Unique Plan Description: ED Therapeutic Hypothermia (MH WH FH) Diagnostic Temp Mgmt
Plan Selection Display: ED Therapeutic Hypothermia (MH WH FH) Diagnostic Temp Mgmt
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-12-05 11:00:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-01-23 14:25:44
Available at all facilities: No

ED Therapeutic Hypothermia (MH WH FH) Diagnostic T
Admit/Discharge/Transfer
	Transfer to Critical Care (WH JE)
		
	ED Request for Bed
		
Vital Signs
	Vital Signs
		T;N, Q15MIN
	Vital Signs/Hemodynamic Monitoring
		MAP goal 70-100mmHg is preferred for optimal cerebral perfusion.  Monitor primary temperature via bladder with foley temp probe continuously
Diet
	NPO
		T;N
Laboratory
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Lactate
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
			Comment: if woman of child bearing age.
Diagnostic Tests
	Chest 1 View
		T;N, Stat
			Comment: Hypothermia post cardiac arrest protocol
	ECG in ED
		T;N, Stat, Indication: Post ACLS/Medical Emergency
	CT Head w/o Contrast
		T;N, Stat, Loss of Consciousness
			Comment: Do NOT delay cooling for testing.
IV Solutions
	Sodium Chloride 0.9%
		2,000 mL, IV, STAT, Bolus
			Comment: Use rapid infuser. Use only in patients with core temp above the desired target, caution in patients with history of CHF and /or compromised renal function and/or pulm edema.
Patient Care
	Foley Catheter
		T;N, Foley, Insert, Critically ill requiring accurate output
			Comment: use temperature sensing catheter
	GI Tube
		T;N, OG, Insert, Once
		T;N, Per Orogastric Tube (OG), Insert
		T;N, Per Orogastric Tube (OG), Connect to low intermittent suction
		T;N, Per Nasogastric Tube (NG), Insert
		T;N, Per Nasogastric Tube (NG), Connect to low intermittent suction
	Intake and Output
		T;N, Q1H
			Comment: Notify MD if urine output >300ml/hr or 30ml for two consecutive hours
	Notify MD
		T;N, PRN MAP <70 despite use of vasopressors. If magnesium level >4.0mg/d
	Passive Convective Cooling
		T;N, Expose patient, dampen skin, cooling fan; ice packs applied to axilla/groin/torso/neck/limbs
Therapies
	Consult Respiratory Therapy-Assess and Treat
		T;N
			Comment: Maintain PO2 90-100 mmHg and normal pH (ABGs must be temperature controlled); Patient on Therapeutic Hypothermia Protocol.
		T;N
			Comment: Remove humidity from vent. Patient on Therapeutic Hypothermia Protocol.
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: Acute Cardiac Arrest
	Consult Pulmonologist
		Reason for Referral: Therapeutic Hypothermia

*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