Indicators

1^o

• • Requiring emergency surgery

2^o

• • Admission

Indicators

1^o

• • pH < 7.25 (arterial or venous)

Indicators

1^o

• • Continuous, adjustable IV medication infusion

Indicators

1^o

• • Visual changes requiring aggressive treatment

Indicators

1^o

• • Intubation

2^o

• • Epiglottitis
  • Angioedema
  • Croup (adult)
  • Ludwig’s angina
  • Retropharyngeal abscess
  • Airway edema (radiation or abscess)
  • Smoke inhalation
  • ICU admission or transfer

Indicators

1^o

• • Hypotensive requiring fluid boluses

2^o

• • IM / IV epinephrine

Indicators

1^o

• • Abnormal vitals signs: HR >120, SBP <80

2^o

• • Syncope
  • Chest pain
  • Packed RBC transfusion
  • Platelet transfusion

Indicators

1^o

• • Airway swelling aggressive treatment requiring IV or IM racemic epinephrine

2^o

• • Intubation
  • Admission
  • Transfer

Indicators

1^o

• • Requiring immediate surgery or transfer

2^o

• • IV medication infusion to control BP

Indicators

1^o

• • Infection
  • Sepsis

Indicators

1^o

• • Requiring immediate surgery or transfer

2^o

• • Infusion of anti-coagulants or anti-thrombotics (blood thinners)

Indicators

1^o

• • BiPap/CPAP

2^o

• • ≥ 3 respiratory treatments and still in distress

Indicators

1^o

• • Continuous IV medication infusion

2^o

• • Ventricular rate > 150 with treatment
  • Chest pain
  • Dyspnea
  • Lightheadedness

Indicators

1^o

• • Pulse < 40 or pacer or atropine

2^o

• • Consult with cardiology for transvenous pacer

Indicators

1^o

• • BiPap/CPAP

2^o

• • Initiation of IV nitroprusside, nicardipine, nitroglycerin, dobutamine, or dopamine

Indicators

1^o

• • Continuous nebulizers and still in distress

2^o

• • BiPap/CPAP
  • O2 sats <80% (on usual oxygen)
  • Respirations >32
  • PH ≤ 7.25

Indicators

1^o

• • 100% FiO2 by high-flow nasal cannula (HFNC), NRB, CPAP/BIPAP
  • Intubation and sedation
  • PRBC transfusion
  • Hyperbaric oxygen

2^o

• • Admssion
  • Transfer

Indicators

1^o

• • CPR

Indicators

1^o

• • Hypotension with IV fluid bolus or pericardiocentesis

Indicators

1^o

• • Immediate ophthalmology consultation

2^o

• • Admission
  • Transfer

Indicators

1^o

• • Immediate ophthalmology consultation

2^o

• • Admission
  • Transfer

Indicators

1^o

• • Requiring admission, transfer, or has neurologic deficit

Indicators

1^o

• • Nitroglycerin drip

2^o

• • Transfer to cardiac center
  • TPA or Integrilin administered
  • New changes on ECG
  • CT scan (look for other causes of pain)
  • Cath lab
  • Pulmonary edema
  • Positive troponin
  • Heparin or enoxaparin

Indicators

1^o

• • Always critical care

Indicators

1^o

• • ED fasciotomy, transfer, or admit to the OR

Indicators

1^o

• • Multiple racemic epinephrine nebulizer treatment with documentation of airway distress after first nebulizer treatment

Indicators

1^o

• • pH < 7.25 (arterial or venous)

Indicators

1^o

• • SBP < 80 (treated with more than 1 L of fluids)

Indicators

1^o

• • Antidote: emergent dialysis

Indicators

1^o

• • Antidote: digibind

Indicators

1^o

• • Antidote: n-acetylcysteine (Mucomyst)

Indicators

1^o

• • Antidote: naloxone

Indicators

1^o

• • Antidote: fomeprizole (Antizol)

Indicators

1^o

• • Antidote: crofab

Indicators

1^o

• • Ventricular Tachycardia

2^o

• • Ventricular fibrillation
  • 3rd Degree Heart Block
  • Pacemaker (inserted in ED or External pacer used in ED)
  • Use of Atropine, Lidocaine, Amiodarone IV, Procainamide IV
  • Synchronized cardioversion

Indicators

1^o

• • To OR

2^o

• • Requiring admission, transfer, or blood transfusion

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Partial or complete

Indicators

1^o

• • Femur, tibia, pelvis, or humerus

Indicators

1^o

• • Patient is hypotensive (SBP < 80)

2^o

• • GI consult for scope in ED or ICU that day
  • Blood transfusion, Plasma or platelet transfusion or Fluid boluses
  • Emergency surgery scheduled w/in next 12 hrs or EGD or colonoscopy
  • Vasopressors
  • Hemoglobin [Hb] < than 7
  • Abnormal vital signs (pulse > 120)
  • Mental status change

