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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-122835-en.cckm

201711324

page

100

UWHC,UWMF,

Tools,

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

ED/IP - Orbital Inflammation Evaluation - Adult/Pediatric - Supplemental [6627]

ED/IP - Orbital Inflammation Evaluation - Adult/Pediatric - Supplemental [6627] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED/IP - Orbital Inflammation Evaluation - Adult/Pediatric - Supplemental [6627]
Laboratory
Lab Orders - Thyroid [237167]
TSH [TSH] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
T4, TOTAL [T4] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
T3, FREE [FT3] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
THYROID STIMULATING IMMUNOGLOBULIN
[XTSI]
STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Sarcoid [237173]
LYSOZYME [XLYSO] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ANGIOTENSIN CONVERTING ENZYME [XACE] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
MISCELLANEOUS TEST - Soluble IL-2 receptor
[RMISC]
STAT For 1 Occurrences, Routine
What lab test would you like to have performed?
Soluble IL-2 receptor
For questions I can be reached at:
Indicate specimen source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Rheumatologic [237177]
ANCA [ANCA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ANA SCREEN WITH TITER IF POSITIVE [ANAT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
RHEUMATOID FACTOR [RF] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ESR [ESR] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 1 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

C REACTIVE PROTEIN [CRPN] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IMMUNOGLOBULIN G SUBCLASS 4 [XIGG4] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL [TP] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN ELECTROPHORESIS [GM3065] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HLA-B27 AG [XHLA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Myasthenia Gravis [238107]
ACETYLCHOLINE RECEP BINDING [XACRAB] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ACETYLCHOLINE RECEP MODULAT [XACMA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ACETYLCHOLINE RECEP BLOCKING [XACBA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
MUSK AUTOANTIBODY [MUSKAB] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Antiphospholipid Syndrome [238109]
CARDIOLIPIN AB, IGG/IGM [XCARGM] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BETA-2-GLYCOPROTEIN, IGG/IGM
[HCB2GGM]
STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Lupus [238111]
Page 2 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

LUPUS ANTICOAGULANT WORK-UP
[HCLUPUS]
STAT For 1 Occurrences, Routine, This test should
not be ordered if the patient is being treated with
rivaroxaban, apixaban, fondaparinux or low molecular
weight heparin, since these drugs may cause invalid
test results. The patient should not have received
unfractionated heparin, dabigatran, argatroban, or
bivalirudin within 24 hours of collection
This order initially tests for APTT, Silica Clot Time
Screen and dilute Russell Viper Venom Screen. May
reflex to Protime, APTT Inhibitor Screen, Thrombin
Time, Factor VIII Assay and dilute Russell Viper
Venom Confirm.
Is the patient receiving any anticoagulant?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - Infectious [237178]
Lyme Ab, IgG and IgM reflex Immunoblot
[236828]
onset.antibody is not recommended beyond 4 weeks after symptom IgM
LYME AB, IGG, W/ REFLEX TO IMMUNOBLOT
[LYMIGGR]
STAT, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
LYME AB, IGM, W/ REFLEX TO IMMUNOBLOT
[LYMIGMR]
STAT, Starting today For 1 Occurrences, Routine,
IgM antibody is not recommended beyond 4 weeks
after symptom onset. There currently is no test of
cure for Lyme disease, and this test should not be
ordered for that purpose. This test also should not
be used to assess response to therapy.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
RPR, CONFIRM IF POSITIVE [RPRFTA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
QUANTIFERON-TB GOLD [GM8455] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TOXOPLASMA AB, IGG/IGM [HCTOXO] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Lab Orders - General [237181]
URINALYSIS WITH MICROSCOPY [UA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL [CBC] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 3 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

URIC ACID [URIC] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Imaging
Imaging [237185]
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
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
CT ORBIT W IV CONTRAST [R70481C] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Can Patient be given oral contrast?
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:
CT ORBIT W/ O IV CONTRAST [R70480C] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Can Patient be given oral contrast?
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:
CT MAXILLOFACIAL W IV CONTRAST [R70487] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Can Patient be given oral contrast?
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:
Page 4 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

CT MAXILLOFACIAL W/ O IV CONTRAST
[R70486]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Can Patient be given oral contrast?
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:
MRI ORBIT FACE NECK W & W/ O CONTRAST
[R70543]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms? Orbital inflammation
What specific question(s) would you like answered by
this exam? Orbit - Tricks Protocol
Relevant recent/past history? Orbital inflammation
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:
Procedures
TB Screening [237186]
TB Skin Test [117075]
tuberculin (APLISOL) injection [43217] 5 units, Intradermal, ONCE PRN For 1 Doses, TB
Competent RN to Administer
Page 5 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

TB INTRADERMAL TEST [IMM0001] ONCE, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Staff with competency in TB Testing to complete
Page 6 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 11/14/2017 1:49:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org