surgical Major elective surgery Routine post operative patients 4

5 care either because of the procedure and/or the condition of the admission. Emergency surgery who are unstable or high risk An increased risk of post operative complications or interventions Intermediate surgery but who are >70 years or > ASA III (i.e. severe system disease with functional limitation or worse) Admissions receiving a greater degree of observation and monitoring than level 1 care Examples may include patients requiring: Observation and monitoring that cannot be safely provided at level 1 or 0, judged on the basis of clinical circumstances and ward resources o Complex surgery, trauma requiring multiple blood transfusions o Treatment for severe DKA o Complex surgery requiring strict monitoring e.g. Free flap surgery, major vascular surgery, cardiac surgery, neuro surgery etc o Confused or fitting patients Patients requiring significant nursing time e.g. Patients requiring specialing Routine post operative patients Admissions moving to stepdown care Admissions with uncorrected physiological abnormalities receiving level 2 care as above Examples are patients who were recently level 3 or 3T but are not well enough to be classed as level 1 or 0. Respiratory rate >40 breaths/min or >30 breaths/min for >6 hours Heart rate >120 beats/min Temperature <35 0 C for >1 hour Systolic BP <80 mmhg for >1 hour Glasgow Coma Scale (GCS) <10 and at risk of deterioration Delayed discharges from critical care where the patient is now classed as level 1. 5

6 (See Appendix 1 for description of basic, advanced respiratory and cardiovascular etc ) Level 1 Criteria Examples Include Exclude Recently discharged from Examples are patients who were recently level 2 All ITU/HDU discharges higher level of care but are not well enough to be classed as level 0. (unless classed level 2) Critical care outreach service required Additional monitoring, clinical input or advice required Care from specialist staff / requiring additional facilities for one or more aspects of critical care on ward Abnormal vital signs but not requiring a higher level of care Examples may include patients requiring: >level 0 care Observations at least 4 hourly Physiotherapy or suctioning at least 6 hourly, but not more than 2 hourly (see level 2) Examples may include patients requiring: Renal replacement therapy (stable chronic renal failure) Epidural analgesia Tracheostomy care Patients requiring specialing Level 0 Criteria Examples Include Exclude Receiving normal ward care Examples may include patients requiring: Oral medication Bolus IV medication Patient controlled analgesia (PCA) Observations less frequently than 4 hourly Additional Notes: Tracheosotomies per se do not contribute to levels of care. 1. If patients are intubated solely for airway protection then this triggers basic respiratory only. It will generally also trigger neurological as many of these patients will also have decreased level of consciousness due to brain dysfunction. See example in level 3 2. If patient are on 50% or less oxygen this does not trigger either advanced or basic respiratory care i.e. patients have to be on 51% or more. 3. Most patients will have their invasive monitoring in situ until just prior to leaving the unit, for patient comfort and our convenience. CVC or IA lines should only contribute to CVS level of care if you would replace or insert the line if it was not in situ at this point in time, and it would be beneficial to patient monitoring. 4. To trigger advanced CVS level of care then a patient must be on more than one inotropes or more than one rhythm control drugs. Being of one of each only triggers basic CVS. 6

