SCGH ED Clinical Guidelines

Note – The guidelines on this page are a combination of relevant guidelines for the management of a range of Emergency Department presentations, and include:

1. Health Department Guidelines
   • Available outside of the WA Health network
2. SCGH Hospital Wide Guidelines
   • Marked as “Intranet links”
   • These require access from within the WA Health network
   • Here is the link to the SCGOPHCG Policies Hub – including a A-Z title search
3. SCGH ED Specific Guidelines
   • Denoted by those having the date of development / most recent update after the title (ie. – 10/2019)
   • These are predominantly developed by SCGH ED staff in consultation with the relevant inpatient specialty teams for use within the emergency department
   • These documents are hosted directly on this website and are accessible for anyone, regardless of the point of internet access

For guidelines not covered on this page. Here is a list of Non-SCGH Clinical Guidelines that provide some useful guidance in patient management for a range of presentations / conditions not included in this list below.

(**) password protected – as per password for EDPACS

Administration / Legal

• SCGH Admission and Bed Allocation Policy – Intranet link
• SCGH General Medicine Orientation Manual (download link that includes the “Sub-Speciality Admission Criteria” starting at page 75) – Intranet link
• SCGH Specialty Admission Criteria – Intranet link
  • SCGH Respiratory Admission Guidance – 12/2020
• Perth Tertiary Hospital Metropolitan Catchment Areas
  • NMHS Catchment Area Map – Intranet link
  • SMHS Catchment Area Map
  • EMHS Catchment Area Map
• Forensic Blood Sampling – Legislation (update 3/2017)
• Patient Confidentiality – 08/2018

Allied Health & Support Services

• Language and Interpreter Services – summary document, including link to SCGH Policy 034
• Alcohol and Drug Service (ADS) – Intranet link

Analgesia and Anaesthetics

• SCGH Acute Pain Service (APS) Pocket Guide – 01/2021
• Analgesia in the ED – 04/2015 **
• Hydromorphone – 04/2015
• Oral opiates as discharge medications – 04/2015 **
• Oral Opioid Prescribing in Acute NON-Cancer Pain (from SCGH Medications Guidelines) – Intranet link
• Intranasal Fentanyl: Emergency Department – Intranet link
• CPOP – Community Program for Opioid Pharmacotherapy – Intranet link
• Bier’s block – 06/2019
• Local anaesthetic infiltration – 05/2017
• Procedural sedation documentation and checklist – 08/2010
• Femoral Nerve Block Procedure – 03/2019

Cardiology

• Chest pain pathway (03/2015) & Code STEMI Protocol (04/2020)
• Atrial fibrillation with Tachycardia – 02/2016
• Defibrillation – 05/2009
• Electrical cardioversion – 05/2009
• Transthoracic cardiac pacing – 05/2009
• ECMO for OOHCA – 10/2017
  • ECMO / ECPR Resources

Cardiothoracics

• Policy for the insertion of a chest drain by trainees – 05/2015
  • Chest Drain Insertion Guideline – 05/2009
  • Blunt Dissection Chest Drain (28Fg) Insertion Pack
• Chest wall injury (rib fractures) – 01/2015
• ECMO for OOHCA – 10/2017
  • ECMO / ECPR Resources

Critical Care

• Airway management – 01/2013
• SCGH Massive Transfusion Protocol – Intranet link
• Tissue (Organ) donation – 09/2015
• Central line insertion – 05/2009
• Metaraminol: High Dependency Unit – Intranet link
• Central Venous Line (CVL) – SCGH Recommended Fixation Standard – 11/2015
• Post resuscitation care – 01/2013
• ECMO for OOHCA – 10/2017
  • ECMO / ECPR Resources

Dental

• Dental injuries – 11/2015

Dermatology

• Delusional Parasitosis

Disaster

• SCGH ED Disaster Management Resources – where can I find them in the ED?

ED Ultrasound

• SCGH ED Clinician Performed Emergency Ultrasound Guidelines – 01/2008

Endocrine

• Adult Variable Rate Intravenous Insulin Guideline (updated 02/2021) – Intranet link
• Adult Diabetic Ketoacidosis (DKA) Guideline (updated 02/2021) – Intranet link
  • DKA Flow Pathway / Disposition Plan – 06/2020
  • SGLT2 Inhibitors (gliflozins) and Euglycaemic Ketoacidosis – 03/2019
• Adult Hyperosmolar Hyperglycaemic State (HHS) Guideline (updated 02/2021) – Intranet link
• Updated 2020 Diabetic Guidelines Educational Package – Intranet link

