Unique Plan Description: ED SHORTNESS OF BREATH
Plan Selection Display: ED SHORTNESS OF BREATH
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-21 15:28:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-06-19 10:30:00
Available at all facilities: Yes

ED SHORTNESS OF BREATH
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Magnesium Level
		Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		Stat, spec type = Blood
	D-Dimer Level - FH
		Stat, spec type = Blood
	ProBNP
		Stat, spec type = Blood
	BNPEP Level - FH
		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
	Heparin Anti-Xa Heparin
		Stat, spec type = Blood
	hsCRP
		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
	hs Troponin I - FH
		Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
	Lactate
		Stat, spec type = Blood
	Respiratory Syncytial Virus (RSV) PCR
		T;N, Stat, spec type = Nasopharynx
	Sputum Culture
		Stat, spec type = Sputum
	Procalcitonin
		T;N, Stat, spec type = Blood
	Influenza A and B Screen PCR
		
Diagnostic Tests
	ECG in ED
		Stat, Indication: Dyspnea
	Chest 1 View
		Stat, SOB
			Comment: At Bedside
	Chest 2 View
		Stat, SOB
	CT Chest w/o Contrast
		Stat, SOB
	CTA Chest Pulmonary Arteries
		Stat, Pulmonary Emboli
		Stat, SOB
	Venous Duplex Bil Upper or Lower
		Stat, Indication: Pain, Location Upper Bilateral
		Stat, Indication: Pain, Location Lower Bilateral
		Stat, Indication: Shortness of breath
	Venous Duplex Unilat Upper or Lower
		Stat, Indication: Pain, Location Left Upper
		Stat, Indication: Pain, Location Left Lower
		Stat, Indication: Pain, Location Right Upper
		Stat, Indication: Pain, Location Right Lower
		Stat, Indication: Shortness of breath
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
	Lactated Ringers - Sepsis
		30 mL/kg, IVPB, Once, STAT
			Comment: Target Dose: Lactated Ringers - Sepsis 30ML/kg
	Lactated Ringers Injection
		1,000 mL, IV, STAT, 1 hr, 999 ml/hr
	Sodium Chloride 0.9% - Sepsis
		30 mL/kg, IVPB, Once, STAT
	nitroglycerin 50 mg/D5W 250 mL Premix IV
		50 mg, EVERY BAG, 5 mcg/min
		250 mL, route of administration: IV, pharmacy order priority: STAT, requested start date/time T;N, duration: 1 Dose(s)/Time(s), Maintain Parameter: SBP> Parameter Goal: 90, Increment Dose Increase: 5 mcg/min, Increment Dose Decrease: 5 mcg/min, Increment
			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.
Medications
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	albuterol CFC free 90mcg/inh inh aerosol
		2 puff, Aerosol, Inhalation, Once, STAT
	ipratropium 0.02% inhalation solution
		2.5 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	aspirin
		325 mg, Tab, BY MOUTH, Once, STAT
	predniSONE
		10 mg, Tab, BY MOUTH, Once, STAT
		20 mg, Tab, BY MOUTH, Once, STAT
		40 mg, Tab, BY MOUTH, Once, STAT
		60 mg, Tab, BY MOUTH, Once, STAT
	SOLU-Medrol
		125 mg, Injection, IV PUSH, Once, STAT
		125 mg, Injection, IM-Intramuscular, Once, STAT
	Lasix Injection
		20 mg, IV PUSH, Once, STAT
		40 mg, IV PUSH, Once, STAT
		60 mg, IV PUSH, Once, STAT
		80 mg, IV PUSH, Once, STAT
		100 mg, IV PUSH, Once, STAT
	Nitrostat
		0.4 mg, Tab, SUBLINGUAL, Q5MIN, chest pain, STAT, 3 Dose(s)/Time(s)
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, STAT
		4 mg, Syringe, IV PUSH, Once, STAT
	Ativan
		1 mg, Injection, IV Push, Once, STAT
		0.5 mg, Injection, IV Push, Once, STAT
		1 mg, Injection, IM-Intramuscular, Once, STAT
	Tylenol
		650 mg, Tab, By Mouth, Once, STAT
		1,000 mg, Tab, By Mouth, Once, STAT
	Arixtra
		5 mg, Injection, SUBCUTANEOUS, Once, STAT
			Comment: weight <50 kg
		7.5 mg, Injection, SUBCUTANEOUS, Once, STAT
			Comment: weight <50 kg
	Lovenox
		1 mg/kg, Syringe, SUBCUTANEOUS, Once, STAT
		30 mg, Syringe, SUBCUTANEOUS, Once, STAT
		40 mg, Syringe, SUBCUTANEOUS, Once, STAT
		60 mg, Syringe, SUBCUTANEOUS, Once, STAT
	Lovenox (MH/WH)
		60 mg, Syringe, SUBCUTANEOUS, Once, STAT
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Once, STAT
		 Non-ICU pneumonia antibiotic selection(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Once, STAT
	Rocephin IVPB
		1,000 mg, Injection-Premix, IVPB, Once, STAT
		2,000 mg, Injection-Premix, IVPB, Once, STAT
	Rocephin IVPB (FH)
		1,000 mg, INT, IVPB, Once, STAT, T;N
		2,000 mg, INT, IVPB, Once, STAT, T;N
	Zithromax IVPB
		500 mg, IVPB, Once, STAT
		 ICU antibiotic selection(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Once, STAT
	Zosyn IVPB
		4.5 gm, Injection-Premix, IVPB, Once, STAT, Infuse Over 30 min(s)
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Once, STAT, T;N, Infuse Over 30 min(s)
	Cipro
		400 mg, Injection-Premix, IVPB, Once, STAT
		500 mg, Tab, By Mouth, Once
Patient Care
	ED Cardiac Telemetry Monitoring
		T;N
			Comment: Continuous
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, Titrate->Keep Sats>/= to 90%
	Continuous Pulse Oximetry by Nurse
		T;N
			Comment: Now
	Glucose POC - RN
		T;N
			Comment: Now, in ED
	Bladder Scan
		T;N
			Comment: Now
	Foley Catheter
		Insert, Once
	Straight Catheter
		Insert, Once
	Sepsis Advisor
		