7 Appendix One (Reference CCMDS DSCN (2006) 14 pgs 15-17) 1. Basic Respiratory Support More than 50% oxygen delivered by face mask. Close observation due to the potential for acute deterioration to the point of needing advanced respiratory (e.g. severely compromised airway or deteriorating respiratory muscle function). Physiotherapy or suction to clear secretions at least two hourly, whether via tracheostomy, minitracheostomy, or in the absence of an artificial airway. Patients recently extubated after a prolonged period of intubation and mechanical ventilation, via an endotracheal tube for more than 24 hours. Mask continuous positive airway pressure CPAP or non-invasive ventilation. Patients who are intubated to protect the airway but needing no ventilatory and who are otherwise stable. 2. Advanced Respiratory Support Indicated by: Invasive mechanical ventilatory (excluding mask / hood continuous positive airway pressure (CPAP) or mask pressure ventilation (BiPAP) or CPAP applied via a tracheal tube). Summary algorithm that explains the differences between basic (BRS) and advanced respiratory (ARS). INTUBATION? Trans-laryngeal Ventilation BiPAP or CPAP No ventilation ARS BRS Tracheostomy Ventilation ARS BiPAP No ventilation, long term airway access only CPAP BRS No ARS or BRS 3. Basic Cardiovascular Support Treatment of circulatory instability due to hypovolaemia from any cause. Use of a central venous pressure CVP line for basic monitoring of central venous pressure and / or the provision of central venous access to deliver titrated fluids to treat hypovolaemia. Use of an arterial line for basic monitoring of arterial pressure or sampling of arterial blood. Single intravenous vasoactive drug used to arterial pressure, cardiac output or organ perfusion. Intravenous drugs to control cardiac arrhythmias. Non-invasive measurement of cardiac output (e.g. echocardiography, thoracic impedance). 4. Advanced Cardiovascular Support 7

8 Multiple intravenous vasoactive and/or rhythm controlling drugs. When used simultaneously to or control arterial pressure, cardiac output or organ perfusion (e.g. inotropes, amiodarone, nitrates) Patients resuscitated after cardiac arrest where critical care is considered clinically appropriate. Observation of cardiac output and derived indices (e.g. pulmonary artery catheter, lithium dilution, pulse contour analyses, oesophageal doppler). Intra aortic balloon pumping and other assist devices. Insertion of a temporary cardiac pacemaker (criteria valid for each day of connection to a functioning external pacemaker unit). Placement of a gastrointestinal tonometer. 5. Renal Support Indicated by: Acute renal replacement therapy (e.g. haemodialysis, haemofiltration etc.) or the provision of renal replacement therapy to a chronic renal failure patient who is requiring other acute organ in a critical care situation. 6. Neurological Support Central nervous system depression sufficient to prejudice the airway and protective reflexes, excepting that caused by sedation prescribed to facilitate mechanical ventilation or poisoning (e.g. self administered overdose, alcohol, drugs etc). Invasive neurological monitoring e.g. Intracranial pressure ICP, jugular bulb sampling. external ventricular drain. Severely agitated or epileptic patients requiring constant nursing attention and/or heavy sedation. Continuous intravenous medication to control seizure and/or continuous cerebral monitoring. Therapeutic hypothermia using cooling protocols or devices. 7. Gastrotintestinal Support Indicated by: Feeding with parenteral or enteral nutrition. 8. Dermatological Support Patients with major skin rashes, exfoliation or burns (e.g. greater than 30% body surface area affected). Use of multiple trauma dressings (e.g. multiple limb or limb and head dressings). Use of complex dressings (e.g. large skin area greater than 30% body surface area, open abdomen, vacuum dressings or large trauma such as multiple limb or limb and head dressings). 9. Liver Support Indicated by: Extracorporeal liver replacement device bioartificial liver or charcoal haemoperfusion. Acknowledgments Much of this document is based on the Intensive Care Society Levels of Care for adult patients standards and guidelines (2002) and work from the Critical Care team in Ysbyty Gwynedd ICU. 8

Levels of Critical Care for Adult Patients

Levels of Critical Care for Adult Patients LEVELS OF CARE 1 Levels of Critical Care for Adult Patients STANDARDS AND GUIDELINES LEVELS OF CARE 2 Intensive Care Society 2009 All rights reserved. No reproduction, copy or transmission of this publication

More information

Board of Directors. 28 January 2015

Board of Directors. 28 January 2015 Executive Summary Purpose: Board of Directors 28 January 2015 Briefing on the requirements for the Trust to comply with Hard Truths Commitments Regarding the Publishing of Staffing Data Director of Nursing

More information

KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE (GEN. ORG.) NURSING AFFAIRS. Scope of Service PEDIATRIC INTENSIVE CARE UNIT (PICU)

KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE (GEN. ORG.) NURSING AFFAIRS. Scope of Service PEDIATRIC INTENSIVE CARE UNIT (PICU) PICU-Jan.2012 Page 1 of 7 Number of Beds: 18 Nurse Patient Ratio: 1:1-2 : The Pediatric Intensive Care Unit (PICU) provides 24 hour intensive nursing care for patients aged neonate through adolescence.