ENT

• Epistaxis – 06/2020

Environmental

• Anaphylaxis – 11/2013
• Diving emergencies – 09/2015

Gastroenterology & Hepatology

• Upper GI bleeding – 10/2017
• Paracentesis in Chronic Liver Disease – Intranet link
• Decompensated Chronic Liver Disease Guideline – 02/2017
• PEG re-insertion – 01/2009

General Medicine

• Eating Disorder Management – 09/2016
• Hyponatraemia Management Guidelines – 07/2020
  • How to make 1.8% and 3% saline solutions from hypertonic saline 23.4%
• Suspected Cauda Equina Pathway – 07/2020

General Surgical

• Hot surgical clinic – 02/2015

Geriatric Medicine

• Frail Rapid Access Clinic (FRAC) – Referral Tips – 04/2020

Haematology & Oncology

• SCGOPHCG Transfusion Policy Manual – Intranet link
  • Transfusion Forms – Intranet link
• SCGH Massive Transfusion Protocol – Intranet link
• Jehovah’s witnesses and blood products – 11/2015 **
• Febrile Neutropenia Management Guideline – Intranet link
• Iron infusions for chronic anaemia – 12/2020 – Intranet link
• Blood transfusion reaction algorithm – 11/2015
• NOAC’s and bleeding – 11/2013
• Management of Immune Related Adverse Events Associated with use of Immune Checkpoint Inhibitors – Intranet link
• Vaccine Induced Immune Thrombotic Thrombocytopaenia (VITT):
  • THANZ Advisory Statement for Haematologists: Suspected Vaccine Induced Prothrombotic Immune Thrombocytopenia (VIPIT)/Vaccine induced immune thrombotic thrombocytopaenia VITT) – 15/05/2021 (link should take you to updated guidelines)
  • ACEM – Thrombosis with Thrombocytopaenia Syndrome (TTS) following COVID-19 vaccination: Assessment of patients presenting to the Emergency Department with TTS symptoms
  • DOHWA: VITT Clinican Alert (16th of April 2021)
  • Where to report vaccine associated adverse events:
    • Western Australia Vaccine Safety Surveillance (WAVSS) System

Immunology

• Anaphylaxis – 11/2013
• Management of Immune Related Adverse Events Associated with use of Immune Checkpoint Inhibitors – Intranet link
• PEP (Post Exposure Prophylaxis) HIV: Starter Packs for Occupational and Non-Occupational exposure – Intranet link
• Where to report vaccine associated adverse events:
  • Western Australia Vaccine Safety Surveillance (WAVSS) System

Infectious Disease

• SCGH ED COVID-19 Guidelines – 03/2020
  • Vaccine Induced Immune Thrombotic Thrombocytopaenia (VITT):
    • THANZ Advisory Statement for Haematologists: Suspected Vaccine Induced Prothrombotic Immune Thrombocytopenia (VIPIT)/Vaccine induced immune thrombotic thrombocytopenia VITT) – 15/05/2021 (link should take you to updated guidelines)
    • ACEM – Thrombosis with Thrombocytopaenia Syndrome (TTS) following COVID-19 vaccination: Assessment of patients presenting to the Emergency Department with TTS symptoms
    • DOHWA: VITT Clinican Alert (16th of April 2021)
    • Where to report vaccine associated adverse events:
      • Western Australia Vaccine Safety Surveillance (WAVSS) System
• SCGH ED Adult Sepsis Pathway – 12/2019
• SCGH Infection Control Unit – Intranet link
• SCGH Infection Protection and Control Manual – Intranet link
• Patient Placement/Admission Criteria: Standard & Additional Transmission Based Precautions (PS026) – Intranet link
• SCGH Viral Haemorrhagic Fever Policy – Intranet link
• Standard and Transmission Based Precautions Policy Includes a table at the bottom that lists precautions indicated for each infectious agent. Note: Airborne Infection Isolation Rooms (AIIRs) must be used for patients with the following conditions:
  • Pulmonary tuberculosis
  • Chickenpox or disseminated shingles infections
  • Measles
  • SARS
  • Avian Influenza
  • Viral Haemorrhagic Fever
  • +/- Mumps (droplet precautions, but prefer door!)
• SCGH Infectious Disease Guidelines – Intranet link
  • SCGH Antimicrobial prescribing policy – Intranet link
• SCGH Antimicrobial Formulary List – Intranet link
  • This list has been created to identify the antimicrobials available and outline the restrictions that exist for certain antimicrobials prescribed at SCGH.
• Febrile Neutropenia Management Guideline – Intranet link
• Admission criteria – HITH (IV Antibiotics) – Intranet link
• STIs – 07/2016
• Sepsis Triage Screening Tool – 01/2018
• Guidelines for Rabies and Australia Bat Lyssavirus exposure – Intranet link
• MERS CoV – 06/2015
• PEP (Post Exposure Prophylaxis) HIV: Starter Packs for Occupational and Non-Occupational exposure – Intranet link
• Blood Cultures – How and when to take (SCGOPHCG Guideline) – Intranet link

