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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-105407-en.cckm

201611312

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ED - CLINICAL DECISION UNIT - TRANSIENT ISCHEMIC ATTACK - ADULT [6087]

ED - CLINICAL DECISION UNIT - TRANSIENT ISCHEMIC ATTACK - ADULT [6087] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision Unit - Transient Ischemic Attack - Adult [6087]
Inclusion Criteria for this Order Set:
1. Suspect transient ischemic attack. With resolution of symptoms prior to transer to the CDU
2. CT head or MRI performed and preliminary results given
3. CBC, BMP, and ECG ordered and resulted
4. Consult to Neurology to see patient in Clinical Decision Unit has been placed
Exclusion Criteria for this Order Set:
1. Neuro imaging positive for hemorrhage, mass, or acute infaction
2. Known embolic source found
Examples include atrial fibrillation, cardiomyopathy, artificial heart valve, endocarditis, known
mural thrombus, recent MI, carotid stenosis greater than 50%
3. Non-focal symptoms:
Altered level of consciousness, significant generalized weakness, fevers, etc.
4. Hypertensive crisis
5. Prior stroke with persistent deficits
6. Severe headache
UWHealth Stroke Dysphagia Screen URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/patient-assessment-tools/name-
97266-en.cckm
Admission Status
Admission Status [210524]
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: TIA
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 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:49:44 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 [210525]
Neurovascular Checks [NURMON0045] EVERY 2 HOURS, Routine
Contingency Parameters [208659]
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:49:44 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:
Laboratory
Laboratory [212858]
Lipid Panel [LIPID] STAT - RN COLLECT For 1 Occurrences, Routine,
Test includes Cholesterol, Total; HDL Cholesterol;
Triglyceride; LDL cholesterol, calculated; and non-
HDL cholesterol.
Patient must fast for 12-14 hours and be heparin free
for 48 hours prior to specimen collection. The patient
can only have water or black coffee during the fasting
period.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests & Imaging
Diagnostic Tests & Imaging [210526]
Ultrasound Carotid Duplex (UW Hospital, East
Clinic) [VASC0002]
ONCE For 1 Occurrences, Routine
Reason for exam:
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Left, Right, or Bilateral?
Performed in Heart Vascular Care Echo/Vasc Lab
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:49:44 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

MRA HEAD W/ O & MRA NECK W & MRI HEAD
W & W/ O CONTRAST [R07006]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Study Needed Within:
Is patient pregnant?
Does patient have a pacemaker or defibrillator?
Allergy to Gadolinium (MRI) contrast?
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.
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.
Relevant Surgical History (Select all applicable or
None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or
None):
Has patient had a colonoscopy/endoscopy in the last
8 weeks?
Last creatinine value? (will auto pull in date and value
in comment):
Last e-GFR value? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
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 [210527]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. No recurrent deficits or changes in
neuro exam
2. Results of imaging and neuro consult has been
reviewed
Hospital [210528]
Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. Recurrent symptoms or new neuro
deficits
2. Evidence of embolic source or treatable disease
discovered
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:49:44 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org