Unique Plan Description: Anes for PACU EKM
Plan Selection Display: Anes for PACU
PlanType: Medical                                 
Version: 4          
Begin Effective Date: 2025-05-15 15:43:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-05-15 15:43:00
Available at all facilities: No

Anes for PACU EKM
Laboratory
Today's Lab
	Glucose POC - RN
		Once
			Comment: on arrival to PACU if on diabetic meds, or if diabetic.
	CBC with Diff
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
Diagnostic Tests

	Chest 1 View
		T;N
IV Solutions
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: in PACU
	albumin human 5% intravenous solution
		25 gm, 500 mL, Solution-Injection, IVPB, Once, T;N
			Comment: in PACU
	Lactated Ringers Injection
		1,000 mL, IV, 20 ml/hr
			Comment: Maintain IV in PACU
		500 mL, IV, Bolus in PACU
			Comment: In PACU
	Sodium Chloride 0.9%
		1,000 mL, IV, 20 ml/hr
			Comment: Maintain IV in PACU
Medications
	ketorolac injectable
		15 mg, Injection, IV PUSH, Once, T;N
			Comment: : In PACU, if not contraindicated for allergies, serum creatinine > 1.5mg/dL, asthma, bleeding, history ulcers, decreased urine output, SBP < 90mmHg. Do not give if given in PRE-OP, the OR, or the patient has received an NSAID in the past 12hr.
		15 mg, Injection, IM-IntraMUSCULAR, Once, T;N
			Comment: In PACU, if not contraindicated for allergies, serum creatinine > 1.5mg/dL, asthma, bleeding, history ulcers, decreased urine output, SBP < 90mmHg. Do not give if given in PRE-OP, the OR, or the patient has received an NSAID in the past 12hr.
		30 mg, Injection, IM-IntraMUSCULAR, Once, T;N
			Comment: Comment: In PACU, if not contraindicated for allergies, serum creatinine > 1.5mg/dL, asthma, bleeding, history ulcers, decreased urine output, SBP < 90mmHg. Do not give if given in PRE-OP, the OR, or the patient has received an NSAID in the past 12hr.
		Select only one of the following per pain level:(NOTE)*
	morphine  IV
		1 mg, Syringe, IV PUSH, Q5MIN, PRN for pain-in PACU (mild), duration: 15 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 15 mg.  Do not give if RR<10.
		2 mg, Syringe, IV PUSH, Q5MIN, PRN for pain-in PACU (mild), duration: 7 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 14 mg.  Do not give if RR<10.
		3 mg, Syringe, IV PUSH, Q5MIN, PRN for pain-in PACU (moderate), duration: 5 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 15 mg.  Do not give if RR<10.
		5 mg, Syringe, IV PUSH, Q5MIN, PRN for pain-in PACU (severe), duration: 3 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 15 mg.  Do not give if RR<10.
	Dilaudid Injectable
		0.2 mg, Injection, IV PUSH, Q5MIN, PRN for pain-in PACU (mild), duration: 7 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 1.4 mg.  Do not give if RR<10.
		0.3 mg, Injection, IV PUSH, Q5MIN, PRN for pain-in PACU (moderate), duration: 5 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 1.5 mg.  Do not give if RR<10.
		0.4 mg, Injection, IV PUSH, Q5MIN, PRN for pain-in PACU (severe), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 1.6 mg.  Do not give if RR<10.
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN for pain-in PACU (mild), T;N, duration: 12 Dose(s)/Time(s)
			Comment: In PACU, Maximum 300 mcg. Start at 25mcg for mild to moderate pain and for patients > 65 years old.  Do not give if RR<10.
		50 mcg, Injection, IV Push, Q5MIN, PRN for pain-in PACU (severe), T;N, duration: 6 Dose(s)/Time(s)
