Harbor-UCLA ED Newsletter
April 1, 2025 Edition
The TLDR
Happy Doctor's Day!
Shoutout to all of you amazing doctors at Harbor. Emergency Medicine docs should get an extra day, don't you think? Here's a brief history of Doctors' Day in the United States:
  • Date of First Observance: March 30, 1933
  • Location: Winder, Georgia
  • Initiated by: Eudora Brown Almond, the wife of Dr. Charles B. Almond
  • Why March 30? It commemorates the first use of general anesthesia in surgery by Dr. Crawford W. Long on March 30, 1842. He used ether to remove a neck tumor from a patient—paving the way for pain-free surgery.
Thank you to our wonderful ED Nurses for celebrating us physicians both in the AED and Peds ED!
TLDR
  • ED Ops highlights: New glidescope connections (we're using the round connections, not the HDMI anymore). For patients with isolate specialty issues going from triage to a specialty clinic, please remember to discharge and use the Request for Urgent Specialty Appointment order
  • Dr. Parmar and the OCN's are going to help us track "pseudoborders" (*read to find out what that means)
  • Dr. Claudius is back with some awesome clinical pearls about Dengue and Typhus (eat your heart out, Measles). Also, OB/ACOG doesn't recommend giving Rhogam in <12 weeks (except special circumstances)
  • Check out Dr. Wilhem's EMS activities. Congrats on a successful Decon drill!
  • Lots of great Peds Updates and Reminders. Click on the Table of Contents to jump to the Peds ED Section. We have some new team members including a new child life specialist (they are magic child whisperers, hooray!)
  • TEAMS Chats will now be retained for 3 years!
  • In addition to new CCP alerts, please contact Ross if you have Firstnet issues
  • Check out the progress photos of our rounding room reno project
Operations Updates
CCC (Lab FollowUp – HAR)
Please be specific with your request. Include what's been done (or not done). This info affects antibiotic selection, number of days of treatment, and this is helpful when reviewing cultures for sensitivities. "Treated for cystitis with macrobid" or "given bactrim for pyelo"
DC to Specialty Clinics
For patients with isolate specialty issues going from triage to a specialty clinic, please remember to discharge and use the Request for Urgent Specialty Appointment order, with "ED Extension" added to the order comments as it is a same day. The Nurse Manager for Optho, ENT, OMFS, Urology, and Gyn UCC noted we have not been doing this consistently.
The only reason to keep them on the ED board and not DC is if you have a high suspicion they will need admission, go to the OR, or they are being seen for other reasons and the specialty consult is just one of many issues.
Fast Track & Equipment Updates
Fast Track Reminder
Please remember, RME 9-12 are available for private conversations, sensitive exams, and procedures. Please do not have these conversations in the hallway.
Glidescopes
  • There is now a dedicated Glidescope in each trauma room
  • All the rooms have the QC (QuickConnect, round, green)
  • For the next few months as we use up HDMI blades, several of the machines will have both a QC (quick connect, circular, green) and HDMI connectors
  • Please pay attention before you open a blade package to make sure you have the right cord
Available Blades
  • Adult: MAC 3, MAC 4, S3 (hyperangulated), S4
  • Pediatrics: Miller 0, Miller 1, LoPro 1 (hyperangulated), LoPro 2, S3, S4
Placement Pathway
  • 3/26 - updates went live this morning; you can now call the IM/FM team 7a-4p after cleared by the ED physician AOD
  • You still have to consult PT/OT/SW/UM first, and confirm with UM there is no ability to transfer the patient
  • Remember to send the AOD the templated info (from WikEM) via Teams chat
  • Text/call if you do not hear back from us within an hour during the 7a-4p placement window
Pseudoborders Tracking Initiative
What Are Pseudoborders?
Each day, our OCNs will fill out a form with the off-going attending at the end of day shift sign-out once daily in the doc boxes (3:55pm Purple, 4:55pm Green). If the off-going attending is not available, they will speak with the oncoming attending at the end of swing rounds.
Please do your best to help them fill this out in a timely fashion, so they may return to their other duties.
