over vocera Orange HIP Alert Folder pulled by RN ED RN gives pain meds and then calls xray 21773 or call xray on vocera Prefer patient taken to Medical Imaging and have pelvis taken first Does Patient have HIP Fracture? NO Cancel HIP ALERT YES Does Patient have EXCLUSION FOR HIP BLOCK ? YES *6am to 9p (call Anesthesia Scheduler on vocera IN HOUSE HRS *Afterhours/weekends call answering service 480-478-6620 AZ Heart Anesthesia ED Provider orders Setup Hip Blockorder fromfavorites 1. Hip Block Cart 2. Hip Block Meds 3. Bring Ultrasound to Bedside Dispo Per ED Provider ED RN Performs HIP BLOCK Exclusion Checklist ED Provider to Call Orthopedics and Admitting Physician RN/Tech Place Ultrasound Machine & HIP Block Cart outside of patient roomand HIP BLOCK meds pulled fromPYXIS Anesthesia Arrives within 1 hour of consult ED Provider to order labs, imaging, analgesics Patient Admitted to 4A Ortho Med/Surg (with REMOTE TELE if getting hip block Patient can be admitted prior to all diagnostics resulted. Need hip fx confirmed, and exclusion labs for HIP block completed Patient presents with acute hip pain ED Staff ED Provider CONTRAINDICATIONS TO HIP BLOCK (absolute & relative) Patient Enters ED with HIP Pain Revised 9/8/2014 H. Patel MD NO NO Is Anesthesia IN HOUSE ? Place physician consult for anesthesia HUC will call AZ Heart answering service Indicate following in your consult order Reason: Notification for HIP BLOCK on floor when available 1. Call anesthesia scheduler on vocera 2. Confirm if they will be available to come to ED within 1hour or if they will be going to Ortho floor for HIP BLOCK 3. Place physician consult for HUC to document call Indicate following in your consult order Reason: HIP BLOCK consult(do not call already discussed) Step 1 Step 2 Will Hip Block be done in the ED? YES YES Do Not Order HIP BLOCK setup NO Do Not Call Anesthesia Step 3 ABSOLUTE CONTRAINDICATIONS: 1. known h/o allergic reaction to local anesthetics, 2. groin infection/cellulitis,( if able to performwithout going thru infected area may be relative contraindication) 3. cant get conset or pt refuses RELATIVE CONTRAINDICATIONS: 1. inr>2, platelets less than 70, or on anticoagulants(xarelto,pradaxa,eliquis etc) 2. groin hematoma/swelling fromfx 3.prior surgery in the area (i.e CFA, FA bypass) 4.less than 6months h/o weakness, paralysis, significant parathesia of the affected limb 5. impaired cognitive fxn who are unable to understand/consent for the block(or MPOA) 6. Morbid Obesity If not able to arrive within an hour or if unexpected delay, HIP block can be done on ortho floor. Do not delay patient transfer.