Unique Plan Description: ED HTN
Plan Selection Display: ED HTN
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2022-02-22 11:27:20
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-05 09:17:59
Available at all facilities: Yes

ED HTN
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		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
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
	Beta-HCG Quantitative - Pregnancy
		Stat, spec type = Blood
Diagnostic Tests
	ECG in ED
		Stat, Indication: Hypertension
	Chest 1 View
		Stat, Pain/Chest
	CT Head w/o Contrast
		Stat
	CT Head w & w/o Contrast
		Stat
IV Solutions
	Cardene 25 mg/NS 250 mL
		25 mg, EVERY BAG, 5 mg/hr
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   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.
	niCARdipine 20mg/NS 200mL
		200 mL, IV, STAT, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   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.
		20 mg, EVERY BAG, 5 mg/hr, T;N
	Nipride 50mg/NS 100mL
		50 mg, EVERY BAG, 0.5 mcg/kg/min
		100 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 0.5 mcg/kg/min, Increment Decrease: 0.5 mcg/kg/min, Increment Freq: 5 min(s), Max Dose: 10 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.
	nitroglycerin 50 mg/D5W 250 mL Premix IV
		50 mg, EVERY BAG, 5 mcg/min
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 5 mcg/min, Increment Decrease: 5 mcg/min, Increment Freq: 5 min(s), Max Dose: 200 mcg/min
			Comment: If no response at 20mcg/min, may increase by 10mcg/min every 5 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.
	Brevibloc 2,500mg/250mL premix diluent IV
		2,500 mg, 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 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.
	nicardipine 20mg/NS 200mL premix
		20 mg, EVERY BAG, 5 mg/hr
		200 mL, IV, STAT, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   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
	cloNIDine
		0.1 mg, Tab, BY MOUTH, Once, STAT
	labetalol  injection
		20 mg, = 4 mL, Injection, IV PUSH, Once, STAT
		10 mg, = 2 mL, Injection, IV PUSH, Once, STAT
	Lopressor
		5 mg, Solution-Injection, IV Push, Once, STAT
	hydrALAZINE
		10 mg, Injection, IV Push, Once, STAT
	magnesium sulfate IVPB
		2 gm, IVPB, Once, STAT, 25 ml/hr
	magnesium sulfate
		2 gm, Injection, IV Push, Once, STAT
Patient Care
	ED Cardiac Telemetry Monitoring
		T;N
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, Titrate->Keep Sats>/= to 90
	Continuous Pulse Oximetry by Nurse
		T;N
	Peripheral Lock-Insert
		T;N, Once
	Straight Catheter
		Once, Straight
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: Hypertension
	Consult Hospitalist
		Reason for Referral: Hypertension

*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