What To Include
Include any patients who have completed their initial ED evaluation and are ready for hospitalization from your standpoint, but you are unable to hospitalize yet due to one of the barriers below. Check as many boxes as apply. The full form is attached above as well.
  • MRN (if you have time)
  • Room LOS (hrs)
  • Reads for Imaging Studies
  • Consultant Issues (Awaiting Consultant Recommendations; Awaiting Admitting Team Evaluation/Orders; Disagreement about Correct Admitting Service)
  • Transfer Issues (Awaiting Outside Hospital Doc-to-Doc call, or Outside Hospital Bed)
  • Additional Testing Requested by Admitting or Consult Services (unlikely to change disposition)
  • Awaiting Interqual
  • Other (please explain)
Please contact Dr. Parveen Parmar with any questions or concerns
Order Updates & Safety Initiatives
Quick Order Page Updates
Both neuro consults are working as of 3/28. The names are self-explanatory: if your patient is having a stroke or going to the Neuro ICU, use that option; for everyone else, use the general neuro consult:
  • Consult to Neurology – General p6085
  • Consult to Neurology – Stroke/ICU p0771; x67707
ED Safety Updates
  • The photo of a particularly violent and disruptive patient is now in triage to help nurses and other staff identify this patient early (pt has a history of checking in under different names). This has been reviewed and approved by ED and Hospital leadership as a first step to try and prevent violence against our staff.
  • A new committee/taskforce to help address and prevent patient assaults is being formed. This will be led by Ms. Martee King, one of our ED Nurse Managers.
Trauma Reminder
If a patient's primary reason for coming to the ED is due to a trauma, and they need admission or transfer for another reason (medical), please consult trauma prior to admission/transfer (even if our trauma workup was negative)
Triage Orders
  • Please be thoughtful with your orders – not just a random assortment of "routine orders"
  • Urine cultures should generally only be done with positive urines – why order from triage when the UA may be absolutely negative, but you have not yet seen the result? A UA with reflex culture is in the works, but it is NOT here yet (be thoughtful with exceptions such as recently treated with antibiotics, elderly patients with a history of incontinence, or symptomatic high-risk patients)
  • PTT – very few indications for this from triage; starting heparin? Concern for ITP/DIC?
  • DHS vs OOP for initial orders – you may want an XR to see if the OSH reduction was adequate, but you do not need above and below the area of injury/pain and pre-op labs if they are OOP; flag for f/up (review in a few minutes once the patient has been registered)
Please contact Dr. Brad Chappell for any overall Operations issues. Contact Dr. Jen Roh for any AED specific issues.
The Clinical Corner with Dr. Claudius
Dengue Fever
Because Ebola, avian flu, and measles are not enough, public health has now issued an update on Dengue! Cases, including in the US are higher than normal. In LA specifically, there were 234 cases in 2024, 14 of which were acquired locally.
Please send CDC DENV-104 PCR when Dengue is the most likely diagnosis within the first 7 days of sx. Later on, serologies are more useful later on. The kits can be obtained from the CDC at [email protected].
So >7d of sx, order the Dengue Fever Ab IgG and IgM-SO which are sent out to quest. For <7d of sx, order the IgG and IgM as above as well as the PCR which will be sent to our lab and from there to public health.
Typhus
Because, really- why stop with Measles and Dengue? Apparently Los Angeles cases of Rickettsia typhi (murine typhus) rose dramatically in 2024 to a total of 187 cases. This is flea-borne so think rats and opossums, as you walk to your car at night past all the Harbor 'possums. It begins with high fever, headache, chills and bodyaches as well as a rash on the chest, back, arms or legs and can cause meningoencephalitis, myocarditis, HLH, or death. There are a number of different ways to test, but we have send-out labs for Ab titers orderable at HUCLA. Obviously, these take a bit of time, so empirically treat with doxycycline if suspicion is high. Want more info? Department of Public Health - Acute Communicable Disease Control
RhoGAM Update
Those wild obstetricians are changing the recommendations again on RhoGAM, apparently due to high-quality studies. Routine Rh screening and prophylaxis with RhIg is no longer recommended for abortion or pregnancy loss at less than 12 weeks gestation. *Exceptions may include: Trauma and ectopics (because the dataset does not include that population and the amount of fetomaternal hemorrhage is unknown and risk of alloimmunization is unknown).
