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Distal Radius Fracture
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject...
Treatment Options
Hormonal Forms of Treatment Progesterone only method: Norethindrone Acetate 10 mg daily; does not act as contraception; goal is amenorrhea while taking Estrogen & Progesterone method: Sprintec...
Residents
2025-2026 Residency Class Postgraduate Year One Residents: Lacey Hunter, PharmD lhunter1@cmh.edu Ashley Lewis, PharmD amlewis5@cmh.edu Mallory Stoll, PharmD mestoll1@cmh.edu Postgraduate Year...
Kirby Bauer Testing
In January 2010, the Clinical and Laboratory Standards Institute (CLSI) published new minimum inhibitory concentration (MIC) breakpoints for cefazolin against Enterobacteriaceae (Wayne, 2010). These new...
Toddler Tibia Fracture: Inclusion and Exclusion
Inclusion Criteria: Patients aged 1 to 4 years. Not bearing weight. Low energy mechanism, defined as: Fall from standing. Trip and fall Injury at the bottom of a slide. Stable tibial shaft or distal tibia...
Myelomeningocele: Clean Intermittent Catheterization (CIC)
After 24 hours of life, check post void residuals. To check post void residual, perform clean intermittent catheterization immediately after wet diaper. If post void residual is consistently above 20 ml...
Catheter Directed Thrombolysis
tPA 0.1-0.3 mg/kg (max dose 10 mg) bolus followed by 0.01-0.03 mg/kg/hr (max 2 mg/hr) x 24-72 hrs. Administer heparin at 10 units/kg/hr or decrease direct thrombin inhibitor rate by 50%. These pathways do...
AOM – Mild Bulging of Tympanic Membrane (TM)
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use...
Febrile Infant: HSV Risk
HSV risk factors: Less than 46 Days Old Ill appearance (off guideline) Prematurity: <37 weeks EGA - off guideline Maternal history of genital HSV lesions Maternal fever from 48 hours before...
Dacryocystocele 2023
Dacryocystoceles are typically noted shortly after birth and appear as a bluish swelling of the skin overlying the lacrimal sac and superior displacement of the medial canthal tendons. It is recommended...
Neisseria gonorrhoeae (GC) Eye Culture Results 2023
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Suspected Neonatal Conjunctivitis 2023
Neonatal conjunctivitis, also known as ophthalmia neonatorum, should be suspected clinically among neonates (≤ 28 days of age) with both injected conjunctiva and mucopurulent discharge, or among those...
Obtain CT or rMRI and Shunt Series
If possible, it is preferable to be consistent with imaging when evaluating for ventricular changes (such as if the patient had a prior CT, then obtain CT now or if patient had a prior rMRI...
Isokinetic Testing
What is Isokinetic Testing? After a major knee injury, isokinetic testing is used to assess the strength of the quadricep and hamstring of each leg. During this type of strength test, the amount of force...
Febrile Infant: Lumbar Puncture Considerations
There is substantial evidence Inflammatory Markers (IM) are predictive of invasive blood infections including bacterial meningitis. For this age group, the number of meningitis cases in published studies...
Preparing for CT Scan
CT scan media block What is a CT scan? A computed tomography scan (CT scan) uses computers and a moving X-ray machine to take pictures of the inside of the body. CTs can make detailed pictures of organs...
Education
Children's Mercy inpatients: Direct patient education on LMWH will be provided and documented by Children's Mercy pharmacists for Children's Mercy inpatients. Education will include potential for...
Acute Chest Syndrome: Severe or Rapidly Progressing ACS
Symptoms of Severe or Rapidly Progressing Acute Chest Syndrome: Oxygen saturation below 90% despite supplemental oxygen, Increasing respiratory distress, Progressive pulmonary infiltrates, and/or Decline...
Glucocorticosteroids
In the pediatric patient diagnosed with a refractory migraine, is glucocorticosteriods an effective treatment for the prevention of migraine relapse (return to ED or provider for relapse of the same...
Magnesium Sulfate
In the pediatric patient diagnosed with a refractory migraine, what is the efficacy of intravenous magnesium sulfate to decrease migraine pain in the Emergency Department? Plain language summary from the...