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201611312

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ED - CLINICAL DECISION UNIT - SYNCOPE OR NEAR SYNCOPE - ADULT [6115]

ED - CLINICAL DECISION UNIT - SYNCOPE OR NEAR SYNCOPE - ADULT [6115] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision Unit - Syncope or Near Syncope - Adult [6115]
Inclusion Criteria for this Order Set:
1. History consistent with syncope or near syncope
2. Minimum Emergency Department evaluation: EGC, CBC, BMP, and consideration of urine
pregnancy test for all women of child bearing age
3. If suspicion for neurological etiology, place neuro consult prior to patient transfer to Clinical
Decision Unit (CDU)
4. If patient requires pacemaker or internal defibrillator interrogation, place consult to
Electrophysiology Fellow prior to patient transfer to the CDU
Exclusion Criteria for this Order Set:
1. Abnormal or unstable vital signs (Systolic Blood Pressure < 100 or Heart Rate < 45 or > 100)
2. Abnormal mental status or neurological complaints/defects
3. ECG abnormalities or changes from previous (concerning ST segment changes, prolonged
QTc > 500, high grade AV block, etc.)
4. History concerning for significant cardiac arrhythmia or observation of significant arrhythmia in
the ED (V. tach, a fib, bradycardia, etc.)
5. Complicated or acute underlying cause suspected:
ACS, PE, CHF, valvular disease, GI bleed, infection/sepsis, intracranial hemorrhage, etc.)
Admission Status
Admission Status [212841]
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: Syncope
Family History:
Expected Treatment/Procedures:
Intravenous Therapy
IV Fluids [207296]
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
Patient Care Orders
Vital Signs [208640]
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:47:22 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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]
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 [210819]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication:
Notify Provider:
Functional Cardiac Defibrillator Present:
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Neurovascular Checks [NURMON0045] EVERY 2 HOURS, Routine
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:47:22 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Holter Monitor - 24/48 Hour Monitor [EKG0026] ONCE For 1 Occurrences, Routine
Reason for exam:
Length of monitoring:
Contingency Parameters [208659]
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:
Diagnostic Tests & Imaging
Diagnostic Tests & Imaging [210820]
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 3 hours post first ECG
Transthoracic Resting Echocardiogram
[ECH0003]
ONCE, Routine
Reason for exam:
Do you want Agitated Bubble Study?
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Disposition Criteria
Home [210821]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. Stable vital signs
2. No concerning findings on cardiac rhythm
monitoring
3. No abnormal or acute concerns resulting from
Neurology or Electrophysiology consults (if
performed)
Hospital [210823]
Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. Evidence of concerning arrhythmia
on cardiac rhythm monitoring
2. Abnormal or unstable vital signs
3. Acutely abnormal imaging or lab findings (troponin,
echocardiogram, ECG results, etc.)
Consults
Consults [212846]
Consult Speech Pathology (for ED) [REF0007] ONCE For 1 Occurrences
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:47:22 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org