Therapies
	Pre and Post Peak Flows-MH/JE/FH
		Stat
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: shortness of breath
	Consult Pulmonologist
		Reason for Referral: shortness of breath

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

ED Blood Culture with Lactate
Laboratory
	Lactate
		T;N, Stat, spec type = Blood
	.Blood Culture.
		T;N, Stat, spec type = Blood
	.Culture Blood
		T;N, Stat, spec type = Blood

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

Respiratory Panel Flu/RSV/COVID EKM
Laboratory
	Respiratory Syncytial Virus (RSV) PCR
		T;N, Routine, spec type = Nasopharynx
		T;N, Stat, spec type = Nasopharynx
	Influenza A and B Screen PCR
		T;N, Routine, spec type = Nasopharynx
			Comment: spec type=Nasoph Micro Swab, RT to Collect
		T;N, Stat, spec type = Nasopharynx
			Comment: spec type=Nasoph Micro Swab, RT to Collect
	COVID-19 (2019 Novel Coronavirus) by PCR
		T;N, Routine, spec type = Nasopharynx
		T;N, Stat, spec type = Nasopharynx
Therapies
	Influenza specimen collection
		T;N

ED Diuretic Protocol
Laboratory
	Magnesium Level
		T;N+240, Timed, spec type = Blood
	Basic Metabolic Panel
		T;N+240, Timed, spec type = Blood
Medications
		Lasix injection-If CHF and taking home diuretic-recommendation to double home dose of Lasix or quadruple home dose of torsemide to a maximum dosage of 200 mg. If dosage ordered is > 100mg Lasix, administer via IVPB to avoid ototoxicity.(NOTE)*
	Lasix Injection
		40 mg, IV PUSH, Once, STAT
		60 mg, IV PUSH, Once, STAT
		80 mg, IV PUSH, Once, STAT
		100 mg, IV PUSH, Once, STAT
		120 mg, IVPB, Once, STAT
		160 mg, IVPB, Once, STAT
		200 mg, IVPB, Once, STAT
	potassium chloride Oral
		20 mEq, Tablet-Extended-Release, BY MOUTH, Once, STAT
		40 mEq, Tablet-Extended-Release, BY MOUTH, Once, STAT
Patient Care
	Intake and Output

Respiratory Panel Flu/COVID
Laboratory
	Influenza A and B Screen PCR
		T;N, Routine, spec type = Nasopharynx
		T;N, Stat, spec type = Nasopharynx
	COVID-19 (2019 Novel Coronavirus) by PCR
		T;N, Routine, spec type = Nasopharynx
		T;N, Stat, spec type = Nasopharynx

ED Blood Culture Set
	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood

*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