The Top Ten Complaints to Consider Sending to the ED: Kay Ella Bleecher, MSN CRNP CEN PHRN York Hospital: Department of Emergency Medicine Kbleecher@wellspan.org Objectives: 1. Review Emergency Nurses Association for usage of Nurse Practitioners in the Emergency or Urgency care area of a hospital or center. 2. List specific chief complaints or medical illnesses or trauma injury that have potential for high acuity and low incident for specific legal, medication, care errors, or benchmarking for areas concern. 3. Discuss history taking and mechanism of injury with regards to Documentation of injury or illness. 4. Describe top 10 Specific Red Flags areas that should be handled by an ED visit. 1. Eye care and prescription medication considerations. 2. Unusual Headaches, evaluation and treatment. 3. Eldercare fall victims of any anticoagulation agents 4. Pediatric Head Injuries 5. Animal and People Bites: Medication and Antibiotic coverage. 6. Medications: Over the counter, Herbals, and interactions specific prescribed pharmacologic agents. 7. Orthopedic indications or injuries, care and documentation outcomes. 8. Pain control, management and frequent flyers (medication seeking patients.) 9. Dental pain, dental medication, abscess care, and prescribing medications and treatment for oral care.
10. Chest Pain or Shortness of Breath. 5. Communicating care, and commitment in the chart, medical record and electronic medical record. Transferring information and care to EMS, Nursing, and ED care providers. 6. Discuss legal ramifications of documentation and referral to Emergency Departments. Outline The Top 10 Complaints to Consider Sending to the ED: for type of care, chief complaint, commitment of the complex care, and competency of care. I. Review Emergency Nurses Association for usage of Nurse Practitioners in the Emergency or Urgency care area of a hospital or center. A. Type of Education 1. Family 2. Emergency 3. Specialty B. Guidelines for Care under LACE 1. Definition of LACE 2. Other considerations II. List ten of the specific chief complaints, medical illnesses, or trauma injury that have high potential for high acuity and low incident for specific medication errors or benchmarking for areas concern. A. Review the listed common complains. B. Discuss Medications specific to these complaints 1. Types of medications a. Antibiotics 1. Coverage
2. Cost 3. Bacteria coverage 4. Dosage Guidelines aa. Adults bb. Pediatrics cc. Elderly 2. Pain Agents a. Topical Agents 1. LET 2. EMLA 3. Spray s a. Pain ease or others 4. Others b. PO Medications 1. Non narcotic 2. Anti-inflammatory 3. Opiods c. Dermal agents 1. Transdermal absorption 2. IM 3. IV III. History taking and mechanism of injury with regards to documentation of injury or illness. A. History and Visual Exam B. Detective Work C. Sources of knowledge. D. Abuse / Self inflicted. IV. Top 10 Specific Red Flags areas: that should be handled by an ED visit 1. Eye care, ophthalmic prescription medication considerations, A. Type of concern B. Visual Field and Acuity 1. With any complaint of eye disorder. C. Assessment and Exam 1. PPE
2. Slit Lamp 3. Types of documentation D. Differentials 1. Pink eye 2. Traumatic Injury a. Hyphema b. Globe injury 3. Retinal Consideration a. Abrasion b. Keratitis 4. Pain a. Glaucoma b. Burns 1. Chemical 2. Alkaline II. Unusual Headaches: A. Initial Triage or screening of calls B. Words to live by: 1. Worse Headache of my life 2. Pounding pain with menses 3. Evaluated by neurologist 4. Time of day of headache C. Evaluation 1. Your detailed neuro assessment 2. Differential Diagnosis 3. Procedure 4. Labs 5. Head CT D. Treatment. a. Non narcotic 1. Non medications aa. Massage bb. Reiki cc. Herbals 11. Feverfew b. Prescription Meds 1. NSAIDS 2. Summatriptine 3. Narcotic
4. Others E. Discharge documentation III. Eldercare fall victims on any anticoagulation agents; 1. Prevention 2. Coordination of Care 3. History and assessment 4. Medications esp. Anticoagulation a. Heparin b. Aspirin c. Plavix IV. Pediatric Head Injuries: A. Detailed history B. Diagnosis C. To scan or not 1. Signs and symptoms D. Post concussion studies 1. Cognitive testing V. Animal and People Bites: A. Medication B. Antibiotic coverage. C. Special considerations D. Reporting considerations VI. Medications, over the counter, herbals, and interactions specific prescribed pharmacologic agents. A. Herbals B. Vitamins C. Interactions
VII. Orthopedic indications or injuries, care and documentation outcomes. A. Assessment B. Nerves and Pulses C. Fractures VIII. Pain control, management and frequent flyers (medication seeking patients.) A. Including medication prescribing for children s pain control. 1. Oxycodone 2. Non-narcotics a. Tylenol b. Motrin B. Documentation C. Chronic pain and documentation IX. Dental pain, dental medication, and abscesses. A. Identifying the teeth 1. Deciduous 2. Adult 3. Teeth ID B. Prescribing medications C. Dental Blocks D. Emergency Treatment for Reimplantation 1. Transportation of teeth 2. Products a. Milk b. Save a tooth X. Cardiovascular Issues and or Shortness of Breath A. Chest pain evaluations 1. Age
2. History 3. Drug usage. 4. Symptoms and Signs B. Stroke (CVA or TIA) C. Acute shortness of breath 1. Asthma 2. Pulmonary Embolism 3. Acute COPD 4. Other V. Communicating care, commitment, and patient care documentation A. Patient care records B. Chart records and electronic medical record. C. Transferring information and care to EMS, Nursing, and ED care providers. D. Legal issues 1. Discovery of evidence. 2. Documentation of care 3. Vital signs 4. EMTALA D. Communication of care Bibliography