Medical Directives
In the Adult Hypoglycemia MD, you should provide the patient with a snack/meal including 15 gms of Carbs and a protein source, once the glucose level has reached this target?
What is >4mmol
This is how often Vitals Signs must be recorded on a stable patient in ED.
What is at least every 4 hours.
Certified Nurses in ED and Critical Care can defibrillate these 2 Cardiac Rhythms without a Doctor present.
What is Vfib and Pulseless Vtach?
A difference of >20mmHg in Rt and Left side BP and chest pain described as sudden ripping, tearing may be indicative of this medical emergency.
What is Aortic Dissection?
Disseminated Shingles requires this level of IPAC precautions
What are Airborne precautions
ED Medical Directive containing a CXR
What is None
Name 3 Discharge criteria included in NH Discharge score after procedural sedation.
What are a NH Discharge Criteria Score of greater than or equal to 9 AND
has returned to the pre-procedure baseline status regarding: i) Vital signs within 5-10% of baseline, unchanged cardiac rhythm unless change in rhythm was anticipated outcome of procedure (i.e. Cardioversion) and airway patent; ii) level of consciousness/responsiveness iii) communication status iv) movement/ambulation v) Meets pre procedure level of pain vi) ability to tolerate fluid if appropriate with minimal to no nausea and vomiting vii) Oxygen and intravenous therapy (if indicated) will be discontinued as ordered unless otherwise required by the patient.
When a patient sustains an injury as a result of a crime, evidence must be collected in this type of container.
What is a paper bag?
This electrolyte is frequently affected in chronic alcohol abusers and can result in a life-threatening cardiac rhythm know as "Torsades de Pointes"
What is Magnesium?
SADV Patient presents to non SCS and is medically cleared- This is how we determine where to send the patient.
What is Contact Niagara Health SADV through switchboard
determine if we have someone on call, or need to send out
ED medical Directives that may not be initiated by RPN.
What are ED Sepsis and ED Overdose
This must be documented on patients with a suspected or confirmed head injury, neurological deficit, and/or an identified change in level of consciousness.
What is GCS
upon arrival, then every 15 minutes for 1 hour, every 30 minutes for 1 hour, and then hourly until otherwise ordered.
MD order for Activated Charcoal 50gms PO for polypharmacy overdose. Time of ingestion unknown. Patient currently GCS 8 BP 100/70, HR 104, RR 12 SpO2 93%. This should be the priority action for this patient.
Airway Management/ Intubation
Patient presents with low back pain, urinary retention and saddle numbness after a hard landing while tobogganing. This patient likely has this medical emergency.
What is Cauda Equina Syndrome
Disciplines who are responsible to give results to a patient over the phone.
What is MD/NP/PA only?
Patient with a Temp 35.7, HR 95, New GCS 14 and a Hx of Indwelling Foley Catheter is eligible for which ED Medical Directive?
What is ED Sepsis MD
Required documentation on discharge- List 3 (of 10)
What is
Time of discharge, patient condition, interventions prior to discharge, vital signs within 2 hours, i/o summary, education provided, instructions for follow-up or referrals, Mode of transportation, full signature and designation, NOK or POA notified
A Pleurex catheter can be accessed by which clinical unit or staff member
What is any RN/RPN in ED or any clinical unit who has the knowledge, skill and ability.
This medication is relatively contraindicated to treat a known right ventricular infarct.
What is nitroglycerin?
The patient has brown coke-like urine, muscular pain and an elevated creatine kinase level
What is rhabdomyolysis?
A 2 month old infant presenting to ED with feeding difficulties and reported as 'sleeping more than normal' is eligible for this ED medical Directive.
What is POC Capillary Blood Glucose MD
Admitted patients in ED must have the following 3 things completed within 12 hours of admission.
What are
MRO swabs, Falls Risk assessment, Braden scale
Current patient requirement for Detox referral.
What is 3 consecutive CIWA score under 10?