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UMMC ANESTHESIA PRIORITY POSTING INFO (Document)
ADULT URGENCY CLASSIFICATION:
LEVEL 0:
a. Clinical or radiographic signs of brainstem herniation
b. Deteriorating Airway
c. Hemodynamically abnormal
i. Maintaining BP with active transfusions
ii. Maintaining BP with vasopressors
iii. Systolic BP < 100
Level A: Acute life and death emergencies to OR within 30 minutes
a. Cardiac surgery postoperative bleeding with tamponade
b. Cardiorespiratory decompensation (severe)
c. Code Grey – stroke revascularization (typically endovascular but possibly open)
d. Liver transplant postoperative emergency
e. Penetrating trauma to the torso without Level Zero criteria
f. Ruptured AAA/TAA
Level B: Emergent, but not immediately life threatening to the OR within 2 hours
a. Acute mastoiditis with complication (CNS, facial nerve)
b. Acute mesenteric arterial thrombosis
c. Acute shunt malfunction
d. Acute sinusitis with complication (CNS, visual)
e. Acute spinal cord compression
f. Bladder rupture
g. Bowel perforation – traumatic/nontraumatic
h. Cardiac congenital emergencies with hemodynamic or pulmonary instability
i. Cauda Equina syndrome
j. Caustic esophageal foreign body
k. Compartment syndrome
l. ECMO cannulation
m. Ectopic pregnancy
n. Embolization for acute hemorrhage
o. Endophthalmitis with hand motion to light perception vision
p. Epistaxis not controllable by nonoperative
techniques
q. Esophageal atresia with tracheoesophageal fistula – unstable
r. Femoral neck fracture in young patient
s. Free flap with arterial compromise
t. Head and neck abscess with airway compromise
u. Hematoma with impending complication
v. Irreducible fracture dislocations with pressure on the skin or neurovascular bundle
w. Incarcerated hernia
x. Intraocular foreign body
y. Intraorbital foreign body with vision loss
z. Intussusception – irreducible
aa. Ischemic limb – compromised arterial flow
bb. Macula on retinal detachment
cc. Neurosurgical condition with acute deficits and brain compression but not impending herniation
dd. Open globe (infections or traumatic)
ee. Orbital blow out fracture with muscle entrapment
ff. Organ procurement
gg. Periorbital abscess with decreased visual activity
hh. Pneumoperitoneum
ii. Reimplantation of fingers, hand or arm
jj. Sepsis with a surgical source
kk. Spontaneous abortion
ll. Tonsil bleed
mm. Torsion of testis/ovary
nn. Uncontrolled sight threatening high intraocular pressure
oo. Wound dehiscence
Level C: Urgent – to the OR within 4 hours
a. Airway (nonsymptomatic
foreign body)
b. Appendicitis with sepsis/rapid progression
c. Biliary obstruction not amenable to nonoperative
therapies
d. Cardiac ventricular assist device placement
e. Cerebral angiogram for intracranial hemorrhage
f. Chest tube placement
g. Contaminated wounds – multiple trauma
h. Hepatic angiogram with suspected vascular thrombus
i. Hip dislocation
j. Irreducible fracture dislocations without obvious neurovascular compromise
k. Intestinal obstruction without suspicion of bowel compromise
l. Massive soft tissue injury
m. Nephrostomy tube placement in septic patients
n. Neurosurgical condition with chronic or subacute deficits and brain compression
o. Obstructed kidney stones in septic patients
p. Open depressed skull fracture
q. Open fracture with obvious contamination
r. Open management of ruptured intracranial aneurysm (endovascular/offsite management of ruptured aneurysm
s. Septic joints
t. Vascular access when patient is without existing line
Level D: Semi – Urgent tothe OR within 8 hours
a. Abscess drainage – not septic Appendicitis – stable
b. Caustic ingestion
c. Chronic airway foreign bodies
d. Clip occlusion of intracranial aneurysm
e. Closure of abdomen – liver transplant
f. Complex eyelid lacerations
g. Complex facial laceration requiring anesthesia
h. Esophageal foreign body without airway compromise
i. Facial nerve laceration
j.
