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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-117233-en.cckm

201706156

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100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Emergency Medicine

ED - Targeted Temperature Management - Adult [6074]

ED - Targeted Temperature Management - Adult [6074] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Targeted Temperature Management - Adult [6074]
for Adult Patients OnlyIntended
should be following are relative exclusion criteria. Targeted Temperature Management The
accepting Critical Care Service. case basis, as determined by the -by-performed on a case
Exclusions:
(ROSC)Greater than 12 hours since return of spontaneous circulation 1)
of Glasgow Coma Scale score greater than or equal to 5 (i.e.,component Motor2)
movement)purposeful
cancer)morbid cognitive status (i.e., advanced dementia, metastatic -Minimal pre3)
statecardiac primary etiology for comatose -Suspected non4)
Sepsis as cause of arrest5)
Do not resuscitate (DNR) status6)
CelsiusCore body temperature less than 30 degrees 7)
Diagnostic Tests and Imaging
Radiology [217251]
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
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.
Is patient pregnant?
Medications
Platelet Inhibitors (Single Response) [109847]
Aspirin [150762]
aspirin tab [34787] 325 mg, Nasogastric Tube, ONCE For 1 Doses
Administer first dose now
aspirin chew tab [720164] 81 mg, Nasogastric Tube, 1 X DAILY Starting
tomorrow For 7 Days
Aspirin Reason Not Ordered [COR0003] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Already on Aspirin/Ordered
Through Med Reconciliation
Analgesics [149827]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
650 mg, Nasogastric Tube, EVERY 6 HOURS For 24
Hours
acetaMINOPHEN (TYLENOL) suppository
[43994]
650 mg, Rectal, EVERY 6 HOURS For 24 Hours
Anesthetic/Sedation [145862]
FENTanyl PF injection - NOTE: Suggested dose
12.5-50 mcg [800187]
Intravenous, ONCE For 1 Doses
NOTE: Suggested dose 12.5-50 mcg
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 1:52:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

