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ED - CLINICAL DECISION UNIT - CHEST PAIN-MI RULE OUT - ADULT [6058]

ED - CLINICAL DECISION UNIT - CHEST PAIN-MI RULE OUT - ADULT [6058] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision Unit - Chest Pain/MI Rule Out - Adult [6058]
Inclusion Criteria for this Order Set:
1. Patients with chest discomfort potential for ischemia
Exclusion Criteria for this Order Set:
1. Patient with unstable vital signs
- HR > 120
- SBP < 90
2. Ischemic ECG changes
3. Newly positive troponin
4. High suspicion or MI or ACS
Prior to Observation Admission:
1. ECG without new ischemic changes
2. 1st troponin result is normal
3. CXR obtained and reviewed
4. Administration of aspirin 325mg
Admission Status
Admission Status [210406]
Admit to CDU (ED Observation) [ADT0019] Patient Class: Observation
Accommodation Code, if IMC request, please enter
Comments in field to the right: OSS/OBS
Will the patient require special placement due to
ISOLATION Precautions?
Is the patient currently a Department of Corrections
(DOC) Inmate?
Is a nursing assessment for CONSTANT
OBSERVATION recommended?
Is the patient currently a resident of CWC or Mendota
Mental Health (MMHI)?
Will the patient go directly to the OR from the ED?
Could this patient have ACS/MI?
Does the patient require CARDIAC MONITORING for
transport?
Admitting Provider?
Attending Provider?
CDU Protocol: Chest Pain
Family History:
Expected Treatment/Procedures:
Patient Care Orders
Vital Signs [208640]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every *** Hours, STAT
Activity [212530]
Page 1 of 5
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:45:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Activity [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition [208641]
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Diet Modifications:
Bedside Meal Instructions:
Diet - General [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Diet - NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Diet - Adult Renal [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Renal
Sodium:
Potassium:
Phosphorus:
Fluid Restriction Total mLs/24H (IV/PO):
Protein:
Bedside Meal Instructions:
Room Service Class:
Patient Monitoring [210407]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication:
Notify Provider:
Functional Cardiac Defibrillator Present:
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Contingency Parameters [208659]
Page 2 of 5
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:45:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C): 36
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL):
Other:
Intravenous Therapy
IV Fluids [210386]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, STAT
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
heparin 10 UNIT/ML lock flush injection [74548] 100 units, Flush, ONCE For 1 Doses
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS
Medications
Analgesics - Opioid - Injection - PRN (Single Response) [210387]
MORPHine PF injection [800122] 1-2 mg, Intravenous, EVERY 2 HOURS PRN, pain
For severe pain, if unable to tolerate oral medications.
HYDROmorphone PF (DILAUDID) injection
[800120]
0.2-0.4 mg, Intravenous, EVERY 2 HOURS PRN,
pain
For severe pain, if unable to tolerate oral medications.
Laboratory
Laboratory [210410]
TROPONIN [GM2447] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TROPONIN [GM2447] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw 3 hours post 1st collection of troponin level
Diagnostic Tests & Imaging
Diagnostic Tests & Imaging [210408]
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam:
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam:
Complete 2 hours post first ECG
NM Myocardial Perfusion Rest and Stress
[117122]
Page 3 of 5
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:45:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

This panel is the IP Level II Chest Pain and routine Nuclear Stress Test order.
Both orders are required for stress testing. Do not remove the orders.
NM MYOCARDIAL PERFUSION REST &
STRESS (SPECT) W WALL MOTION &
EJECTION FRACTION [R78452]
ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms?
Reason for exam:
What specific question(s) would you like answered
by this exam?
Relevant recent/past history?
Is patient pregnant or breastfeeding?
What form of stress is to be performed?
Is the patient ready for discharge today, pending
the results of the stress test?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
For Scheduling purposes, is the patient
claustrophobic or require any form of sedation?
Note: ordering provider is responsible for
prescribing oral anxiolytic or ordering sedation
services.
Last patient weight? (will auto pull in value and date
in comment):
Last patient height? (will auto pull in value and date
in comment):
BMI (will auto pull in value):
Transport Method:
Discontinue any nitro gtt or cream. Hold heart rate
lowering medications. No or minimal food.
Page 4 of 5
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:45:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Exercise or Drug Stress Test (with Nuclear
Medicine) [EKG0007]
ONCE, Routine
Current signs and symptoms?
Reason for exam:
What specific question(s) would you like answered
by this exam?
Relevant recent/past history?
Is patient pregnant or breastfeeding?
What form of stress is to be performed?
Is the patient ready for discharge today, pending
the results of the stress test?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
For Scheduling purposes, is the patient
claustrophobic or require any form of sedation?
Note: ordering provider is responsible for
prescribing oral anxiolytic or ordering sedation
services.
Last patient weight? (will auto pull in value and date
in comment):
Last patient height? (will auto pull in value and date
in comment):
BMI (will auto pull in value):
Transport Method:
Bring comfortable shoes and wear pants.
NPO 4 hours; no caffeine or tobacco 12 hours,
Discontinue any nitro gtt or cream. No or minimal
food.
Consults
Consults [208980]
Consult Respiratory Therapy (Inpatient)
[CON0071]
ONCE For 1 Occurrences, Routine
Reason for Consult:
Can this consult be done via video?
Disposition Criteria
Home [210414]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. No elevation in troponin
2. Results of imaging and/or stress test reviewed
3. Stable vital signs
Hospital [210415]
Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. New positive troponin
2. Abnormal imaging and/or stress test
Page 5 of 5
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:45:37 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org