			Comment: In PACU, Maximum 300 mcg. Start at 50mcg for severe pain.  Do not give if RR<10.
		Phase II Recovery/Post Recovery Only- Choose only one of the following per pain level:(NOTE)*
	acetaminophen-codeine #3
		1 TAB, Tab, By Mouth, Once, PRN for pain-in PACU (mild)
			Comment: In PACU.  Do not give if RR<10.
		2 TAB, Tab, By Mouth, Once, PRN for pain-in PACU (mild)
			Comment: In PACU.  Do not give if RR<10.
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, BY MOUTH, Once, PRN for pain-in PACU (mild)
			Comment: In PACU.  Do not give if RR<10.
		2 TAB, Tab, BY MOUTH, Once, PRN for pain-in PACU (mild)
			Comment: In PACU.  Do not give if RR<10.
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		1 TAB, Tab, BY MOUTH, Once, PRN for pain-in PACU (moderate)
			Comment: In PACU.  Do not give if RR<10.
	Percocet 5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Once, PRN for pain-in PACU (mild)
			Comment: In PACU.  Do not give if RR<10.
	Percocet 10 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Once, PRN for pain-in PACU (severe)
			Comment: In PACU.  Do not give if RR<10.
	Roxicodone
		5 mg, Tab, BY MOUTH, Once, PRN for pain-in PACU (severe)
			Comment: In PACU.  Do not give if RR<10.
		Additional Medications(NOTE)*
	ondansetron
		4 mg, Injection, IV PUSH, Once, PRN for nausea and/or vomiting
			Comment: In PACU,
	Phenergan (MH/WH)
		12.5 mg, Injection, IM-Intramuscular, Once, PRN for nausea and/or vomiting, T;N
			Comment: in PACU; Give DEEP IM (thigh)
	Phenergan (FH)
		12.5 mg, Injection, IM-Intramuscular, Once, PRN for nausea and/or vomiting
			Comment: in PACU; Give DEEP IM (thigh)
		25 mg, Suppository, RECTALLY, Once, PRN for nausea and/or vomiting
		12.5 mg, Suppository, RECTALLY, Once, PRN for nausea and/or vomiting
	Compazine (JE)
		10 mg, Injection, IV Push, Once, PRN, nausea and/or vomiting
			Comment: In PACU,
	Reglan (JE/FH)
		10 mg, Injection, IV Push, Once, PRN, nausea and/or vomiting, T;N
			Comment: In PACU,
	Decadron (JE)
		4 mg, Injection, IV PUSH, Once, PRN, nausea, T;N
			Comment: In PACU,
	droPERidol (FH)
		0.625 mg, Injection, IV Push, Once, PRN for nausea and/or vomiting
			Comment: In PACU
	haloperidol  Injectable
		0.5 mg, Injection, IV Push, Once, PRN for nausea and/or vomiting
			Comment: In PACU
	Diprivan 1000 mg/100 mL vial Premix IV
		1,000 mg, EVERY BAG, 5 mcg/kg/min
		100 mL, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 5 mcg/kg/min, Incremental Decrease: 5 mcg/kg/min, Incremental Freq: 5 min(s), Max Dose: 50 mcg/kg/min
			Comment: Notify ordering LIP if unable to titrate up or down or if max dose is reached and the desired RASS score OR BIS goal is not achieved.  Change bottle and tubing q12hr..
	Vistaril (JE)
		50 mg, Injection, IM-IntraMUSCULAR, Once, T;N
			Comment: In PACU,
	meperidine
		12.5 mg, Syringe, IV PUSH, Q5MIN, PRN, shivering, 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 25 mg
		25 mg, Syringe, IV PUSH, Once, PRN, shivering
			Comment: In PACU,
		50 mg, Syringe, IV Push, Once, PRN, shivering
			Comment: In PACU,
	butorphanol
		2 mg, Injection, IV Push, Once, PRN for shivering, duration: 1 Dose(s)/Time(s)
			Comment: Modify dose to 1mg if patient less than 40kg.
	Benadryl
		25 mg, Injection, IV PUSH, Once, PRN, itching
			Comment: In PACU,
	Nubain (JE)
		10 mg, Injection, IV PUSH, Once, PRN, itching
			Comment: In PACU,
	Versed (JE)
		0.5 mg, Injection, IV PUSH, Once, PRN, anxiety
			Comment: In PACU, /agitation
	Ativan (JE)
		1 mg, Injection, IV PUSH, Once, PRN for pain-in PACU (mild)
