Adult Emergency Medicine Handbook

Master Clinical Directory & Protocol Index

Table of Contents

• Important ED Information • Phone Calls & Consultations • ED Sedations / Consent • EPIC Order Sets for Adults • Patient Resources / Social Work • Clinical Protocols Index • EM Faculty Committee Reps

Important ED Information

Physician-In-Triage (PIT) Workflow • If a patient has been seen in PIT and is now marked "MAIN", you can pick up this Patient.
• PIT patients will already have a note started, and you should take over this note.
• DO NOT DELETE PIT HPI. You should include your own HPI below the old HPI with any additional information.

ED Main Phone Number 35901 Charge Nurse available at main desk (always two on duty)

UKMDs 75522 Use backup navigation routing for hard-to-reach services

UK Interpreter Services Directory

• From your device (Any Language): Call 1 (855) 430-7847 | PIN: 7074
• In-Person Spanish Interpreter: Vocera 39700 on hospital phone OR (859) 323-9700 on your device (Request Spanish Interpreter).
• iPad CyraCom Interpreter: Scattered throughout the ED; required to search out layout fields manually.

Life Point Important Contacts

Provider Issues — Medical Director
Ismaeel Siddiqi MD
Phone: 859-433-9621
Email: ismaeel_siddiqi@teamhealth.com

General Issues — LP Coordinator
Paige Elzinga
Phone: 502-316-4766
Email: Paige.elzinga@LPNT.net

UK Representative (Add to Epic Chats)
DeeDee (Deeanna) McCallie
Phone: 859-312-4677
Email: deeanna.mccallie@uky.edu

• Please add DeeDee to Epic chats with LP issues for assistance.
• LP RN liaison here 7a-7p M-Sun and sits in peds swing area in front of room 9 in peds ED.

Community Paramedicine Hotline: Main: 859-280-8951 | Michael O’Leary: 859-797-6273 | Patrick Branam: 859-230-9841

Phone Calls and Consultations

System Update: This workflow will be changing come July 1st → EPIC VOIP integration deployment.

• Land lines are recorded for quality control and are important if you have issues with a consultant.
• Provider on call icon is located on the desktop layout matrix.
• Make sure you know the clear clinical question for the consultant. If you don’t know why you are consulting someone, please ask your attending to clarify.
• If you cannot reach a consultant, call UKMDs at 7-5522 and they will locate the correct on-call service personnel.
• To page: Dial 9, then enter the pager number (330 numbers), wait for the tone beeps, enter your direct ED callback number followed by #.
• Allow 15 minutes to pass before you repeat page or call a consultant service again.
• Mandatory: Input a formal consult order in Epic immediately after you speak to a consultant!
• First call communication must be a phone discussion. You may follow-up with a consultant via EPIC chat if both agree, but ensure all closed loops are completed.

Specialist Teams Already Utilizing EPIC VOIP Consultations:
• Urology      • Ophthalmology

ED Sedations and Consents

• All procedural sedations must have written consent on file.
• The formal ED procedure note for moderate sedation should be started PRIOR to sedation initiation.
• For specific checklist rules, see the ED Bedside Procedures Consent and Time Out Requirements Table.

Epic Order Sets for Adults

• ED Anaphylaxis
• ED BP Management
• ED Geriatric Agitation
• ED Geriatric Delirium
• ED Geriatric Pain Management
• ED Hyperglycemia

• ED Overdose / Intoxication / Tox
• COM Adult Hyperglycemic Crisis
• COM Adult Sepsis
• Adult Hyperkalemia
• IV Contrast Allergy Prep

Patient Resource Papers / Social Work Documents

• First Bridge Clinic for Opioid Use Disorder
• Primary Care Services
• EMPATH
• Outside Lex Substance Use Disorder Packet of Resources
• Lexington Area Substance Use Resources / Treatment Centers
• Dermatologist in Lexington Area
• Chandler Retail Pharmacy Info

• Measles Testing / Information
• Women’s Health Resources
• UK Healthcare Facility Map
• Dental Urgent Care Clinic
• Spanish Patient Resources
• Dentistry Walk-In Clinic
• PCP Options
• UK Polk-Dalton Clinic Primary Care and OBGYN
• Health First Bluegrass Clinic
• Abuse / Violence / SI

Commonly Used Protocols

Note: Links will activate automatically as individual internal post resources are published.