FENTanyl (50 mcg/mL) infusion [800264] Intravenous, CONTINUOUS
*** mcg/hr Titrate by *** mcg/hr every *** minutes to
maintain pain relief
NOTE: Suggested dose 12.5-50 mcg/hr to maintain
pain relief and sedation score of +1 to -1 RASS.
midazolam (VERSED) injection [800197] 0.05 mg/kg, Intravenous, ONCE For 1 Doses
IV Push rate 1 mg/minute Do NOT administer if
patient has running midazolam infusion.
midazolam (VERSED) 100 mg in dextrose 5 %
100 mL infusion - NOTE: Suggested sedation
goal +1 to -1 RASS [700236]
1-10 mg/hr, Intravenous, CONTINUOUS
Initiate at 1 mg/hour (Maximum initial dose 10
mg/hour or current rate). Titrate rate by 20% of
current rate every 4 hours to maintain sedation score
of +1 to -1 RASS. Bolus by dose equal to current
hourly infusion rate every 2 hours if patient exhibits
signs or symptoms of discomfort. Contact MD with
any questions.
Neuromuscular Blocking Agents [149828]
vecuronium (NORCURON) vial [46843] 0.1 mg/kg, Intravenous, EVERY 1 HOUR PRN,
shivering
Must be sedated with midazolam for at least 5
minutes prior to administration
atracurium (TRACRIUM) vial [156562] 0.4 mg/kg, Intravenous, ONCE For 1 Doses
Prior to initiation of infusion and with each rate
increase of continuous infusion
Post-Op/Phase II
atracurium (TRACRIUM) 200 mg in dextrose 5 %
100 mL infusion [700150]
4-12 mcg/kg/min, Intravenous, CONTINUOUS
For patients with renal or hepatic dysfunction, or
patients receiving corticosteriods. Initiate at 4 mcg/kg,
titrate to Train of Four of 2 out of 4 every 15 minutes
by 1 mcg/kg.
Post-Op/Phase II
Gastric [149829]
ranitidine (ZANTAC) injection [800075] 50 mg, Intravenous, EVERY 8 HOURS
Targeted Temperature Management
UWHC Targeted Temperature Management
Cooling Products
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/cardiovascular/related/name-
100378-en.cckm
UWHC Post Cardiac Arrest Algorithm-Adult-
Emergency-Dept/Inpatient
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/cardiovascular/related/name-
103679-en.cckm
Targeted Temperature Management [217261]
Cooling Process [NURCOM0022] SEE COMMENTS, Use surface cooling or
intravascular temperature management catheter to
achieve core temperature of {UWIP COOLING
TEMP:3500032} degrees Celsius within 3 hours of
initial patient presentation.
Once target temperature is achieved, maintain target
temperature for 24 hours.
Apply Ice Pack to Affected Area [NURTRT0008] SEE COMMENTS, Routine
Site: Other (Comment) (Apply to axilla, torso, groin,
and skin until cooling catheter is placed.)
Apply Cooling Blankets Above and Below Patient
[NURCOM0022]
SEE COMMENTS, Starting today, Place above and
below patient, until cooling catheter is placed.
Patient Care Orders
Respiratory [217264]
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 1:52:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Routine
Mechanical Ventilation [RT0028] CONTINUOUS, Routine, For ADULT patients order
chlorihexidene gluconate (PERIDEX) 0.12% soln
15 mL to swab oral cavity 2x daily while on
ventilation.
Is this a modification to a current vent order?
Ventilator Management:
Wean:
Set Rate/Min:
PEEP (cmH2O):
Mode:
Tidal Volume Multiplier: 6
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
NAVA Level (µV):
chlorhexidine (PERIDEX) 0.12 % soln
MULTIDOSE [792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. Discontinue when patient
no longer on ventilation.
Intake and Output [217266]
Measure Intake And Output [NURMON0005] EVERY 1 HOUR, Starting today, Routine
Non-Categorized Patient Care Orders [217285]
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS For Until specified, Routine, To
discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type: Temperature Probe
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
To urimeter.
Urinary Catheter Removal Protocol does NOT apply
to Urology, Gynecology, spinal cord injured patients
or patients with catheters placed by Urology on prior
admission.
Insert Rectal Temperature Probe
[NURCOM0022]
CONTINUOUS, Starting today
Insert Esophageal Temperature Probe
[NURCOM0022]
CONTINUOUS, Starting today
Glucose, POC [IPGLUCOSE] EVERY 1 HOUR, Starting today, Routine, Glucose,
POC should always be ordered in conjunction with
orders for hypoglycemia management and monitoring
as indicated in the Hypoglycemia Management
(Adult) panel.
If Conditional, What Condition?
Draw from arterial line.
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 1:52:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Use Bedside Shivering Assessment Scale
[NURCOM0022]
EVERY 1 HOUR, Starting today
OG Tube Placement - Adult [120995]
Insert and Maintain Orogastric Tube
[NURTAD0015]
CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Check Residual:
Does this need to be inserted/placed?
Device Status:
Refer to Policy 2.20AP Care & Maintenance of
Enteral Tubes (Adult & Pediatric)
Recommendations for flush quantity:
For adult patients, 30 mLs of fluid should be
sufficient.
X-RAY ABDOMEN AP VIEW (KUB) [R74000] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Orogastric tube
placement
What specific question(s) would you like answered
by this exam? Evaluate orogastric tube placement
Relevant recent/past history? Cardiac Surgery
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date
in comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate orogastric
tube placement. The location of orogastric tube
should be confirmed prior to the instillation of fluids,
medications, or feedings. Refer to Policy 2.20
Enteral Tubes Used for Instillation of Fluids,
Medications, or Feeding
Post Cardiac Arrest Program Data [214664]
Cardiac Arrest Program Data [COR0088] ONCE
Is this a cardiac arrest patient?
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 1:52:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org