Unique Plan Description: ED Weakness
Plan Selection Display: ED Weakness
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-21 15:44:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-23 00:48:23
Available at all facilities: Yes

ED Weakness
Vital Signs
	BP and Pulse, Orthostatic
		T;N, Once
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
	hs Troponin I - FH
		Stat, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine
	Thyroid Panel
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	Toxicology Screen DAU - MH/WH/JE
		T;N, Stat, Urine Random, spec type = Urine
	Drug Screen Urine - FH
		T;N, Stat, Urine Random, spec type = Urine
	hsCRP
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
	Beta-HCG Quantitative - Pregnancy
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	Lactate
		Stat, spec type = Blood
	Procalcitonin
		T;N, Stat, spec type = Blood
Diagnostic Tests
Cardiology
	ECG in ED
		Stat, Indication: Weakness
Radiology
	Chest 1 View
		T;N, Stat, Fatigue
	CT Head w Contrast
		T;N, Stat, Weakness
	CT Head w & w/o Contrast
		T;N, Stat, Weakness
	CT Head w/o Contrast
		T;N, Stat, Weakness
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
	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		30 mL/kg, IVPB, STAT, 1 Dose(s)/Time(s), 1 hr
			Comment: Bolus in ED
	Lactated Ringers - Sepsis Bolus
		3,750 mL, IVPB, Once, STAT
			Comment: Target Dose: Lactated Ringers - Sepsis 30ML/kg
	Sodium Chloride 0.9% - Sepsis Bolus
		3,750 mL, IVPB, Once, STAT
	DOPamine 400 mg/D5W 250 mL Premix IV
		400 mg, EVERY BAG, 5 mcg/kg/min
		250 mL, IV, STAT, Duration: 1 Dose(s)/Time(s), Increment Increase: 2.5 mcg/kg/min, Increment Decrease: 2.5 mcg/kg/min, Increment Freq: 10 min(s), Max Dose: 50 mcg/kg/min
			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.
	Levophed 4mg/D5W 250mL Premix
		4 mg, EVERY BAG, 8 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: 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.
	Levophed 8mg/D5W 250mL Premix
		8 mg, EVERY BAG, 8 mcg/min
		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.
Medications
	ondansetron
		4 mg, Injection, IV PUSH, Once, STAT
	ondansetron (MH/WH)
		8 mg, Injection, IV Push, Once, STAT
	Phenergan (FH)
		6.25 mg, INT, IVPB, Once, STAT
	meclizine
		25 mg, Tab, BY MOUTH, Once, STAT
Patient Care
	Glucose POC - RN
		T;N, Once
	Oxygen Therapy, Nurse to Administer
		
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Foley Catheter
		T;N, Insert, Once
	Straight Catheter
		T;N, Insert, Once
	ED Cardiac Telemetry Monitoring
		T;N
			Comment: In ED
	Sepsis Advisor
		
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: weakness
	Consult Hospitalist
		Reason for Referral: weakness
	Consult Neurologist
		Reason for Referral: weakness
	Consult Tele Neurology (JEFH)
		Reason for Referral: weakness

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

RRT Dynamic Assessment of Fluid Responsiveness
IV Solutions
	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		500 mL, IVPB, STAT, 1 Dose(s)/Time(s), 1 hr
			Comment: Perform Fluid Bolus Challenge Test Infuse over 5 min, for 1 Dose/Time per instructions outlined in attached reference text, for specific device being used
		Fluid Bolus Challenge Test Reassessment(NOTE)*
	Sodium Chloride 0.9%
		250 mL, IV, STAT, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Perform Fluid Bolus Challenge Test. Notify MD: Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations (>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)
Patient Care
	Passive Leg Raise
		
	Notify MD
		Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations  	(>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)

ED Blood Culture Set
Laboratory
	.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