			Comment: In PACU,
	Narcan
		0.1 mg, Injection, IV PUSH, Q5MIN, PRN, see comment, 4 Dose(s)/Time(s)
			Comment: In PACU, For sedation and or respiratory depression (respiratory rate less than or equal to 6bpm). Contact Anesthesiologist.
	flumazenil
		0.1 mg, Injection, IV PUSH, Q5MIN, PRN, see comment
			Comment: In PACU, For sedation and or respiratory depression (respiratory rate less than or equal to 6bpm) due to benzodiazepines. Max dose 0.2mg. Avoid in patients with history of seizures Contact Anesthesiologist.
	hydrALAZINE
		5 mg, Injection, IV PUSH, Q10MIN, PRN, see comment, 4 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90.Use if beta blocker contraindicated/ineffective or if heart rate less than 60. Max dose 20mg
		10 mg, Injection, IV PUSH, Q10MIN, PRN, see comment, 2 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90.Use if beta blocker contraindicated/ineffective or if heart rate less than 60. Max dose 20mg
		20 mg, Injection, IV PUSH, Once, PRN for see comment, duration: 1 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90.Use if beta blocker contraindicated/ineffective or if heart rate less than 60. Max dose 20mg
		Choose only one of the following:(NOTE)*
	Lopressor
		1 mg, Solution-Injection, IV PUSH, Q10MIN, PRN for see comment, duration: 10 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90. Do not give if heart rate less than 60. Max dose 10mg
		5 mg, Solution-Injection, IV PUSH, Q5MIN, PRN for see comment, duration: 3 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90. Do not give if heart rate less than 60. Max dose 15mg
	labetalol  injection
		5 mg, = 1 mL, Injection, IV PUSH, Q10MIN, PRN, see comment, 3 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90. Do not give if heart rate less than 60. Max dose 15mg
		20 mg, = 4 mL, Injection, IV PUSH, Q10MIN, PRN, see comment, 3 Dose(s)/Time(s)
			Comment: In PACU, For blood pressure greater than 155/90. Do not give if heart rate less than 60.  Max dose 60 mg.
		Choose only one of the following:(NOTE)*
	ePHEDrine
		25 mg, Solution, IV PUSH, Q10MIN, PRN, see comment, 2 Dose(s)/Time(s)
			Comment: In PACU, For BP < 80
	Neo-Synephrine (JE/WH)
		80 mcg, Syringe, IV PUSH, Q10MIN, PRN, systolic blood pressure < ....
			Comment: < 90 and symptoms of hypotension.  In PACU,
		40 mcg, Syringe, IV PUSH, Q10MIN, PRN, systolic blood pressure < ....
			Comment: < 90 and symptoms of hypotension.  In PACU,
	Neo-Synephrine (NMH)
		80 mcg, Injection, IV Push, Q10MIN, PRN for systolic blood pressure < (see comment)
			Comment: < 90 and symptoms of hypotension.  In PACU,
		40 mcg, Injection, IV Push, Q10MIN, PRN for systolic blood pressure < (see comment)
			Comment: < 90 and symptoms of hypotension.  In PACU,
	cloNIDine
		0.1 mg, Tab, SUBLINGUAL, Once, PRN, systolic blood pressure > (see comment)
			Comment: In PACU, 120mmHg; Use only if patient hemodynamically stable and no significant risk of hemorrhage.
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Once, T;N
			Comment: In PACU,
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, T;N
			Comment: In PACU,
	Aponvie 32 mg/4.4 mL intravenous emulsion
		32 mg, Injection, IV Push, PREOP, T;N
Patient Care
	Notify MD
		Notify Anesthesiologist if Respiratory rate less than 10
		Call supervising anesthesiologist when patient is ready to be discharged from PACU
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, Titrate->Keep Sats>/= to 92
	Continuous Pulse Oximetry by Nurse
		