More information

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY créée sous le Patronage de l'union Européenne Detailed plan of the program of six courses 1. RESPIRATORY 1. ESPIRATORY AND THORAX 1.1 Physics and principles of measurement 1.1.1 Physical laws 1.1.2 Vaporizers

More information

APPENDIX B SAMPLE PEDIATRIC CRITICAL CARE NURSE PRACTITIONER GOALS AND OBJECTIVES

APPENDIX B SAMPLE PEDIATRIC CRITICAL CARE NURSE PRACTITIONER GOALS AND OBJECTIVES APPENDIX B SAMPLE PEDIATRIC CRITICAL CARE NURSE PRACTITIONER GOALS AND OBJECTIVES The critical care nurse practitioner orientation is an individualized process based on one s previous experiences and should

More information

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out

More information

U of C Critical Care Bedside Competencies Map

U of C Critical Care Bedside Competencies Map no experience rudimentary understanding and little practical experience reasonable, but incomplete practical experience no further educational need for an independent competent execution of this medical

More information

College of Applied Medical Sciences\ Department of Nursing

College of Applied Medical Sciences\ Department of Nursing 2 nd Edition 2014/2015 College of Applied Medical Sciences\ Department of Nursing CAMS/ Department of Nursing/ Internship Training Logbook 2 nd Edition 1 INTERNSHIP TRAINING LOGBOOK Nurse Intern Name:

More information

BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 info@bpsweb.org www.bpsweb.

BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 info@bpsweb.org www.bpsweb. BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC 20037-2985 202-429-7591 FAX 202-429-6304 info@bpsweb.org www.bpsweb.org Content Outline for the CRITICAL PHARMACY SPECIALTY CERTIFICATION

More information

HLTEN609B Practise in the respiratory nursing environment

HLTEN609B Practise in the respiratory nursing environment HLTEN609B Practise in the respiratory nursing environment Release: 1 HLTEN609B Practise in the respiratory nursing environment Modification History Not Applicable Unit Descriptor Descriptor This unit addresses

More information

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response. Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational

More information

PARAMEDIC TRAINING CLINICAL OBJECTIVES

PARAMEDIC TRAINING CLINICAL OBJECTIVES Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members

More information

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012.

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012. PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing

More information

Oxygen - update April 2009 OXG

Oxygen - update April 2009 OXG PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4

Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4 1 Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4 Unit 1 - COURSE This unit will present the instructional syllabus and define the Student Learning Outcomes (SLO) for

More information

Program Specification for Master Degree Anesthesia, ICU and Pain Management

Program Specification for Master Degree Anesthesia, ICU and Pain Management Cairo University Faculty of Medicine Program type: Single Program Specification for Master Degree Anesthesia, ICU and Pain Management Department offering program: Anesthesia, intensive care and pain management

More information

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel Specific tasks in this document shall refer to the Virginia Education Standards. AIRWAY TECHNIQUES Airway Adjuncts Airway Maneuvers Alternate Airway Devices Cricothyrotomy Obstructed Airway Clearance Intubation

More information

Resuscitation and preparation for anaesthesia and surgery

Resuscitation and preparation for anaesthesia and surgery 13 Resuscitation and preparation for anaesthesia and surgery Key Points 13.1 MANAGEMENT OF EMERGENCIES AND CARDIOPULMONARY RESUSCITATION ESSENTIAL HEALTH TECHNOLOGIES The emergency measures that are familiar