Legal

• Forensic Blood Sampling – Legislation (update 3/2017)

Neurology

• Stroke Call Pathway – 05/2021
  • Acute Large Vessel Occlusion (LVO) Stroke: Emergency Clot Removal Information Sheet – 5/2017
• Spontaneous intracerebral haemorrhage – 11/2014
• Vertigo Assessment Guideline – 11/2020
• Lumbar puncture – 05/2009
• Seizures – 09/2009
  • FSH ED Seizure Guideline – 12/2014 
  • SCGH First Seizure and Epilepsy: SAFETY & DRIVING INSTRUCTIONS – 11/2016

Neurosurgery

• Head injury – 05/2015
• Spinal cord injury assessment and documentation – 04/2015
• Suspected Cauda Equina Pathway – 07/2020

Oncology

• Febrile Neutropenia Management Guideline – Intranet link
• Management of Immune Related Adverse Events Associated with use of Immune Checkpoint Inhibitors – Intranet link

Ophthalmology

• Emergency Eye Assessment Sheet – 12/2016
• Acute Angle Closure Glaucoma Management – 01/2020

Orthopaedics

• Arthrocentesis (joint aspiration) – 05/2009
• Spinal cord injury assessment and documentation – 04/2015
• Femoral Nerve Block Procedure – 03/2019
• Bier’s block – 06/2019
• Orthopaedic Investigation Ordering Guideline – 08/2019
• Basic Fracture Treatment – 05/2018
• Base of 5th Metatarsal Fracture – Patient Information Handout – 01/2018

O&G

• Mx of of 1st Trimester Pain &/or Bleeding – 10/2015
• Sexual assault – 02/2009
• Obstetric patients at SCGH ED – 11/2015
• Radiology Procedure for Imaging Pregnant Patients – 01/2016

Paediatrics

• Perth Children’s Hospital (PCH) Guidelines & Calculators
• Children’s Antimicrobial Mx (ChAMP) Guidelines
• Kids Health WA Paediatric Calculators

Palliative Care

• SCGH Palliative Care Service webpage – Intranet link
  • Evidence Based Clinical Guidelines for adult patients in terminal phase – palliative care book

Pharmacy

• SCGH Medication Guidelines – Intranet link

Psychiatry & Behavioural

• SCGH ED Policy – Mental Health Crisis Transfers Policy (ie. via SJA / Police / RFDS / Private Hospital)
  • Mental Health Catchment Areas – 02/2016
• NMHS Patient Flow Process to access a Mental Health Bed – 3/2014
• Eating Disorder Management – 09/2016
• Delusional Parasitosis
• Child & Adolescent Mental Health Service (CAMHS)
  • CAMHS Emergency Telehealth Service
    • General Flyer
    • Health Professionals Flyer

Radiology

• Radiology Procedure for Imaging Pregnant Patients – 01/2016
• Cervical spine injury investigation – 01/2015
• Pulmonary embolism initial diagnostic pathway – 05/2011
• X-Ray Risk Calculator – as the name suggests
• Diagnostic Imaging Pathways WA DOH

Renal

• CAPD peritonitis – 02/2014

Respiratory

• SCGH Respiratory Admission Guidance – 04/2021
• Policy for the insertion of a chest drain by trainees – 05/2015
  • Chest Drain Insertion Guideline – 05/2009
  • Blunt Dissection Chest Drain (28Fg) Insertion Pack
• COPD – 08/2015
• Pulmonary embolism initial diagnostic pathway – 09/2017
• Pulmonary embolism advanced care pathway – 02/2021
• Pneumothorax – 04/2014 (for review)

Toxicology and Toxinology

• Toxicology Hanbook (3rd Edition) – via SCGH Library
• Paracetamol poisoning – 06/2019
• Lithium toxicity – 04/2016
• Snake bite envenomation – 09/2015
• Emergency Department Prescription and Recreational Drug Screening Trial – 12/2015

Trauma

• Resuscitation / Trauma Team Roles – 4/2015
• SCGH Trauma Call Criteria – 02/2021
• Traumatic Cardiac Arrest Guideline (Royal Melbourne Hospital) – 5/2018
• Cervical spine injury investigation – 01/2015
• Philadelphia collar application – 04/2015
• Head injury – 05/2015
• Femoral Nerve Block Guideline – 03/2019
• Burns Assessment & Management – 08/2019
• Wound Closure Advice from Closing the Gap Website

Urology

• Urinary catheterisation – 05/2009

Vascular

• Deep Vein Thrombosis (DVT) – 9/2019
• Central catheter related venous thrombosis – 04/2014
• Foot and leg ulcers – 05/2015