Clinical Reference:

Clinical Web Sites (see also Disaster/Bioterrorism/Hazmat links at bottom of this page)

bulletNCEMI -- National Center for Emergency Informatics
bulletMD Consult (requires password)
bulletMercyNet (PMHS Intranet - only available from within PMHS firewall)

Mercy CT Reading Site Only available from within PMHS firewall

bulletCT Reading Confidentiality Form

PMHS Standard Orders  see MercyNet for orders

Clinical Information (Official Mercy Dept. of Emergency Medicine Guidelines so noted)

ACLS/Resuscitation

bulletACLS Pocket Card
bulletAirway Pocket Card
bulletSafar Center Induced Hypothermia Protocol Draft

Anaesthesia/Pain

bulletKetamine Sedation Guideline - Mercy DEM
bulletLow Back Pain Assessment and Treatment - Mercy DEM
bulletPain Management  - Part 1: General - Mercy DEM
bulletPain Management  - Part 2: Abdominal Pain - Mercy DEM

Chest Pain/Cardiac

bulletAcute Coronary Syndrome Guideline - Mercy DEM
bulletAcute Coronary Syndrome Pathway - Mercy DEM
bulletIntegrilin Dosing
bulletSafar Center Induced Hypothermia Protocol Draft
bulletNuclear Stress Testing: is available on Saturday and Sunday. Orders placed by noon will be completed on the day it is ordered. The test must be ordered through INVISION. Patients must be kept NPO. Patients should not have any caffeinated or decaffeinated beverages prior to stress test. Sunday nuclear stress testing will be done if: 1) the patient is 23-hour observation 2) pre-op clearance is needed 3) patient discharge is pending test results.

Drug Information

bulletVitamin K Dosing Guidelines (Mercy "Drugs and Therapeutics" July 1999, p. 4)
bulletProtonix (pantoprazole) I.V. Therapeutic Guidelines (Mercy Pharmacy Newsletter, June 2001)
bulletCommon Pediatric Medications
bulletMethadone Guidelines

Endocrine

American Diabetes Association Diabetes Care Journal (Diabetes Care 25:S100-S108, 2002): Flowcharts for managing diabetic emergencies

bulletAdult DKA
bulletAdults with HHS
bulletPediatric Patients (< 20 years) with DKA or HHS

ENT

bulletVertigo and Otolith Repositioning

Infectious Disease

bulletRapid Influenza Testing
bulletNeedlestick/Bloodborne Exposure Guidelines, Mercy DEM (Summary)
bulletNeedlestick/Bloodborne Exposure Guidelines, Mercy DEM (Complete)
bulletManagement of Occupational Blood Exposures (from CDC) 
bulletAllegheny Co. Health Department Rabies Guidelines
bulletSexually Transmitted Diseases: Treatment Guidelines 2002 (from CDC)
bulletPA State West Nile Virus Website
bulletPA Health Dept. Advisory: West Nile Season 2004
bulletPertussis (Whooping Cough) Upsurge in PA 2003-4
bulletAvian Flu: World Health Organization Update
bullet Avian Flu: PA Dept. of Health Update and Recommendations
 
bulletCDC DTP Vaccine Information Sheet
bulletCDC dT Vaccine Information Sheet
 
bulletCDC Infectious Disease Information
bulletAnthrax Information
bullet Smallpox vaccination information (CDC) - excellent site, many pictures
bulletPMHS SARS policies, 4/17/03
bulletPMHS SARS Triage Guidelines
bulletPMHS SARS Fact Sheet (Patient/Public Information)
bulletCDC SARS website
bulletSARS Recommendations from PA Dept. of Health
  1. Participate in surveillance activities to detect new SARS cases, in accordance with public health guidelines (See SUPPLEMENT B: SARS SURVEILLANCE <http://www.cdc.gov/ncidod/sars/pdf/smp_supplementb.pdf>).
  2. Screen all patients hospitalized with pneumonia for the three following characteristics that might indicate a higher index of suspicion for SARS-CoV infection:
  1. In the 10 days before illness onset, travel to or close contact with other ill persons who recently traveled to a previously affected SARS area, or
  2. Employment as a healthcare worker, or
  3. Close contact with person(s) recently found to have radiographic evidence of pneumonia without an alternative diagnosis

Neurologic

bulletUrgent Neurosurgery Consult Guidelines
bulletEmergency MRI Information
bulletStroke Thrombolysis: Mercy Worksheet
bulletNCEMI NIH Stroke Scale Calculator
bulletNCEMI Thrombolysis in Stroke Calculator
bulletSafar Center Induced Hypothermia Protocol Draft

OB/GYN

bulletPelvic Pain Diagnostic Guideline - Mercy DEM
bulletVaginal Bleeding Guideline Chart - Mercy DEM
bulletVaginal Bleeding Checklist Form - Mercy DEM

Ophthalmology

bulletTonopen Manual Excerpt

Orthopedic/Musculoskeletal

bulletStryker Pressure-Monitor instructions in article on exertional compartment syndrome
bulletPiriformis Syndrome
bullet Piriformis Syndrome Overview
bulletPiriformis Syndrome at eMedicine
bullet Piriformis Syndrome Anatomy
bullet Piriformis Syndrome Treatment
bullet Piriformis Stretch Animation
bullet Piriformis Syndrome overview and another stretch

Pediatrics

bulletPediatric Internal Alert Criteria
bullet"Beamsley Blaster" for removing nasal foreign bodies (unofficial)
bulletBoston Children's Child Protection site (child abuse reporting etc.)

Psychiatric

bullet"302" (Involuntary Psychiatric Commitment) forms
bulletPsych Transfers Memo, August 2001
bulletPsych Transfers Email, July 2003
bulletPsych Transfers under EMTALA (EMTALA guidelines article)

Pulmonary

bulletDeep Venous Thrombus (DVT) Evaluation Guidelines
bulletPulmonary Embolism Evaluation Guidelines
Notes about pregnant patients:  
1. 9/9/04: Per Dr. Carlin, Chair of Radiology: based on a careful evaluation of the teratogenicity of radiation and iodine (less radiation for CT, but uses iodine), they recommend the following: if < about 16 weeks: V/Q scan; if > about 16 weeks, CT/angio. Exact dating not required.
2. based on a discussion between the Departments of Emergency Medicine and Radiology, 11/19/02, discussing the variety of protocols for V/Q scans in the pregnant patients, recommended the following (also recommended by the American College of Radiology): (1) ventilation is performed first (to avoid a 12-hour delay to do the ventilation scan in case the perfusion scan is positive) (2) perfusion scan is done at half dose (due to the compression of the lungs in pregnant patients). We will not be using the oft-suggested "do the perfusion first and then skip the ventilation if the perfusion is negative" protocol here at Mercy. We will also not be routinely using D-dimer or venous dopplers in pregnant patients prior to V/Q scanning due to their low predictive power.
Note about IV access for CT for PE
bulletABG and Acid-Base Analysis

Radiology

bulletCT Reading Confidentiality Form
bulletCT Scans of the Abdomen - Mercy DEM
bulletemail correspondence with clarification about AAA CT scans
bulletEmergency MRI Information
bulletPelvic Pain Diagnostic Guideline- Mercy DEM
bulletUltrasound Form: Resident - Mercy DEM
bulletUltrasound Form: Attending - Mercy DEM

Trauma

bulletTrauma Alert Criteria - Adult - Mercy
bulletTrauma Alert Criteria - Pediatric - Mercy
bullet Trauma Consult Criteria - Mercy
bulletUrgent Neurosurgery Consult Guideline - Mercy DEM

Disaster/HazMat/Bioterrorism (see also Infectious Disease, above)

bulletClinical clues to a chemical attack--from CDC
bulletPA Health Dept.:  how to detect chemical exposures
bullet MEDICAL MANAGEMENT OF RADIOLOGICAL CASUALTIES HANDBOOK, Military Medical Operations, Armed Forces Radiobiology Research Institute
bulletCDC ricin website (with PDF of patient information)
bulletAnthrax Information

Hazmat

bulletAgency for Toxic Substances and Disease Registry (ATSDR)
bulletAmerican Chemistry Council's CHEMTREC

Bioterrorism: Be Aware

The CDC recommends that all ED personnel be on the lookout for indications of bioterrorism effects.  Click here to link to the CDC recommendation.

WMD (Weapons of Mass Destruction) Links

bulletACEP Bioterrorism Links Page
bulletRhode Island Health Dept. Links

These pages designed for internal use at the Emergency Departments of hospitals of the Pittsburgh Mercy Health System.  Others are welcome to use them recognizing that the information on them are not designed for the public, but for PMHS emergency medicine professionals.