More information

Nursing Education and Research

Nursing Education and Research Melissa Meloche Meloche, RN RN, MSN MSN, CCRN Nursing Education and Research Describe the purpose p of common clinical equipment found in the Intensive Care Unit and how this equipment could impact a patient

More information

Emergency Medical Services Advanced Level Competency Checklist

Emergency Medical Services Advanced Level Competency Checklist Emergency Services Advanced Level Competency Checklist EMS Service: Current License in State of Nebraska: # (Copy of license kept in file at station) Date of joining EMS Service: EMS Service Member Name:

More information

Corporate Medical Policy

Corporate Medical Policy File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main

More information

Non-invasive Ventilation (NIV)

Non-invasive Ventilation (NIV) Non-invasive Ventilation (NIV) (Risk Associated: Misuse & overuse) Dr.Wagih Ouda ICU Consultant Coordinator HMG Al Qassim Hospital Kingdom of Saudi arabia Objectives Introduction. Goals of NIV. Advantages

More information

TRANSPORT OF CRITICALLY ILL PATIENTS

TRANSPORT OF CRITICALLY ILL PATIENTS TRANSPORT OF CRITICALLY ILL PATIENTS Introduction Inter-hospital and intra-hospital transport of critically ill patients places the patient at risk of adverse events and increased morbidity and mortality.

More information

Human Capital Development & Education Program Proposal

Human Capital Development & Education Program Proposal Human Capital Development & Education Program Proposal Cardiology & Cardiovascular Surgery Emergency Medicine Respiratory Medicine Infection Control HMIS 1 (15 Courses) Module 1/2 1/15 Course Title : Management

More information

ALS INTERFACILITY TRANSFERS. SUPERSEDES: January 8, 2009

ALS INTERFACILITY TRANSFERS. SUPERSEDES: January 8, 2009 EFFECTIVE: September 8, 2010 AUTHORIZATION: AR PAGE: 1 of 7 *This Administrative Requirement may be effectuated by an ambulance service only upon appropriate training of its EMS personnel.* Minimum Standards

More information

Appendix. Costing Case Samples for OOHCA

Appendix. Costing Case Samples for OOHCA Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF

More information

Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest - Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble Survival from cardiorespiratory arrest for patients who present with ventricular fibrillation

More information

Overall Goals/Objectives - Surgical Critical Care Residency Program The goal of the Pediatric Surgical Critical Care Residency program is to provide

Overall Goals/Objectives - Surgical Critical Care Residency Program The goal of the Pediatric Surgical Critical Care Residency program is to provide Overall Goals/Objectives - Surgical Critical Care Residency Program The goal of the Pediatric Surgical Critical Care Residency program is to provide advanced proficiency in the care and management of critically

More information

Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit.

Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit. University of Kentucky / UK HealthCare Policy and Procedure Policy # CH02-02 Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit.

More information

V: Infusion Therapy. College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181

V: Infusion Therapy. College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181 V: Infusion Therapy College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181 Competency: V-1 Principles of V-1-1 V-1-2 V-1-3 V-1-4 V-1-5 Demonstrate knowledge and ability

More information

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the

More information

Thrombolysis from a nursing perspective. Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust

Thrombolysis from a nursing perspective. Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust Thrombolysis from a nursing perspective Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust First hour managing the infusion First 24 hours: Observations Complication identification

More information

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY ANESTHESIA BILLING: MUST BE DOCUMENTED AS: Personally performed: you perform the case without a resident or a CRNA

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

Recommendations: Other Supportive Therapy of Severe Sepsis*

Recommendations: Other Supportive Therapy of Severe Sepsis* Recommendations: Other Supportive Therapy of Severe Sepsis* K. Blood Product Administration 1. Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial

More information

CARDIAC NURSING. Graduate Diploma in Nursing Science. Overview. Entry Requirements. Fees. Contact. Teaching Methods.

