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Archive for the ‘Critical Care’ Category

Massive Transfusion

As promised, see the attached Massive Transfusion Protocol Final.

Some important points are highlighted. The guideline for when a patient might need the MTP is:
· one blood volume transfusion over 24 hours,

· 50% blood volume in 3 hours

· ongoing blood loss >150 ml/min

· expected >10 pRBC units in 24 hours

Most of all, please remember, there are TWO ways to get emergent blood and they are both done by a PHONE CALL to the blood bank:
· Emergent release of blood

o This could be o-neg or type specific uncrossed blood.

o Be aware you might get O-pos blood for men and women over child-bearing years.

o Use this for unstable bleeding patients who need blood ASAP, but don’t meet the above MTP criteria

· Massive Transfusion

o Use this for patients meeting the above criteria.

o The blood bank will put an order into Epic saying which products were sent.

Pleased send a reply to me indicating that you have read and understand the policy.

Peter Shearer, MD FACEP

Written by phil

March 17th, 2014 at 3:11 pm

Team 7000

Areas Covered:

MC level- all areas (except B1 dialysis)

1st floor-
-all lobbies, hallways
-Guggenheim (cafeteria, etc)
-Klingenstein Pavilion
-1184 5th Ave
-Atran Building

*one common thing that comes up is the 2nd floor and above for KCC, it usually says clinical center which sounds like it is outpatient, but if its above the 1st floor it isn’t us.

911 and ED respond in concert to:

19 E. 98th St
5 E. 98th St
Primary Care Building
Basic Sciences Building
1425 Madison (Icahn or East Building)

Hope this helps!

Natasha Desai

Written by phil

December 27th, 2012 at 10:49 pm

Posted in Critical Care

EHC Cardiac Room Presentations

Reminder to attendings/residents in Critical Care area:

When cases are presented to you from triage

1) Cardiac Room (CR) attending must see/examine patient if the patient is to be sent to the team
2) CR attending signs the EKG (if one is available) before “refusing patient”
3) RN represents patient to the Team (A/B) attending
4) A/B attending ALSO signs the EKG (when one is available) before scanning into HMED
5) A/B attending personally speaks to the CR attending if there is a disagreement about where is safest for patient to be evaluated.

PGY-4 (Pre-attendings) residents:

1)Cardiac room resident can accept patient but cannot be the only one to refuse them.
2) Team senior resident can evaluate these patients and, if the resident has a concern, discuss the case with the team attending.
3) The team attending discusses the case with the CR attending when there is a disagreement.

Phil (Fairweather)

Written by phil

December 26th, 2012 at 5:23 pm

Central Line Policy

Written by phil

November 29th, 2012 at 7:50 pm

Setting up NIV / BiPAP / CPAP

1. Notify RESPIRATORY THERAPIST that there will be a patient on NIV.
2. Turn Ventilator On.
3. Select NEW PATIENT.
4. Enter patient’s Ideal Body Weight (IBW) and press CONTINUE.
5. Select VENT TYPE button, turn knob to select NIV.
6. Select MODE button, turn knob to select SIMV.
7. Select MANDATORY type, turn knob to Pressure Control (PC).
8. Select SPONTANEOUS type, turn knob to Pressure Support (PS). Press CONTINUE.
9. For IPAP 10 / EPAP 5, adjust Psupp button to 5, adjust PEEP button to 5. O2% as indicated.
10. Press ACCEPT to apply settings. Airflow will not begin until mask is attached to patient.

Here is the poster in in powerpoint format.

Written by reuben

February 18th, 2012 at 1:03 am