Lakeshore General Hospital

Consult the algorithm

Specific inclusion criterias: 

• Present signs of biliary colic

Specific exclusion criterias:

• Infection signs: Intense sweats, shivers, fever
• Intense pain for more than 12 h, not alleviated by analgesics
• Active and known liver disease
• Severe hematologic disorder
• Patient taking immunosupressants
• Ascites

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias: 

• Present signs of nephritic colic

Specific exclusion criterias:

• Signs or urosepsis: shivers, fever, nausea, vomiting, tachycardia
• Intense pain for <12 h, not alleviated by analgesics
• Patient taking immunosuppressants
• Kidney disease or single kidney

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias:

• MD/NP sends report of urinalysis which confirms hematuria

Specific exclusion criterias:

• Signs or urosepsis: shivers, fever, nausea, vomiting, tachycardia 
• Anuria (macroscopic obstructive hematuria)
• Intense pain for > 12h, not alleviated by PO analgesics
• Patient taking anticoagulants or immunosupressants
• Kidney disease or single kidney

To be filled out / given to the patient

Please print, fill out and fax the referral form. 

The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias (min of 1 out of 3):

• Substernal chest discomfort of characteristic quality & duration
• Discomfort provoked by exertion or emotional stress
• Discomfort relieved by rest or nitroglycerin within minutes

Specific exclusion criterias:

• According to the Canadian Cardiovascular Society classification: Grade III or IV angina
• Chest discomfort within the last 12 hours
• Hemodynamically unstable
• Crescendo pattern
• Known aortic stenosis

Exclusion criterias for stress test:

• Pt on B-blocker, Cardizem or Verapamil
• Arthritis to knee, hip or back
• Lumbar stenosis
• Patient not able to walk independently
• LBBB

To be filled out / given to the patient

Please print, fill out and fax the referral form. 

The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias: 

• Significant blood loss (toilet water completely red) 
• Referring MD/NP must do a rectal exam and write findings on reference form

Specific exclusion criterias:  

• Hemodynamic instability: tachycardia, hypotension                     
• Severe abdominal pain not relieved by PO analgesics                 
• Patient at risk of cardiac instability (ex: with implantable cardioverter-defibrillator, mechanical heart valve, CHA2DS2-VASc ≥ 3, LVEF ≤ 35%, etc.)            
• Repeated vomiting
• Hematemesis    
• Fever > 38.5 °C 
• Melena, maroon stool 
• ≥ 2 episodes of significant rectal bleeding in last 12 h

To be filled out / given to the patient

Please print, fill out and fax the referral form. 

The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias:

• < 13 weeks pregnancy

Specific exclusion criterias:

• >1 sanitary napkin/Hour
• Hemodynamically unstable
• Abdominal pain not relieved with PO analgesia
• Fever > 38,5 °C oral

To be filled out / given to the patient

Please print, fill out and fax the referral form. 

The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias: 

• Transient unilateral motor weakness
• Transient unilateral sensory deficit
• Transient speech difficulty, expressive or receptive
• Transient monocular vision loss

Specific exclusion criterias:

• Brief symptoms (<1 min)
• Extremity numbness accompanied by pain
• Isolated vertigo that is positional
• Stereotypical and frequently recurring symptoms over he past weeks 
• Migraine with aura 
• Progressive gait difficulty
• Generalized weakness
• Isolated memory/cognitive decline 

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias:

• Patient is experiencing NEW LLQ (left lower quadrant) pain >24h
• The following symptoms are common: Nausea / vomiting, fever > 37.5°C , constipation or change in bowel habits

Specific exclusion criterias:

• Signs of shock: hypotension, tachycardia, desaturation
• Intense pain not relieved by PO analgesia
• Signs of peritonitis: Abdominal rigidity, rebound tenderness upon abdominal palpation, absence of peristalsis

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias: 

• Presents signs and symptoms of AF (palpitations, tachycardia, fatigue, weakness, lightheadedness, mild dyspnea)

Specific exclusion criterias:

• Signs of hypoperfusion
• HR > 120 beats/min
• AF < 48 h  
• Syncope
• Signs of ischemia: angina, ↑ chest pain 
• Signs of severe heart failure: panting, palpitations, lipothymia
• Patient with mechanical heart valve
• Symptoms of TIA/stroke or previous event: partial paralysis, paralysis, numbness, aphasia, visual/cognitive impairment
• Significant arrhythmia
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Polymorphic ventricular tachycardia
  • Ventricular flutter
  • Idioventricular rhythm
  • Paroxysmal supra-ventricular tachycardia
  • AV block 2^nd degree Mobitz 2 or 3^rd degree
  • Wolf-Parkinson-White syndrome

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Consult the algorithm

Specific inclusion criterias: 

• Referring MD/ NP must specify Wells Score for the patient on the referral sheet.

Specific exclusion criterias:

• Febrile > 38,5 °C
• Hemorrhage/peptic ulcer within the last 3 months
• Kidney failure (eGFR <30)
• Severe liver failure (AST > 37 IU/L, ALT >41 IU/L)
• Patient anticoagulated
• Active bleeding
• Thrombocytopenia < 50 X 10⁹/L
• Signs of pulmonary emboli: Sudden chest pain (CP) or CP ↑ on deep breath, HR ≥100bpm, RR ≥22/min, O2 Sat<92% (unless chronic)
• Recent CVA
• Concomitant use of drugs that are strong CYP3A4 inhibitors and P-GP inhibitors (ex : antiepileptic, Amiodarone, Diltiazem, Omeprazole)

To be filled out / given to the patient

• Please print, fill out and fax the referral form. 
• The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document