k. GJ tube/NJ tube placement with no other nutritional access
l. Head and neck abscesses without complications
m. Hematuria with clot retention
n. Joint aspiration or bone biopsy prior to starting antibiotic therapy
o. Lacrimal canaliculus lacerations
p. Nephrostomy tube – not septic
q. Obstructed kidney stones – not septic
r. Open fracture without obvious contamination
s. Open wound to face requiring debridement
t. TMJ dislocation
u. Tunneled dialysis catheter
Level E: Semi – Urgent to the OR within 48 hours –but does not require manipulation of the elective schedule
a. Broviac/Port insertion in a patient not urgently needing access
Urgency Case Classification and Bump Policy
Page 7 of 14
Published Date: 11/24/2014 Effective Date: 9/17/2014 HPOSORGENPO00026
b. Burn debridement/coverage
c. Cholecystectomy
d. Chronic retinal detachment
e. Closed or open reduction of closed fracture
f.
g. Esophageal atresia with tracheoesophageal fistula
h. Feeding access
i. Femoral neck fracture in an old patient
j. Fundoplication with or without feeding access
k. Inguinal hernia – non incarcerated
l.
m. Liver biopsy
n. Lymph node biopsy
o. Mastoidectomy without complication
p. Maxillofacial trauma with open wound
q. Percutaneous or open thrombectomy of an autogenous dialysis fistula (not prosthetic)
r. Pyloromyotomy
s. Sever vitreous hemorrhage
t. VATS/decortication
7. Level T: Transplant
a. Cardiac transplant*
b. Kidney transplant*
c. Liver transplant*
d. Organ Procurement*
e. Pancreas transplant*
PEDIATRIC URGENCY CLASSIFICATION:
Level Zero
a. Clinical or radiographic signs of brainstem herniation
b. Deteriorating Airway
c. Hemodynamically abnormal
i. Maintaining BP with active transfusions
ii. Maintaining BP with vasopressors
iii. Hypotension (specific level according to age)
Level A: Acute life and death emergencies to OR within 30 minutes
a. Button battery esophageal foreign body
b. Cardiac surgery postoperative bleeding with tamponade
c. Cardiorespiratory decompensation (severe)
d. Compartment syndrome or impending ischemia
e. Code Grey – stroke revascularization (typically endovascular but possibly open)
f. Intestinal obstruction with suspicion of compromised bowel
g. Liver transplant postoperative emergency
h. Malrotation with suspicion of volvulus
i. Multiple magnet ingestion
j. Penetrating trauma to the torso without Level Zero criteria
k. Post tonsillectomy hemorrhage
l. Torsion of testis/ovary
m. Unstable airway foreign body
Level B: Emergent, but not immediately life threatening to the OR within 2 hours
a. Acute mastoiditis with complication (CNS, facial nerve)
b. Acute mesenteric arterial thrombosis
c. Acute shunt malfunction
d. Acute sinusitis with complication (CNS, visual)
e. Acute spinal cord compression
f. Bladder rupture
g. Bowel perforation – traumatic/nontraumatic
h. Cardiac congenital emergencies with hemodynamic or pulmonary instability
i. Cauda equina syndrome
j. Caustic esophageal foreign body
k. ECMO cannulation
l. Ectopic pregnancy
m. Embolization for acute hemorrhage
n. Endophthalmitis with hand motion to light perception vision
o. Epistaxis not controllable by nonoperative
techniques
p. Esophageal atresia with tracheoesophageal fistula – unstable
q. Free flap with arterial compromise
r. Head and neck abscess with airway compromise
s. Hematoma with impending complication
t. Incarcerated hernia
u. Initial gastrochisis or ruptured omphalocele
v. Intraocular foreign body
w. Intraorbital foreign body with vision loss
x. Intussusception – irreducible
y. Ischemic limb – compromised arterial flow
z. Macula on retinal detachment
aa. Neurosurgical condition with acute deficits and brain compression but not impending herniation
bb. Newborn intestinal obstruction
cc. Open globe (infections or traumatic)
dd. Orbital blow out fracture with muscle entrapment
ee. Organ procurement
