Unique Plan Description: ED Critical Care Meds
Plan Selection Display: ED Critical Care Meds
PlanType: Medical                                 
Version: 4          
Begin Effective Date: 2020-05-06 08:40:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-08-22 14:32:08
Available at all facilities: Yes

ED Critical Care Meds
IV Solutions
		Post Intubation Meds(NOTE)*
	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.
	fentaNYL 2500mcg/NS 250mL
		2,500 mcg, EVERY BAG, 25 mcg/hr
		250 mL, IV
			Comment: Start at 25mcg/hr.  Incremental dose increase: 25mcg/hr, incremental dose decrease 25mcg/hr, incremental frequency 30min; RASS sedation goal of 0 to -1.  Max dose of 300mcg/hr.  Contact ordering LIP if unable to titrate up or down or if max dose is reached and the desired RASS sedation goal OR BIS goal is not achieved. Give 25mcg fentaNYL IV push with an increase in rate of continuous fentanyl infusion. Reorder from pharmacy 1 hr before needed.
	fentaNYL 1250mcg/NS 125mL
		125 mL, IV
			Comment: Start at 25mcg/hr. Titrate by 25 mcg/hr at a maximum of every 30 minutes until desired RASS score achieved.  Max dose of 300mcg/hr. Reduce dose by 25mcg/hr at a minimum every 30 minutes after adequate sedation established and adjust to desired RASS score.  Contact 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.  Reorder from pharmacy 1 hr before needed.
		1,250 mcg, EVERY BAG, 25 mcg/hr
	Ativan 50mg/50mL Premix
		50 mg, EVERY BAG, 0.5 mg/hr
		50 mL, Solution, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 0.5 mg/hr, Incremental Decrease: 0.5 mg/hr, Incremental Freq: 20 min(s), Max Dose: 4 mg/hr
			Comment: Notify ordering LIP, lisenced internal practitioner, if unable to titrate up or down or if max dose is reached and the desired RASS score OR BIS goal is not achieved.
	Ativan 50mg/50mL IV
		50 mL, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 0.5 mg/hr, Incremental Decrease: 0.5 mg/hr, Incremental Freq: 20 min(s), Max Dose: 4 mg/hr
			Comment: Notify ordering LIP, lisenced internal practitioner, if unable to titrate up or down or if max dose is reached and the desired RASS score OR BIS goal is not achieved.
		50 mg, EVERY BAG, 0.5 mg/hr
	Versed 50 mg/NS 50 mL Premix
		50 mg, EVERY BAG, 2 mg/hr
		50 mL, Solution, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 0.5 mg/hr, Incremental Decrease: 0.5 mg/hr, Incremental Freq: 30 min(s), Max Dose: 4 mg/hr
			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.
	Versed 50 mg/NS 50 mL IV
		50 mL, route of administration: IV, pharmacy order priority: Routine, requested start date/time T;N, RASS Sedation Goal: 0 to -1, incremental dose increase 0.5 mg/hr, incremental dose decrease 0.5 mg/hr, incremental freq: 30 min(s), maximum dose: 4 mg/hr
			Comment: Notify ordering LIP if unable to titrate up or down or if max dose is reached and the desired RASS score is not achieved.
		50 mg, EVERY BAG, 2 mg/hr
		Pressors(NOTE)*
	EPINEPHrine 5 mg/NS 250 mL
		5 mg, EVERY BAG, 1 mcg/min
		250 mL, IV, STAT, Duration: 1 Dose(s)/Time(s), Increment Increase: 1 mcg/min, Increment Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 20 mcg/min
			Comment: Concentration: 20mcg/mL.  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.
	Levophed 8mg/D5W 250mL Premix
		250 mL, IV, STAT, Increment Increase: 1 mcg/min, Increment Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 30 mcg/min
			Comment: **LEVOPHED** Concentration: 32mcg/mL .  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.
		8 mg, EVERY BAG, 8 mcg/min
		Post Resuscitative Meds(NOTE)*
	Levophed 4mg/D5W 250mL Premix
		4 mg, EVERY BAG, 8 mcg/min
		250 mL, drug form: IV Large Volume, route of administration: IV, pharmacy order priority: STAT, duration: 1 Dose(s)/Time(s), Increment Dose Increase: 1 mcg/min, Increment Dose Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 30 mcg/min
			Comment: **LEVOPHED** Concentration: 16mcg/mL .  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.