Addiction

• Alcohol Withdrawal Protocol
• Buprenorphine Initiation

Cardiology

• Chest Pain / Troponin Pathway
• Pulmonary Embolism Treatment

ENT

• Epistaxis (needs to be made)
• Nasal Fracture (needs to be made)
• Intra-tonsillar vs Peritonsillar Abscess (needs to be made)

Gastroenterology

• GI Bleed (needs to be made)

Infectious Disease & Microbiology

• CAP Guidelines • Dalbavancin Guidelines • Endocarditis Guidelines • IPAC Serious Communicable Disease • Nosocomial Pneumonia Guidelines • STI Guidelines • Skin and Soft Tissue Infection • Strep Pharyngitis Guidelines • Tickborne Illness Guidelines • UTI Guidelines

Neurosurgery

• Admission for Non-Traumatic ICH
• Neurosurgery Transfer from OSH
• NSICU Admission Process

Neurology

• Migraine Protocol (needs updated)
• Cerebell info (Rapid EEG 2025)
• Cranial Nerve Palsy Guidelines 2021
• Papilledema Pathway (needs updated to include retinal scanner)
• Seizure Workup
• Status Epilepticus Protocol

Oncology

• Hypercalcemia Management
• Neutropenic Fever Guidelines
• Tumor Lysis Syndrome Management

OBGYN

• Abnormal Uterine Bleeding
• Ectopic Pregnancy
• Postpartum Hemorrhage
• Pre-Eclampsia / Eclampsia
• Fetal Demise
• OB to ED Transfer Algorithm

Pharmacy & Toxicology

• Critical Bleeding / Anticoagulation Reversal
• Nitrous Policy
• Acetaminophen Toxicity Guideline

Trauma and Surgery

• BIG Head Injury Guidelines
• Frostbite Protocol
• Spine Injury Imaging Algorithm
• Trauma Service Consultation Guideline
• Trauma Admission Guideline
• Trauma Activation Criteria
• Gallbladder Throughput Improvement Plan

Orthopedics

• Fracture Admission Guideline
• Open Wound / Fracture ABX Guidelines

Urology & Psychiatry

• Priapism (needs to be made)
• Testicular Torsion (needs to be made)
• Psych EMPATH Transfers (needs to be made)

Good Samaritan Inpatient Medicine

• Good Sam Medicine Admission Exclusion Criteria
• Difficult Airway Good Sam Admission Exclusions
• Family Medicine Inpatient Admission Criteria

Hospital Medicine Chandler

• HM / MICU Admission Workflow

Physical Therapy

• Physical Therapy Locations and Services List

Emergency Medicine Systems

• ED Bedside Procedures Consent & Time Out Requirements
• ED Observation Protocols

EM Faculty Clinical Committee Representatives

If you have a specific ED issue related to this area, please contact the representative and CC Dr. Houck.

• Fragility Fracture Committee: Houck

• PERT Committee: Houck

• IDTQA Trauma Committee: Belcher and Houck

• Sepsis Committee: Grace

• STEMI Committee: Houck

• EGS Committee: Owens

• Stroke Committee: E. Kim

• Lung Service Line: Davidson

• NKY OFR Case Review Committee (Opioid): Akpunonu

• CDS/OMC Steering Committee: Akpunonu and Martin

• Donation and Transplantation Action Committee: Akpunonu

• Physician SME Champion: Akpunonu and Martin

• Resuscitation and Rapid Response Committee: Trott

• ICU Committee: Trott

• Time Out Task Force: Micciche

• Provider Documentation Sub-Committee (Hospital-Wide): Owens

• GCH Resuscitation Committee: Luedke

• Pediatric Ambulatory Critical Event Readiness (PACER-C): Luedke

• SANE: Abby Bailey

• Community Paramedicine: Houck and Woolum

• IPAC: Joel Hamm