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Archive for the ‘Surgery’ Category

These guidelines are to be used in determining the most appropriate service to which a patient shall be admitted. Clinical circumstances may, on occasion, require the responsible ED attending to make an admission decision that overrides these guidelines.

Patients with the following primary diagnoses are to be admitted to the Surgery Service.

• Lower GI Bleeds
• Pancreatitis with gallstones or if the patient requires an lCU admission.
• Diverticulitis (with or without abscess)
• Appendicitis
• Bowel obstruction (large or small bowel)
• Bowel perforation.
• Cholecystitis
• Cholangitits / choledocholithiasis
• Liver abscess
• Post-operative complication (including DVT) within 30 days of surgery goes to service that operated on the patient.
• Animal bites (except to upper extremity distal to elbow, which goes to service covering hand)
• Frostbite / burns (except to upper extremity distal to elbow, which goes to service covering hand)
• Acutely Incarcerated Hernia
• Spontaneous primary pneumothorax. (This excludes those patients with
underlying pulmonary disease as the probable cause ofthe pneumothorax, such as
COPD, TB, PCP or other HIV-related disease)
• Perirectal abscess
• Cellulitis to be admitted on an alternating basis with medicine (except for upper
extremity cellulitis distal to the elbow, which gets admitted to the service covering hand)

Admissions Criteria Regarding Trauma Patients

Patients with traumatic injury requiring admission are to be admitted as follows: Red Trauma: Surgery (Trauma Service).*
Traumas other than Red Traumas (Yellow Traumas and non-activated traumas)
• More than one organ system injury: Trauma Service.
• Syncope with significant trauma**: Trauma Service.
• Syncope with isolated intracranial bleed**: Neurosurgery Service or Trauma
• Isolated facial trauma not requiring ICU: Service covering facial trauma.
• Isolated genitourinary trauma: Trauma Service
• Isolated upper extremity fracture: Orthopedic Service (Social goes to Medicine)
• Isolated lower extremity fracture: Orthopedic Service.
• Pelvic Fracture: Hemodynamically unstable and / or accompanied by significant
blood loss: Trauma Service. Otherwise, Orthopedic Service.
• Altered mental status (or post-concussive syndrome) after mechanism of trauma except for syncope (i.e. pedestrian struck, assault, motor vehicle crash): Trauma
service, even if trauma work up is negative.
• Rib fractures: Trauma Service
• Isolated vertebral fractures after trauma: Service covering spine.
* These patients may be discharged ONLY IF the ED attending agrees and the senior surgical resident and / or surgical attending writes a progress note that can be scanned into HMED to document this decision. They should not be downgraded to Yellow Trauma prior to discharge.
** Syncope patients with a traumatic injury should only be admitted to Medicine if they are suspected to be at risk of serious cardiac dysrhythmia or cardiac ischemia as determined the ED attending.

Trauma and General Surgey Admission Guidelines

Written by reuben

April 3rd, 2012 at 6:11 pm

Posted in Elmhurst,Surgery

when to consult surgery for c. diff diarrhea

Written by reuben

September 23rd, 2011 at 5:09 pm

Posted in Surgery