Indicators

1^o

• • Always critical care (except hypoglycemia)

Indicators

1^o

• • GCS ≤ 12

Indicators

1^o

• • Requiring urgent chest tube inserted by ED physician

Indicators

1^o

• • Requiring admission, transfer

Indicators

1^o

• • Calcium gluconate, calcium chloride

2^o

• • Insulin
  • Dextrose
  • Albuterol
  • Sodium bicarbonate
  • Furosemide
  • Fluid boluses

Indicators

1^o

• • SBP > 230 or DBP > 130

AND

2^o

• • Signs or symptoms of end organ involvement (CVA, acute renal failure, non-STEMI)
  • Attempted control with IV medications including but not limited to nitroglycerin, clevidipine, labetalol, nicardipine
  • Mental status change (encephalopathy)
  • CHF
  • Chest pain
  • Pulmonary edema
  • Pre-eclampsia
  • Eclampsia
  • Seizure

Indicators

1^o

• • D50: 3 or more doses

Indicators

1^o

• • Frequent finger sticks (3 or more) and intervention

Indicators

1^o

• • Potassium ≤ 2 with IV potassium ordered in ED

Indicators

1^o

• • Requiring admission, transfer

2^o

• • Seizure

Indicators

1^o

• • SBP < 80

2^o

• • Multiple fluid bolus (3L or greater)
  • Vasopressors
  • Central line placement
  • Respiratory rate (RR) > 32

Indicators

1^o

• • Oxygen saturation < 80% (on usual 02)

Indicators

1^o

• • Always critical care (not chronic)

Indicators

1^o

• • STEMI

2^o

• • NSTEMI
  • Elevated troponin (not chronic or non-cardiac causes)
  • Cath lab
  • tPA

Indicators

1^o

• • Altered mental status (GCS ≤ 12)
  • Abnormal vital signs

AND

2^o

• • Immediately to OR
  • Transfer to trauma center
  • Multiple fluid boluses
  • Blood transfusion
  • Platelet transfusion
  • Central line
  • Spine, pelvis, or femur fracture
  • Flail chest
  • Pneumothorax / hemothorax chest tube
  • Intracranial bleed
  • Intubation
  • Solid organ injury

Indicators

1^o

• • With encephalopathy (mental status change)

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Treated with IV Levothyroxine

Indicators

1^o

• • 30 days or younger with fever > 100 & full septic workup including (LP)

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Oxygen saturation < 80% (on usual 02)

2^o

• • HR > 120
  • SBP < 80
  • Respirations > 32

Indicators

1^o

• • Oxygen saturation < 80% (on usual 02)

2^o

• • HR > 150
  • SBP < 60
  • Respirations > 40

Indicators

1^o

• • Requiring urgent chest tube inserted by ED physician

Indicators

1^o

• • Admission or transfer

Indicators

1^o

• • Requiring treatment with IV nitroglycerin or other medications

2^o

• • Intubation
  • BiPap/CPAP
  • O2 sats <80% (on usual oxygen)
  • Respirations >32

Indicators

1^o

• • Heparin, enoxaparin, tPA

Indicators

1^o

• • Immediate dialysis

2^o

• • Abnormal vital signs (HR > 120, SBP < 80)
  • Sodium bicarbonate
  • Calcium
  • Insulin / D50
  • Pulmonary edema
  • ECG changes

Indicators

1^o

• • BiPap/CPAP

2^o

• • Intubation

Indicators

1^o

• • Always critical care

Indicators

1^o

• • 2 SIRS criteria & source of infection

2^o

• • Multiple fluid boluses (30 mL/kg)
  • Vasopressors
  • Broad spectrum antibiotics
  • Hypotension
  • Tachycardia
  • Elevated lactic acid levels

Indicators

1^o

• • SBP < 80

Indicators

1^o

• • Continuous seizure or repeated seizure without returning to baseline

Indicators

1^o

• • Thrombolysis considered or given
  • Endovascular treatment

2^o

• • Admission
  • Transfer
  • Intubation

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Serious attempts to harm

Indicators

1^o

• • Cardioversion

2^o

• • Calcium channel blockers
  • Sodium channel blockers
  • Adenosine

Indicators

1^o

• • Always critical care

Indicators

1^o

• • IV propanolol, esmolol, reserpine

2^o

• • PTU
  • Methimazole
  • Adrenal insufficiency
  • Plasmapheresis

Indicators

1^o

• • Altered consciousness

2^o

• • Threat to life or limb
  • Admission
  • Transfer

Indicators

1^o

• • Always critical care

Indicators

1^o

• • Requiring IV medications

2^o

• • Cardioversion