Unique Plan Description: ED Pelvic Pain/Bleeding
Plan Selection Display: ED Pelvic Pain/Bleeding
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-01 13:48:59
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-01-28 13:33:07
Available at all facilities: Yes

ED Pelvic Pain/Bleeding
Vital Signs
	BP and Pulse, Orthostatic
		T;N, Once
Laboratory
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine
			Comment: change the indwelling catheter prior to obtaining specimen if catheter in place greater than 2 weeks, or unknown.
	Beta-HCG Quantitative - Pregnancy
		Stat, spec type = Blood
		For type and screen, enter orders for ABORH patient type and Antibody Screen Gel below:(NOTE)*
	ABORh Patient Type
		Stat, spec type = Blood
	Antibody Screen
		Stat, spec type = Blood
	Kleihauer-Betke
		Stat, spec type = Blood
		Stat, spec type = Blood
		ED Pelvis Exam (MJE)(NOTE)*
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Stat, spec type = Cervix
		T;N, Stat, spec type = Urine
		T;N, Stat, spec type = Vaginal
	Vaginitis Panel PCR
		T;N, Stat, spec type = Genital
	Rhogam Workup
		T;N, Stat, spec type = Blood
Diagnostic Tests
	CT Abd Pelvis R/O Kidney Stone
		Stat, Abnormal Findings
	US OB Transvaginal 1st Trimester
		Stat, Pelvic Pain
	US OB Transvaginal
		Stat, Pelvic Pain
	US OB Limited
		Stat, Pelvic Pain
	CT Abd Pelvis w Contrast
		Stat, Pain/ Abdominal
		Pelvic Pain r/o ovarian torsion - US(NOTE)*
	US Transvaginal
		Stat, Pain/ Pelvic
	US Duplex Abd Pelvis Renal Scrotum Limited
		Stat, Pain/ Pelvic
	US Pelvis Complete Non OB
		Stat, Pain/ Pelvic
		Non pregnancy or no clinical concern for torsion(NOTE)*
	US Transvaginal
		Stat, Pain/ Pelvic
	US Pelvis Complete Non OB
		Stat, Pain/ Pelvic
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 999 ml/hr
		1,000 mL, IV, STAT, 75 ml/hr
		1,000 mL, IV, STAT, 100 ml/hr
		1,000 mL, IV, STAT, 125 ml/hr
		1,000 mL, IV, STAT, 500 ml/hr
Medications
		Dilaudid Dosing Recommendations: Opiate naïve = > 0.2-0.6mg, 65yrs old = 0.1-0.4mg; Hydromorphone 1mg IV = morphine 7mg IV(NOTE)*
	Dilaudid Injectable
		0.5 mg, Injection, IV PUSH, Once, STAT
		1 mg, Injection, IV PUSH, Once, STAT
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, STAT
		4 mg, Syringe, IV PUSH, Once, STAT
		Toradol Dosing Recommendations: Normal Renal Function = 60 mg IM or 30 mg IV; If >/= 65 yrs old, < 50kg or ClCr < 50ml/min = 30mg IM or 15mg IV(NOTE)*
	ketorolac injectable
		15 mg, Injection, IV PUSH, Once, STAT, 1 Dose(s)/Time(s)
		30 mg, Injection, IV PUSH, Once, STAT, 1 Dose(s)/Time(s)
		60 mg, Injection, IM-IntraMUSCULAR, Once, STAT, 1 Dose(s)/Time(s)
	droPERidol
		0.625 mg, Injection, IV Push, Once, STAT
		1.25 mg, Injection, IV Push, Once, STAT
		2.5 mg, Injection, IV Push, Once, STAT
		0.625 mg, Injection, IM-Intramuscular, Once, STAT
		1.25 mg, Injection, IM-Intramuscular, Once, STAT
		2.5 mg, Injection, IM-Intramuscular, Once, STAT
	Rocephin IM
		500 mg, Injection, IM-IntraMUSCULAR, Once, Gyn infection, STAT
	Zithromax
		2,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
		1,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
	metroNIDAZOLE
		2,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