*article attached to TEAMS
Quality Improvement
Sepsis Documentation
Don't forget to document your repeat assessment on septic shock patients after the fluid is completed. The phrase "I performed the sepsis reassessment" with a time stamp is all you need. It is part of the .harsepsis and .edsepsisprotocol autotexts
EMS + Disaster
Thank you to everyone who participated in the DECON Night Operations event! It was a great opportunity to set up our showers at nighttime and make some protocol adjustments. - Dr. Kelsey Wilhelm, EMS Medical Director
Harbor Base Station Updates
LA-DROP Prehospital Blood Transfusion Pilot
The LA-DROP Prehospital Blood Transfusion Pilot in LA County will be going live April 1, 2025! Base job aids will be posted in the radio room to help with online medical direction. Harbor will be the primary base providing medical direction and receiving many of the pilot patients so it's important everyone understands the protocol.
Training Videos
Below are some videos used in paramedic education that you might find helpful. The protocol video is probably the most relevant to you all. Shout out to Dr. Michael Kim for his video editing skills!
TBI Oxygen Reminder
Reminder to order high flow oxygen on all prehospital patients (NRB/BVM/SGA/ETT) with suspected TBI (GCS 14 or less) in patient with head trauma EVEN IF they have good oxygenation on room air.
Peds ED
Dr. Padlipsky and the Ped's ED Updates and Reminders
Hello everyone. Happy Spring.
Peds ED Follow-ups
Weekend Follow-ups
Thank you for remembering to do the follow ups on the weekends and holidays. Remember the 10am intern/resident scheduled on Sat, Sun, and holidays should do the follow ups when their shift first starts.
Discharge Protocol
Remember to put anyone who is discharged home with an outstanding lab on the follow-up list. We are responsible for making sure we follow up on any labs sent from the ED.
Peds IV Placement Guidelines
1
Most of the PED patients that are being admitted do require IV access.
2
It is a rare occasion that a pediatric patient is admitted that does not need IV access. If the PED team does not think a patient requires an IV they should discuss this with the admitting team. If it is agreed upon that the patient does not need an IV an order should be placed that says no IV is needed for admission.
3
During sign-out between PED providers and admitting team, it should be communicated to the admitting team whether an IV was placed or whether the IV was requested but has not yet been successfully placed and why (difficult access, parents refusing, etc.).
4
If during sign-out the admitting team requests that an IV be placed, then an order should be placed by PED providers for an IV to be done and this should be communicated to the patient's nurse. (Rationale: While this order can be placed by the admitting team it will be more efficient for PED provider to place the order if it is determined at sign out that the patient should have an IV).
Peds IV Placement Guidelines (continued)
5
If after the Pediatric admitting team assesses the patient, they feel an IV is necessary, the admitting teams should place an order as soon as possible and discuss it with the patient's nurse. (Include any other orders the admitting team is requesting). The PED nurses should try and put in any IV ordered by the admitting team if time allows.
  • If the order is placed and the patient is assigned a bed shortly after the order is placed – the nurse should communicate with the admitting nurse and the admitting nurse can place the IV upstairs.
  • Patients should not be held downstairs if an inpatient bed is available just to get an IV
  • If the PED nurse is encumbered with sick patients, or the PED is extremely busy and the nurse does not get to the IV and the bed is assigned, they should discuss with the charge nurse and with the admitting nurse upstairs. Again, we should try not to keep patients downstairs if a bed is assigned
  • If there are other circumstances that prevent the PED nurse from putting in the IV and completing any other urgent orders, the PED nurses will communicate with the Ward nurses directly.
6
It is of utmost importance that PED nursing communicates with the responsible provider (either PED provider before admission orders are placed or admitting team after admission orders are placed) if IV access is not successfully obtained.