Therapies
Respiratory Therapy
	Rapid Ventilator Weaning Protocol
		
Consults/Follow-up

	Consult Intensivist
		Reason for Referral: Ventilation
	Consult Pulmonologist
		Reason for Referral: Ventilation

zzlevalbuterol (Xopenex) 1.25mg (ONCE)
Medications
	levalbuterol 1.25 mg/3 ml inhalation solution
		0.5 mL, Solution-Nebulization, NEBULIZED, Once
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once

racemic epinephrine-NS (racepinephrine)
	racepinephrine 2.25% inhalation soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 3 mL sodium chloride 0.9% inh soln.
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 0.5 mL racemic EPINEPHrine

Anes Ocular Protocol
	LacriLube ophthalmic ointment
		1 appl, Ointment, Eye, Affected, Once, NOW
		1 appl, Ointment, Eye, Affected, Q6H, PRN, discomfort, Routine, T;N+360, 4 Dose(s)/Time(s)
Patient Care
	Cold Therapy
		T;N
			Comment: apply an ocular crushed ice pack to the eyes or a cold gel pack.
	Notify MD
		T;N+720, Ophthalmology if significant eye pain or visual disturbance after 12 hours
		T;N, Ophthalmology if severe symptoms persist after ocular lubricant and ice packs have been implemented

Phase II Recovery/Post Recovery
Medications
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	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Once, PRN pain-breakthrough
			Comment: In PACU phase 2.  Do not give if RR<10.
	oxyCODONE
		5 mg, Tab, By Mouth, Once, PRN pain-breakthrough
			Comment: In PACU phase 2.  Do not give if RR<10.

HYDROmorphone Low Dose PACU Order
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 50 mcg. Give before HYDROmorphone PRN severe pain doses administered.  Do not give if RR<10.
	HYDROmorphone Injectable
		0.5 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 1mg; may give after all fentanyl severe pain doses administered..  Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg.
		0.3 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 1.2mg.  Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg
		0.2 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 0.8mg. Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg.

Morphine High Dose PACU Order
	fentaNYL
		75 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 150 mcg. Give before morphine PRN severe pain doses administered.  Do not give if RR<10.
	morphine  IV
		7.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 15mg; may give after fentanyl severe pain doses administered..  Do not give if RR<10.
		5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 20mg..  Do not give if RR<10.
		2.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 10mg.  Do not give if RR<10.

Morphine Low Dose PACU Order
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 50 mcg. Give before morphine PRN severe pain doses administered.  Do not give if RR<10.
	morphine  IV
		2.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 5mg; may give after fentanyl severe pain doses administered.  Do not give if RR<10.
		1.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 6mg.  Do not give if RR<10.
		1 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 4mg..  Do not give if RR<10.

Morphine Standard Dose PACU Order
	fentaNYL
		50 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 100 mcg. Give before morphine PRN severe pain doses administered.  Do not give if RR<10.
	morphine  IV
		5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 10mg; may give after fentanyl severe pain doses administered.  Do not give if RR<10.
		2.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 10mg.  Do not give if RR<10.
		1.5 mg, Syringe, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose 6mg.  Do not give if RR<10.

HYDROmorphone High Dose PACU Order
	fentaNYL
		75 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 150 mcg. Give before HYDROmorphone PRN severe pain doses administered.  Do not give if RR<10.
	HYDROmorphone Injectable
		1.5 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 3mg; may give after fentanyl severe pain doses administered..  Do not give if RR<10. . Notify Provider if cumulative hydromorphone dose in PACU is 2mg.
		0.75 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 3mg.  Do not give if RR<10. . Notify Provider if cumulative hydromorphone dose in PACU is 2mg.
		0.5 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 2mg.  Do not give if RR<10. . Notify Provider if cumulative hydromorphone dose in PACU is 2mg.

HYDROmorphone Standard Dose PACU Order
	fentaNYL
		50 mcg, Injection, IV Push, Q5MIN, PRN pain-in PACU (severe), T;N, duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 100 mcg. Give before HYDROmorphone PRN severe pain doses administered.  Do not give if RR<10.
	HYDROmorphone Injectable
		1 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (severe), duration: 2 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 2mg; may give after fentanyl severe pain doses administered. Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg.
		0.5 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (moderate), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 2mg.  Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg
		0.3 mg, Injection, IV Push, Q10MIN, PRN pain-in PACU (mild), duration: 4 Dose(s)/Time(s)
			Comment: In PACU, Maximum dose = 1.2mg..  Do not give if RR<10. Notify Provider if cumulative hydromorphone dose in PACU is 2mg

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase