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Sunshine ED Fast Track

  • ensure YOU check EVERY patient's ID wrist band and comply with patient identification processes
  • ensure you order investigations for the correct patient
  • ensure YOU comply with hand hygiene
  • don't forget to check pregnancy status BEFORE ordering x-rays or medications which may not be appropriate in pregnancy
  • indications for serum HCG in Fast Track:
    • females of child bearing age who have not had a hysterectomy or USS evidence of intrauterine pregnancy pregnancy and EITHER:
      • have abdominal pain or PV bleeding or needing serial HCG follow up of suspected ectopic or miscarriage
    • NB. if > 8 wks gestation on dates with a +ve urine HCG, then serum HCG may not be needed as USS should be diagnostic, and be the preferred investigation
    • THUS, patients with mild PV bleeding in pregnancy, if known to be > 8wks pregnant with past USS confirming pregnancy and Rh group known to be Rh +ve, then NO BLOOD TESTS are required

ENT

facio-maxillary

general med

    • most febrile patients with cellulitis should be admitted to EOU for initial IV antibiotics
    • patients with co-morbidities (eg. bariatric, diabetic, chronic leg oedema, etc) should be admitted as inpatient under gen med
  • referrals for blood transfusion without acute bleeding:
  • patient with possible DVT and no clinical features of PE:
    • if Wells score = 0, no cancer, no PH DVT, a negative D-Dimer is sufficient to exclude a DVT
    • if Wells score > 0, need an USS - if there are delays to US then s/c enoxaparin until result of USS
    • if proven DVT then stat s/c enoxaparin and start DOAC (eg. rivaroxaban)
  • patient with possible PE:
    • if very low probability PE (PERC negative and Wells < 2) then no need to Ix for PE
    • if low probability PE (Wells 2-4) then negative D-Dimer adequate to exclude PE (consider admit to EOU)
    • if mod-high probability PE (Wells > 4) then D-Dimer not useful, admit to EOU and just do CTPA or V/Q
    • if proven PE and no compromise features, consider outpatient Mx with stat s/c enoxaparin and start DOAC (eg. rivaroxaban), otherwise admit under resp. unit

general surgery

  • low to medium risk patients with undifferentiated abdominal pain / suspected diverticulitis or appendicitis, etc who need further investigations in ED should be considered for work up or review by surg reg in EOU
  • patients who have clear cut surgical admission indications should preferably be admitted to a ward bed ASAP if they are stable - may require interim admission orders to be completed if there are delays in surg team reviewing in ED - there is usually no need to await a CT abdo prior to admission
  • don't forget to exclude ectopic pregnancy!
  • see:

gynae

neurology

oncology

ophthalmology

  • there is a slit lamp in the procedure room near EOU at Sunshine
  • consider referral to Western Eye Clinic for follow up review of corneal FBs, etc
    • Private clinic at Suite 210, Level 2, 1 Thomas Holmes Rd, Maribyrnong
    • All patients require a referral letter with the patient’s bradma sticker and a provider number (please fax this to the clinic and ask patient to phone clinic for an appointment), and the patient will be billed
    • ph: 9317 8930 fax: 9912 2306

ortho

plastics

  • plastics is only at Sunshine
  • open wounds with possible joint involvement (excluding hands) are generally managed by orthopaedics not plastics
  • Achilles tendon injury are managed by orthopaedics not plastics

vascular surgery

sh_fast_track.txt · Last modified: 2018/05/05 04:18 by 127.0.0.1

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