CARDIAC NURSING. Graduate Diploma in Nursing Science. Overview. Entry Requirements. Fees. Contact. Teaching Methods. Graduate Diploma in Nursing Science CARDIAC NURSING Overview The Graduate Diploma in Nursing Science (Cardiac Nursing) is designed to develop advanced theoretical knowledge and specialist skills essential

More information

CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT

CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT The 'DR ABCDE' approach to assessing an acutely unwell patient should be at the front of every junior doctor's mind whenever they get bleeped or asked to see

More information

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social

More information

Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz

Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz The mechanically ventilated patient presents many challenges for the intensive

More information

Emergency Fluid Therapy in Companion Animals

Emergency Fluid Therapy in Companion Animals Emergency Fluid Therapy in Companion Animals Paul Pitney BVSc paul.pitney@tafensw.edu.au The administration of appropriate types and quantities of intravenous fluids is the cornerstone of emergency therapy

More information

Guidelines for the Management of Severe Traumatic Brain Injury Patients:

Guidelines for the Management of Severe Traumatic Brain Injury Patients: Guidelines for the Management of Severe Traumatic Brain Injury Patients: ICP Monitor Group 1. Required patient monitoring measures a. Place ICP monitor i. If the initial placement of the ICP monitor is

More information

Medical/Surgical Nursing Core Competency Individual Assessment

Medical/Surgical Nursing Core Competency Individual Assessment Name: Orientation Start Date: Completion Date: Instructions: Pre--the nurse will rate each knowledge, skill, or ability (KSA) from 1 (novice) to 5 (expert) in each box. Following orientation or training,

More information

Non Invasive Ventilation

Non Invasive Ventilation Non Invasive Ventilation Linda Grady Clinical Nurse Specialist 2010 Non-Invasive Ventilation (NIV) Technique that provides and enhances alveolar ventilation without the use of an endotracheal intubation

More information

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting

More information

AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 RECOMMENDATIONS FOR THE POST-ANAESTHESIA RECOVERY ROOM

AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 RECOMMENDATIONS FOR THE POST-ANAESTHESIA RECOVERY ROOM Review PS4 (2006) AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 RECOMMENDATIONS FOR THE POST-ANAESTHESIA RECOVERY ROOM 1. INTRODUCTION A well-planned, well-equipped, well-staffed

More information

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection L14: Hospital acquired infection, nosocomial infection Definition A hospital acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after

More information

MEDICAL INTENSIVE CARE UNIT - HEALTH SCIENCES CENTRE Reviewed August 2011

MEDICAL INTENSIVE CARE UNIT - HEALTH SCIENCES CENTRE Reviewed August 2011 MEDICAL INTENSIVE CARE UNIT - HEALTH SCIENCES CENTRE Reviewed August 2011 Goal The rotation in the Medical Intensive Care Unit at HSC is designed to allow the resident to encounter patients with tertiary

More information

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure.

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure. Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left

More information

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble In contrast to cardiac arrest in adults, cardiopulmonary arrest in pediatric

More information

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE UNIT: INTENSIVE CARE UNIT - ICU SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE STANDARD #: EFFECTIVE DATE: REVISED DATE: STANDARD TYPE: INTENSIVE CARE UNIT-ICU STANDARD I - SAFETY 3/88

More information

Heart Center Packages

Heart Center Packages Heart Center Packages For more information and appointments, Please contact The Heart Center of Excellence at the American Hospital Dubai Tel: +971-4-377-6571 Email: heartcenter@ahdubai.com www.ahdubai.com

More information

TABLE 2 ASA Physical Status Classification

TABLE 2 ASA Physical Status Classification TABLE 2 ASA Physical Status Classification ASA Class I II III IV V Description A normal, healthy patient, without organic, physiologic, or psychiatric disturbances A patient with controlled medical conditions

More information

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC CPR Chest compressions, Airway, Breathing (C-A-B) BLS Changes New Old Rationale New science indicates the following order:

More information

Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.

Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies. Overview Estimated scenario time: 10 15 minutes Estimated debriefing time: 10 minutes Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.

More information

Goals and Objectives for the General Surgery Rotation Resident PGY1 Hamilton Health Sciences or St. Joseph Healthcare (2 four-week rotational blocks)

Goals and Objectives for the General Surgery Rotation Resident PGY1 Hamilton Health Sciences or St. Joseph Healthcare (2 four-week rotational blocks) Goals and Objectives for the General Surgery Rotation Resident PGY1 Hamilton Health Sciences or St. Joseph Healthcare (2 four-week rotational blocks) Overview During the first year of their residency training

More information

Postoperative management in adults

Postoperative management in adults Scottish Intercollegiate Guidelines Net work 77 Postoperative management in adults A practical guide to postoperative care for clinical staff 1 Introduction 1 2 Clinical assessment and monitoring 3 3 Cardiovascular

More information

Protocols for Early Extubation After Cardiothoracic Surgery

Protocols for Early Extubation After Cardiothoracic Surgery Protocols for Early Extubation After Cardiothoracic Surgery AATS / STS CT Critical Care Symposium April 27, 2014 Toronto, Ontario Nevin M. Katz, M.D. Johns Hopkins University Foundation for the Advancement

More information

Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new?

Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new? Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new? DVM, DACVA Objective: Update on the new Small animal guidelines for CPR and a discussion of the 2012 Reassessment Campaign on

More information

Guidelines for Transport of the Critically Ill

Guidelines for Transport of the Critically Ill Page 1 of 16 Guidelines for Transport of the Critically Ill Version Effective Date 1 May 1994 2 Feb 2002 3 Apr 2014 Document Number Prepared by College Guidelines Committee Endorsed by HKCA Council Next

More information

1.4.4 Oxyhemoglobin desaturation

1.4.4 Oxyhemoglobin desaturation Critical Care Therapy and Respiratory Care Section Category: Clinical Section: Clinical Monitoring Title: Monitoring of Patients Undergoing Conscious Sedation Policy #: 09 Revised: 05/00 1.0 DESCRIPTION

More information

Mississippi Board of Nursing

Mississippi Board of Nursing Mississippi Board of Nursing Regulating Nursing Practice www.msbn.state.ms.us 713 Pear Orchard Road, Suite 300 Ridgeland, MS 39157 Administration and Management of Intravenous (IV) Moderate Sedation POSITION

More information

Patient Care Technician (Bridge Program)

Patient Care Technician (Bridge Program) Patient Care Technician (Bridge Program) Introduction: At Prestige Medical Solutions we are fully vested in helping students succeed. Our vision is to be a great place to learn, where people are inspired

More information

Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*

Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing* Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon

More information

Central Venous Pressure and Central lines. Big Lines for Big Problems

Central Venous Pressure and Central lines. Big Lines for Big Problems Central Venous Pressure and Central lines Big Lines for Big Problems Challenging Knowledge Before starting this module; Answer the following questions (1) What sites are used to site a CVL? (2) What is

More information

Schedule 3. Services Schedule. Respiratory Therapy

Schedule 3. Services Schedule. Respiratory Therapy Respiratory Therapy Services Schedule 20122014 Consolidated Services Version Template Final Version September, 20122014 Schedule 3 Services Schedule Respiratory Therapy Respiratory Therapy Services Schedule

More information

LPN / LVN SKILL CHECKLIST

LPN / LVN SKILL CHECKLIST LPN / LVN SKILL CHECKLIST Name: When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your

More information

Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used

Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used appropriately Can cause harm if used inappropriately Main indication

More information

THERAPEUTIC INDUCED HYPOTHERMIA GUIDELINES

THERAPEUTIC INDUCED HYPOTHERMIA GUIDELINES THERAPEUTIC INDUCED HYPOTHERMIA GUIDELINES Guidelines for Inclusion: (check all that apply) Cardiac arrest patients with any of the following: Ventricular fibrillation Pulseless Ventricular tachycardia

