CEN35....Our deptartment has an extablished orthopedic protocol. It has been approved by several different commitees in the hospital and approved by the orthopedic Doc's. On all isolated injuries (below the knee and below the shoulder) the nurses may triage an xray prior to MD eval. We also triage EKG's for pt's with complaints of CP. We don't really order much lab work without MD eval first. Hope this helps you. I'll try to find out more info. on establishing the algorhythms we use if you would like.