Unique Plan Description: ED Arrhythmia
Plan Selection Display: ED Arrhythmia
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2020-04-19 19:31:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-23 00:53:32
Available at all facilities: Yes

ED Arrhythmia
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		Stat, spec type = Blood
	D-Dimer Level - FH
		Stat, spec type = Blood
	Digoxin Level
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Magnesium Level
		Stat, spec type = Blood
	Thyroid Panel
		Stat, spec type = Blood
	ProBNP
		Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
	hs Troponin I - FH
		Stat, spec type = Blood
	Toxicology Screen DAU - MH/WH/JE
		T;N, Stat, Urine Random, spec type = Urine
	Drug Screen Urine - FH
		T;N, Stat, Urine Random, spec type = Urine
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine
Diagnostic Tests
Radiology
	ECG in ED
		Stat, Indication: Arrhythmia
	Chest 1 View
		T;N, Stat, Abnormal EKG
	Chest 2 View
		Stat, Abnormal EKG
IV Solutions

	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 500 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 125 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 100 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 75 ml/hr
	amiodarone 450 mg/D5W 250 mL
		250 mL, IV, STAT, T;N, 1 Dose(s)/Time(s)
			Comment: 1 mg/min (33ml) for 6hr then 0.5 mg/min (16.5ml/hr) continuous.
		450 mg, EVERY BAG, 1 mg/min
	amiodarone 900 mg/D5W 500 mL Titrate IN ED
		900 mg, EVERY BAG
		500 mL, IV, STAT, 1 Dose(s)/Time(s)
	amiodarone 360mg/D5W 200mL Premix IV
		200 mL, IV, Routine, T;N
			Comment: 1 mg/min (33ml) for 6hr then 0.5 mg/min (16.5ml/hr) continuous
		360 mg, EVERY BAG, 1 mg/min
	Cardizem 100 mg/100 mL NS Premix IV
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
			Comment: ACTIVATION REQUIRED PRIOR TO USE.  increase infusion to 15mg/hr if heart rate greater than or equal to 120 after second bolus. Discontinue Diltiazem infusion 1 hour after oral dose initiated.  Begin Tiazac 180 mg po when HR rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 5mg/hr. Begin Tiazac 240 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 10 mg/h.  Begin Tiazac 300 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 15 mg/hr.  Enter oral diltiazem order from Acute Atrial Fibrillation Powerplan.
	Cardizem 100 mg/100 mL NS Premix IV (JE)
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
	diltiazem 100 mg/NS 100 mL (FH)
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
	Brevibloc 2,500mg/250mL premix diluent IV
		2,500 mcg, EVERY BAG, 50 mcg/kg/min
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 50 mcg/kg/min, Increment Decrease: 50 mcg/kg/min, Increment Freq: 5 mg/kg/min, Max Dose: 300 mcg/kg/min
			Comment: If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
Medications
	amiodarone IVPB (MH/WH)
		150 mg, IV Large Volume - Premix, IVPB, Once, STAT
	amiodarone
		150 mg, Injection, IV Push, Once, STAT
	Cardizem
		0.25 mg/kg, Injection, IV Push, Once
			Comment: PRN heart rate >/= 120bpm, for 20 minutes. Give over 2 minutes, then begin diltiazem infusion at 10mg/hr. Max dose 20mg.
		0.35 mg/kg, Injection, IV Push, Once
			Comment: PRN heart rate > 120bpm 30 min after 1st bolus given. Give over 2 minutes, if heart rate greater than 120 bpm after bolus, increase infusion to 15mg/hr.  Max dose 25mg.
	atropine
		1 mg, Syringe, IV Push, Once, STAT
	Lopressor
		5 mg, Solution-Injection, IV Push, Once, STAT
		Adenosine Dosing Recommendations: IV dosing for Adults greater than 50 kg: 6 mg IV, flush with 20 mL(NOTE)*
	adenosine IV Push
		6 mg, Injection, IV Push, Once, STAT
		12 mg, Injection, IV Push, Once, STAT
	digoxin
		0.125 mg, Injection, IV PUSH, Once, STAT
		0.25 mg, Injection, IV PUSH, Once, STAT
		0.5 mg, Injection, IV PUSH, Once, STAT
Patient Care
	ED Cardiac Telemetry Monitoring
		T;N, Once
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Foley Catheter
		T;N, Insert, Once
	Oxygen Therapy, Nurse to Administer
		T;N
	Straight Catheter
		T;n, Insert, Once
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: arrhythmia
	Consult Hospitalist
		Reason for Referral: arrhythmia

ED Peripheral Lock Insert with Flush
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush, 4 hr
Patient Care
	Peripheral Lock-Insert
		T;N, Once

*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