ED Update — March 2025

Criticall

Tip sheet is attached.

Acute Low Back Pain Clinic

FYI, there is an acute low back pain clinic that you can advise your patients about. They require a referral from their family doctor and do not take referrals directly from the ER. We will keep the attached handout in the department to provide to your patients.

📄 Acute Low Back Pain Clinic — ER Handout

Stroke Admissions

For patients that receive TNK:

ICU admission can be considered if —

• Patient requiring IV labetalol or IV hydralazine post-TNK and cannot be weaned off easily
• Patient requiring ICU and neurocritical care expertise:
  • Intubation, etc.
  • Seizure management in circumstances where the patient is in status epilepticus and otherwise cannot be managed on the ward
  • Other concomitant conditions requiring ICU expertise
  • In other circumstances where the clinician feels it is warranted

Otherwise, stable patients can be admitted to the stroke unit post-TNK. Both ICU and stroke teams are aware.

Azithro

Option of dosing 500 mg daily × 3 days has been added in powerplans — FYI.

Measles

Main info to look at this week. Public Health has started sending some patients to the ER for PEP for IM / IVIG (not ideal, but it is happening).

Background

Measles is a highly infectious virus. Symptoms begin 7 to 21 days after exposure and can include any of:

1. Fever
2. At least one of: cough, runny nose (coryza), conjunctivitis
3. Small white spots known as "Koplik's spots" can appear on the inside of the mouth and throat
4. 3 to 7 days after symptom onset, a red maculopapular rash appears on the face and then progresses down the body, head to toe
5. Cases are infectious from 4 days before to 4 days after rash onset

Isolation Direction (GRH)

Measles exposures from days 0–4 do not require isolation. Day 5 and onward require isolation (airborne / droplet / contact). A negative pressure room — or a private room with a door and HEPA filter — is acceptable.

Acute Measles PowerPlan — Labs, Urine, Swab

The Acute Measles PowerPlan is found in Cerner as shown — search "measles" and select LAB Acute Measles Diagnostic Bundle.

Ordering IMIG

Type in "Blood Plasma Protein" and scroll down until you see GAMASTAN.

IMIG vs IVIG

To determine if the patient requires IMIG or IVIG, refer to the table within the red measles binder near the tube station.

Ordering IVIG

There is a red binder with the measles info in the department containing all of this printed out if you need it on shift.