	DOPamine 400 mg/D5W 250 mL Premix IV
		400 mg, EVERY BAG, 5 mcg/kg/min
		250 mL, drug form: IV Large Volume, route of administration: IV, pharmacy order priority: STAT, duration: 1 Dose(s)/Time(s), Increment Dose Increase: 2.5 mcg/kg/min, Increment Dose Decrease: 2.5 mcg/kg/min, Increment Freq: 10 min(s), Max Dose: 50 mcg/kg/m
			Comment: Concentration: 1600mcg/mL. .Notify MD if > 20mcg/kg/min.  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.
	amiodarone IVPB
		150 mg, Injection, IVPB, Once, STAT
	amiodarone IV Push
		150 mg, Injection, IV Push, Once, STAT
	amiodarone 360mg/D5W 200mL Premix IV
		200 mL, IV, STAT, T;N
			Comment: reduce to 0.5mg/min after the first 6 hr
		360 mg, EVERY BAG, 1 mcg/min
	amiodarone 450 mg/D5W 250 mL
		250 mL, IV, STAT, T;N
			Comment: reduce to 0.5mg/min after the first 6 hr
		450 mg, EVERY BAG, 1 mg/min
	amiodarone 900mg/D5W 500mL
		900 mg, EVERY BAG, 1 mg/min
		500 mL, IV, STAT
			Comment: 1 mg/min, IV STAT, T;N comment: reduce to 0.5mg/min after the first 6 hr
	esmolol 2,500mg/250mL premix diluent IV
		2,500 mg, EVERY BAG, 50 mcg/kg/min
		250 mL, IV, STAT, Duration: 1 Dose(s)/Time(s), Increment Increase: 50 mcg/kg/min, Increment Decrease: 50 mcg/kg/min, Increment Freq: 5 min(s), 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
	esmolol
		0.5 mg/kg, IV Push, Once, STAT
			Comment: Administer over 1 minute before starting esmolol infusion.
		Rapid Sequence Intubation(NOTE)*
	vecuronium
		0.1 mg/kg, Injection, IV Push, Once, STAT
			Comment: Dilute with 10mL sterile water for injection. Concentration = 1 mg/mL
	Versed 5 mg/5 mL vial
		2 mg, Injection, IV Push, Once, STAT
		5 mg, Injection, IV Push, Once, STAT
	Versed (FH)
		2 mg, Injection, IV Push, Once, STAT
		5 mg, Injection, IV Push, Once, STAT
	succinylcholine
		0.6 mg/kg, Solution-Injection, IV Push, Once, STAT
		0.9 mg/kg, Solution-Injection, IV Push, Once, STAT
		1.2 mg/kg, Solution-Injection, IV Push, Once, STAT
		1.5 mg/kg, Solution-Injection, IV Push, Once, STAT
	rocuronium
		0.6 mg/kg, Injection, IV Push, Once, STAT
			Comment: Calculate dose using Ideal Body Weight (IBW)
		0.9 mg/kg, Injection, IV Push, Once, STAT
			Comment: Calculate dose using Ideal Body Weight (IBW)
		1.2 mg/kg, Injection, IV Push, Once, STAT
			Comment: Calculate dose using Ideal Body Weight (IBW)
		100 mg, Injection, IV Push, Once, STAT
			Comment: MAX Dose is 1.5mg/kg based on Idea Body Weight (IBW)
	fentaNYL
		100 mcg, Injection, IV Push, Once, STAT
	Amidate
		20 mg, Injection, IV Push, Once, STAT
	ketamine
		1 mg/kg, Injection, IV Push, Once, STAT
		1.5 mg/kg, Injection, IV Push, Once, STAT
		2 mg/kg, Injection, IV Push, Once, STAT
	Diprivan
		1 mg/kg, Injection, IV Push, Once, STAT
	Ativan Injectable
		2 mg, Injection, IV Push, Once, STAT
		4 mg, Injection, IV Push, Once, STAT
	phenylephrine
		mg, Injection, IV Push, Once
		0.1 mg, Injection, IV Push, Once
		50 mcg, Injection, IV Push, Once
		80 mcg, Injection, IV Push, Once
	atropine
		mg, Syringe, IV Push, Once
		0.01 mg/kg, Injection, IV Push, Once
		0.4 mg, Injection, IM-Intramuscular, Once
		0.4 mg, Injection, IV Push, Once
		0.5 mg, Injection, IM-Intramuscular, Once, STAT
		0.5 mg, Injection, IV Push, Once, STAT
		1 mg, Injection, IM-Intramuscular, Once
		1 mg, Injection, IV Push, Once, STAT
		2 mg, Injection, IV Push, Once, STAT
		1 mg, Syringe, IV Push, Once, STAT
	glycopyrrolate
		mg, Injection, IV Push, Once
		0.2 mg, Injection, IV Push, Once
	lidocaine 2% 100 mg/5 mL syringe
		mg, Syringe, IV Push, Once
		50 mg Syringe IV PUSH IN DSC
		5 mL, Syringe, SUBCUTANEOUS, Once, T;N
		100 mg Syringe IV PUSH IN DSC

*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