ff. Periorbital abscess with decreased visual activity
gg. Pneumoperitoneum
hh. Reimplantation of fingers, hand or arm
ii. Sepsis with a surgical source
jj. Spontaneous abortion
kk. Uncontrolled sight threatening high intraocular pressure
ll. Wound dehiscence
mm. Septic hip different from septic joint
nn. Unstable SCFE, Femoral neck fracture and hip dislocation
Level C: Urgent – to the OR within 4 hours
a. Airway (nonsymptomatic foreign body)
b. Appendicitis with sepsis/rapid progression
c. Biliary obstruction not amenable to nonoperative
therapies
d. Cardiac ventricular assist device placement
e. Cerebral angiogram for intracranial hemorrhage
f. Chest tube placement (unstable vital signs increased work of breathing or decrease SaO2
g. Contaminated wounds – multiple trauma
h. Hepatic angiogram with suspected vascular thrombus
i. Hip dislocation
j. Intestinal obstruction without suspicion of bowel compromise
k. Liver laparotomy
l. Massive soft tissue injury
m. Nephrostomy tube placement in septic patients
n. Neurosurgical condition with chronic or subacute deficits and brain compression
o. Obstructed kidney stones in septic patients
p. Open depressed skull fracture
q. Open management of ruptured intracranial aneurysm (endovascular/offsite management of ruptured aneurysm
r. Vascular access when patient is without existing line
Level D: Semi – Urgent to the OR within 8 hours
a. Caustic ingestion
b. Chest tube placement (patient with stable vital signs)
c. Chronic airway foreign bodies
d. Clip occlusion of intracranial aneurysm
e. Closure of abdomen – liver transplant
f. Coarctation repair in newborn
g. Complex eyelid lacerations
h. Complex facial laceration requiring anesthesia
i. Esophageal foreign body without airway compromise
j. Facial nerve laceration
k. GJ tube/NJ tube placement with no other nutritional access
l. Head and neck abscesses without complications
m. Hematuria with clot retention
n. Joint aspiration or bone biopsy prior to starting antibiotic therapy
o. Lacrimal canaliculus lacerations
p. Nephrostomy tube – not septic
q. Obstructed kidney stones – not septic
r. Open fracture – grade III
s. Open fracture
t. Open wound to face requiring debridement
u. Septic joint
v. TMJ dislocation
w. Tunneled dialysis catheter
Level E: Semi – Urgent to the OR within 48 hours –but does not require manipulation of the elective schedule
a. Abscess drainage not septic
b. Appendicitis stable
c. Broviac/Port insertion in a patient not urgently needing access
d. Burn debridement/coverage
e. Cholecystectomy
f. Chronic retinal detachment
g. Closed reduction
h.
i. Esophageal atresia with tracheoesophageal fistula
j. Extension type III supracondylar humerus fracture
k. Feeding access
l. Femoral neck fracture
m. Fundoplication with or without feeding access
n. Gastroschisis/omphalocele – final reduction and closure
o. Inguinal hernia – non incarcerated
p.
q. Liver biopsy
r. Lymph node biopsy
s. Mastoidectomy without complication
t. Maxillofacial trauma with open wound
u. Open fracture – grade I/II
v. Open reduction of fracture
w. Percutaneous or open thrombectomy of an autogenous dialysis fistula (not prosthetic)
x. Pyloromyotomy
y. Sever vitreous hemorrhage
z. Unstable slipped capital femoral epiphysis
aa. VATS/decortication
Level T: Transplant
a. Cardiac transplant*
b. Kidney transplant*
c. Liver transplant*
d. Organ Procurement*
e. Pancreas transplant*
*(Applies to A and B cases) The transplant team (or MORA in the case of procurement) will call the AIC to inform
them of the intended start time for the transplant. Every effort will be made to give the AIC and the OR a minimum
of 3 hours’ notice for a level T case. Every effort will be made by the AIC and the OR to ensure that the case starts
within 30 minutes of that time.
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