			Comment: Do not give if recent alcohol use
		500 mg, Tab, By Mouth, Once, Gyn infection
			Comment: Do not give if recent alcohol use
	Diflucan
		150 mg, Tab, BY MOUTH, DAILY, Other- type in, gyn infection, STAT
	ondansetron
		4 mg, Injection, IV PUSH, Once, STAT
	Phenergan (FH)
		6.25 mg, INT, IVPB, Once, STAT
	cefixime
		800 mg, Capsule, By Mouth, Once, Indication: Gyn infection, STAT
	doxycycline
		100 mg, Capsule, By Mouth, Once, Gyn infection, STAT
	doxycycline (FH)
		100 mg, Tab, By Mouth, Once, Gyn infection, STAT
	Rho (D) immune globulin 1500 intl units (300mcg)
		1,500 intl_units, Solution, IM-Intramuscular, Once, STAT
			Comment: 1500 intl units = 300 mcg = 1 Each
		GC TREATMENT RECOMMENDATIONS(NOTE)*
		For weight less than 150kg(NOTE)*
	Rocephin IM
		500 mg, Injection, IM-IntraMUSCULAR, Once, Other- type in, STD Prophylaxis, STAT
			Comment: 500mg cefTRIAXone vial dissolved with 1mL yields 350mg/mL final concentration.
	Xylocaine-MPF 1% preservative-free injectable solution
		1 mL, Injection, IM-Intramuscular, Once, STAT
			Comment: 500mg cefTRIAXone vial dissolved with 1mL yields 350mg/mL final concentration.
		For weight greater than 150kg(NOTE)*
	Rocephin IM
		1,000 mg, Injection, IM-IntraMUSCULAR, Once, Other- type in, STD Prophylaxis, STAT
			Comment: 1,000mg cefTRIAXone vial dissolved with 2.1mL yields 1,000mg/2.86mL final concentration.
	Xylocaine-MPF 1% preservative-free injectable solution
		2.1 mL, Injection, IM-Intramuscular, Once, STAT
			Comment: 1,000mg cefTRIAXone vial dissolved with 2.1mL yields 1,000mg/2.86mL final concentration.
		IF ALLERGIC TO PCN OR CEPHALOSPORINS(NOTE)*
	gentamicin
		240 mg, Injection, IM-Intramuscular, Once, Gyn infection, STAT
			Comment: Give with Azithromycin 2000mg PO; Gentamicin contraindicated in patients with impaired renal function.
	azithromycin
		2,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
			Comment: Give with Gentamicin 240mg IM
		CHLAMYDIA PROPHYLAXIS TREATMENT RECOMMENDATIONS(NOTE)*
		2,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
		1,000 mg, Tab, By Mouth, Once, Gyn infection, STAT
Patient Care
	ED Cardiac Telemetry Monitoring
		T;N
	Oxygen Therapy, Nurse to Administer
		T;N, Via Nasal Cannula
			Comment: Titrate->Keep Sats>/= to 90%
	Bladder Scan
		T;N, Once
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Foley Catheter
		T;N, Insert, Once
	Straight Catheter
		T;N, Insert, Once
	Prepare for pelvic exam
		T;N, Prepare for Pelvic Exam
Consults/Follow-up
	Consult Infectious Disease
		Reason for Referral: pelvic pain/bleeding
	Consult OB/GYN
		Reason for Referral: pelvic pain/bleeding

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

ED Pelvic Exam (MH WH FH)
Laboratory
	Vaginitis Panel PCR
		T;N, Stat, spec type = Genital
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Stat, spec type = Cervix
		T;N, Stat, spec type = Vaginal
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
		T;N, Stat, spec type = Urine
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Stat, spec type = Urine
	Wet Prep - PC/FH
		T;N, Stat, spec type = Genital
Consults/Follow-up
	Consult Hospitalist

*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