7
PED nurses should follow their algorithm when an IV cannot be placed – patient's nurse, charge or most experienced nurse, ask about ultrasound guided IV from a nurse or provider, Vascular access team, PICU/NICU.
Pediatric Protected Time from Admissions
Peds ED Supplies
Cart between trauma 6 and trauma 7:
Drawer 1
Glidescope blades: Miller 0 and 1 and Lopro 1, 2, and 3s.
Drawer 2
3 sizes Glidescope stylets: small, medium, large.
Drawer 3
iGels, Katz extractors, extra LP needles, 3-way stopcocks, intranasal syringes, nose clamps for epistasis, disposable wire cutters
Drawer 4
Pediatric size chest tubes – 10fr – 24 fr
Drawer 5
Pediatric size c-collars (1-5)
Drawer 6
Pediatric LP trays (more of these in the med room) and pediatric central line kits sizes 4 fr and 5 fr.
New PED Team Members
Catherine De La Torre
Medical Case Worker, Office of Violence Prevention
Los Angeles County Department of Public Health
Dept: Psychiatric Department at Harbor
Hours: Monday - Wednesday & Friday from 8:00am-4:30pm
Cell: (323) 200-4107
DHS Crisis Response, Youth Suicide Prevention-Postvention Project at Harbor UCLA Medical Center
Nikki Radomsky
Certified Child Life Specialist
Current hours are 8am – 4pm M – F (we may adjust these as time goes on). Please make her feel welcome. We are so very excited to have her in the PED.
As usual, thank you so much for all that you do for our patients and their families. I am honored to work along side each of you. Please reach out anytime 310-930-6387 --Patricia
(Dr. Patricia Padlipsky)
IT Section
TEAMS Update
TEAMS Chat history now retained for 3 years
County Counsel has directed the CIO to change the Retention Period for our Teams Chats. This will include Chats inside meetings AND the one-to-one Chats we send each other through Teams.
On the one hand, you'll be able to use the Teams Search box to track down a comment in a Chat that's up to three years old.
On the other hand, even casual chats will be persistent for three years. May want to be careful about those 'side chats' on TEAMS. From now on "treat everything like it's an email" is the rule.
Cerner
If your FirstNet freezes please try this
You are on an active citrix session connecting you to Cerner/Oracle. Your "active session" is not reset when you restart your computer. You actually need to reset your citrix session or your "frozen" session will remain frozen even after logging off on your local computer.
How to do this:
You can also call IT to resolve this on shift
Please email Dr. Ross Fleischman if you experience this issue
Upcoming Events & Wellness
Organ and Tissue Donation Awareness
April is Donate Life Month!
Join us in raising awareness for organ and tissue donation. Harbor-UCLA will host a series of activities, culminating in the One Legacy Walk/Run on April 26.
Rounding Room Renovation
Residents: please fill out the coffee survey so we can get that fancy machine (the Jura Giga 10) in the rounding room!
Lockers have been removed and the walls have been repaired and repainted! It looks so pretty <3, hooray! Shoutout to the whole team involved in the renovation project!
The progress! (fyi, we moved the nerve cart to the TEE supply room)
Just for Fun - April Fool's Medical Jokes
In honor of April 1st, I asked ChatGPT what was the most epic medical April Fool's joke and this is what it gave me.
One of the most epic medical April Fool's jokes of all time comes from The British Medical Journal (BMJ) — known for slipping in clever and hilarious spoof articles every April 1st. Here's a legendary one:
🧠 BMJ's 1974 April Fool's Article: "Unilateral Left-Handedness in Southpaw Patients"
It claimed researchers had discovered a new syndrome: "Unilateral Left-Handedness" — where patients used their left hand only on one side of the body. The article included fake data, bizarre case reports, and pseudoscientific jargon, describing patients brushing their teeth with the left hand only on the left side, and shaving just half their face—because their "left-handedness" was restricted to the left side.
(lol, the humor of medical nerds)
Do you have any epic April Fool's jokes or pranks?
Thanks for reading until the end!
If you have updates, patient stories or reflections you would like to share in a future newsletter, please email Dr. Jen Roh, [email protected]