Starting Feb 2018 we will move to a three tiered system of antimicrobial stewardship. For all the details go to Clinical -> Infection prevention -> Antimicrobial Stewardship.
Please note that the CT Chest ILD protocol is specifically to evaluate for and differentiate between different types of interstitial lung diseases and includes expiratory phase and prone imaging. Usually this is on patients with known pulmonary fibrosis or longstanding shortness of breath. Also this is usually ordered by pulmonologists on outpatients. If a patient is acutely short of breath, has a lung nodule/mass, or in the hospital, usually a CT chest is the more appropriate order. This was previously named “High-Resolution Chest CT,” but the name was changed to better reflect it’s intended use. All of our CTs are high resolution.
|Guideline Watch | GENERAL MEDICINE, INFECTIOUS DISEASES |
January 11, 2018
|David J. Amrol, MD reviewing Greenhawt M et al. Ann Allergy Asthma Immunol 2018 Jan . |
All available flu vaccines are safe in all egg-allergic patients.
Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)
Target Audience: All providers who administer influenza vaccines
Historically, patients with egg allergy have been told to avoid flu vaccines, because most flu vaccines are produced in embryonated chicken eggs; the concern was that a vaccine might contain residual egg protein, which could lead to anaphylaxis. Many studies have shown that flu vaccines are safe for egg-allergic patients, but many physicians still have been hesitant to vaccinate such patients. This updated practice parameter incorporates recent data on flu vaccine safety in egg-allergic patients, including children.
|Editor Disclosures at Time of Publication |
Disclosures for David J. Amrol, MD at time of publication
Flu season is up us. Please see these guidelines for this season from Infectious Disease Society of America for current updates.
Paragon will not be available from 10:00 pm Tuesday 1/9/2018 through 6:00 am 1/10/2018 while the database is being upgraded.
MPF will be available to pull up past notes.
Please be aware that Centricity DMS (Cardiology application) will experience downtime this weekend for a system upgrade. Users will NOT be able to log into Centricity DMS and/or send images to Centricity. A hard copy of the Downtime Resource Guide is always available on each unit as well as an electronic copy is located on the Centegra Portal.
When will Centricity DMS go offline?
Friday, November 17th @ 5p
When will Centricity DMS be available again?
Tuesday, November 21st @ 5p
What will this affect?
- Images can still be viewed by clinicians on ZFP Cardio Images
- Medical Imaging will fax a form to the floors with preliminary findings from the Cardiologist’s readings
- No official reports until Tuesday (this includes echo, cath and stress)
- Preliminary reports will be available for EMERGENT echoes ONLY. This report will only have pertinent findings and will be faxed to the patient’s POD.
Who will this affect?
- Anyone that uses Centricity DMS
- Anyone that needs a Cardiologist’s reading (echo, cath and stress)
Who can i contact for help?
- For report issues please contact the reading Cardiologist directly
- For all other questions, please contact the department
We apologize in advance for any delays this may cause. We ask that you please be patient with this process as there will be likely delays in viewing echos in particular (due to a lengthy/cumbersome viewing process). Please be sure to adjust your clinical care accordingly.
There is a nationwide shortage on DOBUTamine 500 mg/250 mL IVPB. At present consumption, we expect CHS has about a 12 day supply. We may continue to receive backordered quantity, but we cannot rely on this. Please be aware of this shortage and consider alternatives as our supply depletes.
Alan Mader, PharmD, BCPS
Department of Pharmacy Services
Centegra Health System
Morphine Injection Shortage 10.18.2017
There is a nationwide shortage of morphine injection that expected to last until early to mid-November. The Pharmacy Department is running very low on supply and expects that the drug will become unavailable. Please consider ordering an alternate injection product for pain management. An opioid dose conversion chart is included below for your convenience.
Oral: Parenteral Ratio
Oral Morphine: Analgesic Ratio
|Morphine||30 mg||10 mg||3 : 1||1 : 1||4 – 6 hrs||3 hrs|
|Oxycodone||20 mg||—||—||1.5 : 1||3 – 5 hrs||4 – 5 hrs|
|Hydromorphone||7.5 mg||2 mg||4: 1||4: 1||3 – 4 hrs||2 – 3 hrs|
|Fentanyl||—||100 mcg||—||See Table B on page 2||1 hr||3 – 12 hrs|
|Methadone||20 mg||10 mg||2 : 1||See Table C on page 2||4 – 12 hrs||15 – 50 hrs|
|Codeine||200 mg||130 mg||1.5 : 1||1 : 7||4 – 6 hrs||3 hrs|
|Hydrocodone||30 mg||—||—||1 : 1||3 – 6 hrs||3 – 4 hrs|
|Meperidine||300 mg||75 mg||4 : 1||1 : 10||2 – 4 hrs||2 – 3 hrs|
|Nalbuphine||—||10 mg||—||1 : 1||3 – 6 hrs||5 hrs|