More information

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice P.O. BOX 2129 Raleigh, NC 27602 (919) 782-3211 FAX (919) 781-9461 Nurse Aide II Registry (919) 782-7499 www.ncbon.com Issue: Administration

More information

LIFEFLIGHT OF MAINE GUIDELINES FOR HELICOPTER TRANSPORT

LIFEFLIGHT OF MAINE GUIDELINES FOR HELICOPTER TRANSPORT LIFEFLIGHT OF MAINE GUIDELINES FOR HELICOPTER TRANSPORT I. GENERAL GUIDELINES Many patients who require transport to centers with specialized or tertiary level resources are appropriate for transport by

More information

HELPING US TO HELP YOU

HELPING US TO HELP YOU HELPING US TO HELP YOU Page 1 of 8 The Royal Surrey County Hospital Patient Transport Services Does Your Patient Require Patient Transport? Hospital-Funded Patient Transport can only be provided to patients

More information

ACLS PHARMACOLOGY 2011 Guidelines

ACLS PHARMACOLOGY 2011 Guidelines ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.

More information

V: Infusion Therapy. Alberta Licensed Practical Nurses Competency Profile 217

V: Infusion Therapy. Alberta Licensed Practical Nurses Competency Profile 217 V: Infusion Therapy Alberta Licensed Practical Nurses Competency Profile 217 Competency: V-1 Knowledge of Intravenous Therapy V-1-1 V-1-2 V-1-3 V-1-4 V-1-5 Demonstrate knowledge and ability to apply critical

More information

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No. M07 Medications 2015-07-15 All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam

More information

Preoperative Laboratory and Diagnostic Studies

Preoperative Laboratory and Diagnostic Studies Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no

More information

The Complete list of NANDA Nursing Diagnosis for 2012-2014, with 16 new diagnoses. Below is the list of the 16 new NANDA Nursing Diagnoses

The Complete list of NANDA Nursing Diagnosis for 2012-2014, with 16 new diagnoses. Below is the list of the 16 new NANDA Nursing Diagnoses The Complete list of NANDA Nursing Diagnosis for 2012-2014, with 16 new diagnoses. Below is the list of the 16 new NANDA Nursing Diagnoses 1. Risk for Ineffective Activity Planning 2. Risk for Adverse

More information

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

Scope and Standards for Nurse Anesthesia Practice

Scope and Standards for Nurse Anesthesia Practice Scope and Standards for Nurse Anesthesia Practice Copyright 2013 222 South Prospect Ave. Park Ridge, IL 60068 www.aana.com Scope and Standards for Nurse Anesthesia Practice The AANA Scope and Standards

More information

CLINICAL PRIVILEGES- NURSE ANESTHETIST

CLINICAL PRIVILEGES- NURSE ANESTHETIST Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 8/5/2015. Applicant: Check off the Requested box for

More information

Both clinical condition and treatment criteria must be met to qualify for critical care coding.

Both clinical condition and treatment criteria must be met to qualify for critical care coding. Yale Compliance Department CRITICAL CARE FACT SHEET 99291 - Critical care, evaluation and management; first 30-74 minutes + 99292 - Critical care, evaluation and management, each additional 30 minutes

More information

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,

More information

First Responder (FR) and Emergency Medical Responder (EMR) Progress Log

First Responder (FR) and Emergency Medical Responder (EMR) Progress Log First Responder (FR) and Emergency Medical Responder (EMR) Progress Log Note: Those competencies that are for EMR only are denoted by boldface type. For further details on the National Occupational Competencies

More information

!!! BOLUS DOSE IV. Use 5-10 mcg IV boluses STD ADRENALINE INFUSION. Use IM adrenaline in advance of IV dosing!

