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Clinical Guides


Atrial Fibrillation

For patients presenting in Atrial Fibrillation please see current NYGH ED protocol


IMPORTANT: Phone contact with the interventionalist is required prior to all STEMI transfers and initiation of antiplatelets or heparin.

DO NOT GIVE TICAGRELOR until the patient is confirmed for PCI.

Please note: Sunnybrook is using one table for PCI for STEMI so there may be delays, redirect to UHN and then St.Mikes is still available.

Relevant PowerPlans (order through Firstnet):

  1. CrCU/ED Tenecteplase/TNKase for Myocardial Infarction/STEMI

  2. Enoxaparin for Myocardial Infarction/STEMI: Thrombolytic Given

Supporting documents linked to the PowerPlans and IV guidelines with their links on ERIC (links only active while @ NYGH)

  1. Thrombolysis for Myocardial Infarction: Inclusion and Exclusion Criteria  (Link) (PDF)

  2. Enoxaparin Dose Banding Table for Myocardial Infarction (STEMI) with Thrombolytic (Link) (PDF)

  3. IV Tenecteplase guidelines (Link) (PDF)

  4. IV enoxaparin guidelines (Link) (PDF)

Infectious Diseases

Blood Cultures


Lyme Disease

Lyme Disease 2023
Download PDF • 571KB

Rabies (Toronto Public Health) PEP/Reporting Tool

Rabies TPH May 2023
Download PDF • 177KB

To solely report an animal exposure without requesting PEP:

To request PEP:


NYGH Pediatrics Post Circumcision Care Guide

Post Circumcision Care
Download PDF • 687KB



Rib Fracture

Rib Fracture Protocol

  • Applied to patient with a rib fracture (either primary or secondary diagnosis) with plan to admit patient

  • Anaesthesia consulted by ER or Medicine for pain management for patients who are to be admitted

  • APS consult completed and patient started on pain management protocol (rib fracture order set to be created. This initial management will consist of multimodal analgesia (acetaminophen, NSAIDS, lyrica, opioids – likely PCA).  

  • Plan for patient to come down to block room after 1pm next business day for regional anesthesia if patient meets criteria. Criteria for regional block as follows: 

    • Thoracic epidural analgesia (TEA): bilateral rib fractures or flail chest with no coagulopathy or anti-coagulation 

    • Erector Spinae (ESP) catheter: unilateral rib fractures with no coagulopathy or anticoagulation 

    • Single Shot Serratus anterior (SA) block: if patient has coagulopathy or anticoagulated. 

  • Patients who will receive either TEA or ESP will require surgical bed while epidural or catheter is in place 3-4 days for nursing care. They may then be transferred back to their admitting service. Patients who receive SA block can be monitored in block room for 20-30min for Local Anaesthetic Toxicity (LAST) and then returned to their admission bed. Single shot blocks may be repeated q24hr a maximum of two times. 

Emerg: If a patient is to be admitted with a rib fracture, please consult anesthesia (this needs to be a phone call rather than a computer order - anaesthesia on call extension 6894) and they will try to see the patient within 24hrs. 

Communication Guides

NYGH Palliative Care Goals of Care Discussion Guide

NYGH Rapid Sequence Discussion Goals of Care Guide
Download PDF • 230KB


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