Consulting Well: Pulm, Cards, OBGYN

Pulm/CC & FMC Collaboration

Call early for all complicated undifferentiated shock patients

any patient requiring rescue CPAP/BiPAP - FYI only to pulm for possible invasive ventilation need!

Guidelines for Early Pulm Consultation in the Critically Ill Patient:

• Patients with rapid deterioration or worsening clinical condition 

• Refractory shock to single vasopressor (≥ 0.2 mcg/kg/min) or sooner if assistance is needed for hemodynamic monitoring and fluid evaluation.   

• Respiratory failure that is not improving on NIPPV/Airvo or requiring probable intubation  

• PE with hemodynamic or respiratory instability  

• Submassive PE with cardiac complications (RV strain, elevated trop)

• Critically ill young (≥ 17 years old) or pregnant patients  

• Multisystem organ failure

• Massive transfusion protocol 

• Glasgow coma score < 9 

• Alcohol withdrawal/overdose with high risk for intubation  

• Pneumothorax 

• Persistent status epilepticus 

• Cardiac Arrest  

• Any perceived clinical need for cognitive or procedural assistance

OB & FMC Collaboration

INDICATIONS FOR C/S NECESSITATING COLLABORATION
– OB as primary surgeon

• Placenta accreta 

• Cesarean hysterectomy 

• Placenta previa

INDICATIONS FOR C/S NECESSITATING COLLABORATION
– Second skilled surgeon in the OR (FP or OB)

• Preterm delivery <30 weeks (OB) 

• Stat/crash c-section (abruption/general anesthesia/etc.)

• Transverse back down 

• 3rd c-section with other risk factors (history of adhesions, obesity, etc.) 

• 4th or greater c-section

INDICATIONS FOR C/S NECESSITATING COMMUNICATION with OB

• Morbid obesity BMI >45 

• High PPH risk

• Significant uterine fibroids (size > 4 cm) 

• Multiple gestation pregnancies 

• Preterm delivery <34 weeks

INPATIENT ANTEPARTUM OB PATIENTS

• Family Practice provider will notify OB hospitalist of patient

• If either provider wants or requests, a formal consultation will be performed 

• Care will not be assumed by obstetrics unless mutually agreed upon

• Patients >23 weeks going to the OR for non-obstetrical procedures require notification of provider with c/s privileges