!!! BOLUS DOSE IV. Use 5-10 mcg IV boluses STD ADRENALINE INFUSION. Use IM adrenaline in advance of IV dosing! ADRENALINE IVI BOLUS IV Open a vial of 1:1000 ADRENALINE 1 mg /ml Add 1 ml to 9 ml N/Saline = 1mg adrenaline in 10 ml (or 100 mcg/ml) Add 1 ml 1:10,000 to 9 ml N/Saline = 100 mcg adrenaline in 10 ml (or

More information

Official Online ACLS Exam

Official Online ACLS Exam \ Official Online ACLS Exam Please fill out this form before you take the exam. Name : Email : Phone : 1. Hypovolemia initially produces which arrhythmia? A. PEA B. Sinus tachycardia C. Symptomatic bradyarrhythmia

More information

Respiratory Care. A Life and Breath Career for You!

Respiratory Care. A Life and Breath Career for You! Respiratory Care A Life and Breath Career for You! Respiratory Care Makes a Difference At 9:32 am, Lori Moreno brought a newborn baby struggling to breathe back to life What have you accomplished today?

More information

GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS

GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

Quality and Safety Programme Inter-hospital transfers - adults

Quality and Safety Programme Inter-hospital transfers - adults Quality and Safety Programme Inter-hospital transfers - adults London quality standards October 2014 Introduction A lack of robust inter-hospital transfer and acceptance standards is a current issue for

More information

Rehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary

Rehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Rehabilitation within critical care By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Contents Negative effects of Critical illness/ prolonged ventilation Evidence

More information

Degree of Intervention

Degree of Intervention Inglewood Care Centre Degree of Intervention Handbook for Residents and Families Index Introduction..................................................... 2 Beliefs, Values, and Wishes.........................................

More information

NAME OF HOSPITAL LOCATION DATE

NAME OF HOSPITAL LOCATION DATE MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES BUREAU OF EMERGENCY MEDICAL SERVICES TRAUMA CENTER SITE REVIEW CRITERIA CHECK SHEET LEVEL I 19CSR 30-40.430 NAME OF HOSPITAL LOCATION DATE (1) GENERAL

More information

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false.

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false. PHSW Procedural Sedation Post-Test Answer Key 1 1. Define Procedural (Conscious) Sedation: A medically controlled state of depressed consciousness where the patient retains the ability to continuously

More information

Overview. Geriatric Overview. Chapter 26. Geriatrics 9/11/2012

Overview. Geriatric Overview. Chapter 26. Geriatrics 9/11/2012 Chapter 26 Geriatrics Slide 1 Overview Trauma Common Medical Emergencies Special Considerations in the Elderly Medication Considerations Abuse and Neglect Expanding the Role of EMS Slide 2 Geriatric Overview

More information

CPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009.

CPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. CPT Pediatric Coding Updates 2009 The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. NEW CODES Evaluation and Management Services Normal Newborn Care Codes 99431-99440

More information

ANESTHESIA - Medicare

ANESTHESIA - Medicare ANESTHESIA - Medicare Policy Number: UM14P0008A2 Effective Date: August 19, 2014 Last Reviewed: January 1, 2016 PAYMENT POLICY HISTORY Version DATE ACTION / DESCRIPTION Version 2 January 1, 2016 Under

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

Bradycardia (Unstable) Protocol revised October 2008

Bradycardia (Unstable) Protocol revised October 2008 Bradycardia (Unstable) Protocol revised October 2008 Preamble Occasionally, patients experiencing an acute cardiac event present with bradycardia that is hemodynamically unstable. Under these circumstances,

More information

National Registry of Emergency Medical Technicians Emergency Medical Responder Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT TRAUMA

National Registry of Emergency Medical Technicians Emergency Medical Responder Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT TRAUMA PATIENT ASSESSMENT/MANAGEMENT TRAUMA Scenario # Note: Areas denoted by ** may be integrated within sequence of Primary Survey/Resuscitation SCENE SIZE-UP Determines the mechanism of injury/nature of illness

More information