/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/,

/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-122856-en.cckm

201711326

page

100

UWHC,UWMF,

Tools,

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

ED - Musculoskeletal Infections - Pediatric - Procedure [6446]

ED - Musculoskeletal Infections - Pediatric - Procedure [6446] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Musculoskeletal Infections - Pediatric - Procedure [6446]
Peds MSK Infection Evaluation and Management
Algorithm
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-
isolation/related/name-117963-en.cckm
Diagnostic Tests & Imaging
Upper Extremity [236010]
X-RAY HAND >= 3 VIEWS RIGHT [R73130R] 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?
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
X-RAY HAND >= 3 VIEWS LEFT [R73130L] 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?
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
X-RAY FOREARM 2 VIEWS RIGHT (ULNA)
[R73090R]
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?
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
X-RAY FOREARM 2 VIEWS LEFT (ULNA)
[R73090L]
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?
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
Page 1 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

X-RAY ELBOW 2 VIEWS RIGHT [R73070R] 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?
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
X-RAY ELBOW 2 VIEWS LEFT [R73070L] 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?
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
X-RAY HUMERUS >= 2 VIEWS RIGHT
[R73060R]
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?
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
X-RAY HUMERUS >= 2 VIEWS LEFT [R73060L] 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?
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
X-RAY SHOULDER >= 2 VIEWS RIGHT
[R73030R]
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?
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
Page 2 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

X-RAY SHOULDER >= 2 VIEWS LEFT
[R73030L]
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?
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
Lower Extremity [239636]
X-RAY FOOT >= 3 VIEWS RIGHT [R73630R] 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?
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
X-RAY FOOT >= 3 VIEWS LEFT [R73630L] 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?
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
X-RAY ANKLE >= 3 VIEWS RIGHT [R73610R] 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?
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
X-RAY ANKLE >= 3 VIEWS LEFT [R73610L] 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?
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
Page 3 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

X-RAY TIBIA-FIBULA >=3 VIEWS RIGHT
[R73590BR]
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?
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
X-RAY TIBIA-FIBULA >=3 VIEWS LEFT
[R73590BL]
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?
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
X-RAY KNEE 1-2 VIEWS RIGHT [R73560R] 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?
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
X-RAY KNEE 1-2 VIEWS LEFT [R73560L] 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?
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
X-RAY FEMUR>=2 VIEWS RIGHT [R73550R] 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?
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
Page 4 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

X-RAY FEMUR>=2 VIEWS LEFT [R73550L] 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?
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
X-RAY HIP UNILATERAL W/PELV WHEN
PERFMD 2-3 VIEWS RIGHT [R73502R]
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?
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
X-RAY HIP UNILATERAL W/PELV WHEN
PERFMD 2-3 VIEWS LEFT [R73502L]
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?
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
Ultrasound [239637]
Lower Extremity Limited Ultrasound - Right
[R76882CR]
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?
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.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Page 5 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Lower Extremity Limited Ultrasound - Left
[R76882CL]
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?
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.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Lower Extremity Limited Ultrasound - Bilateral
[R76882D]
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?
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.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
MRI [239638]
MRI QUICK LOWER EXTREMITY RIGHT
[R73718DR]
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:
Does patient have a pacemaker or defibrillator?
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?
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.
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:
Page 6 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

MRI QUICK LOWER EXTREMITY LEFT
[R73718DL]
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:
Does patient have a pacemaker or defibrillator?
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?
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.
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:
Intravenous Therapy
Premedication for Needle Insertion [30232]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks
to reduce pain. See "LMX Use Instructions" order in
Active Orders report or the Admin Instructions for
application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
IV Fluids [236014]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Page 7 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

sodium chloride 0.9% BOLUS [730003] 10-20 mL/kg, Intravenous, ONCE For 1 Doses
sodium chloride flush 0.9% 10 mL injection
[785055]
Flush, PRN, flush/line care
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
Medications
Analgesics - Acetaminophen - PRN (Single Response) [224829]
acetaMINOPHEN alcohol free (TYLENOL) susp
RANGE [750003]
10-15 mg/kg, Oral, ONCE PRN For 1 Doses,
pain/fever
Mild pain, multimodal therapy, first line agent No more
than 4 grams acetaminophen per 24 hours for adults
or 15mg/kg per dose for peds <40kg
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 10-15 mg/kg. Must order
in whole suppository size (Maximum 650
mg/dose) [43994]
Rectal, ONCE PRN For 1 Doses, pain/fever
Mild pain, multimodal therapy, first line agent.
Maximum 5 doses/day No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per
dose for peds <40kg
acetaMINOPHEN (TYLENOL) tab NOTE:
Suggested dose 10-15 mg/kg [34149]
Oral, ONCE PRN For 1 Doses, pain/fever
Analgesics - NSAIDS - PRN (Single Response) [236015]
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [45376]
Oral, ONCE PRN For 1 Doses, pain, mild to moderate
pain or multimodal therapy
ibuprofen (MOTRIN) tab - NOTE: Suggested dose
10 mg/kg (Maximum 600 mg/dose) [38353]
Oral, ONCE PRN For 1 Doses, pain, mild to moderate
pain or multimodal therapy
Analgesics - Opioids - PRN (Single Response) [236016]
MORPHine PF injection RANGE - NOTE:
Suggested dose 0.05-0.1 mg/kg/dose (Max dose
10mg) [750057]
0.05-0.1 mg/kg, Intravenous, ONCE PRN For 1
Doses, pain, severe pain, for 4 Minutes
NOTE: Suggested dose 0.05-0.1 mg/kg/dose (Max
dose 10 mg)
oxycodone tab [45976] Oral, ONCE PRN For 1 Doses, pain, severe pain
Sedation
Sedation [236032]
PEDIATRIC SEDATION REQUEST - AFCH
[4500100]
ONCE, STAT
Procedure (procedure order will need to be placed):
Priority (procedure needed within):
Family Time/Day preferences:
What is reason for procedure?
Does patient have Acute Issues/Illness?
Does patient have Airway Issues?
Does patient have pulmonary problems?
Does patient have cardiovascular problems?
Does patient have neurologic disorders?
Does patient have gastrointestinal metabolic
problems?
Does patient have any other problems?
Does patient already have venous access?
Follow up appointment needed with provider:
Provider performing procedure, if applicable.
Consult Pediatric Anesthesia Pain Service
[CON0166]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Laboratory
Laboratory - Blood - Order When There is High Suspicion For Joint Infection [235987]
CBC WITH DIFFERENTIAL, C REACTIVE
PROTEIN, ESR, CULTURE, BLOOD,
BACTERIA/YEAST (2 SITES) [235988]
Page 8 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
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?
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?
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?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
BASIC METABOLIC PANEL [BMET] STAT For 1 Occurrences, Routine, Test includes
Sodium; Potassium; Chloride; Carbon Dioxide, Total;
Anion Gap; Glucose; BUN; Creatinine; and Calcium.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LACTATE [GM2255] STAT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BLOOD GASES [HCBGAS] STAT For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Laboratory - Lyme Ab, IgG and IgM Reflex Immunoblot [235961]
Lyme Ab, IgG and IgM reflex Immunoblot
[220889]
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?
Page 9 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

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?
Laboratory - Synovial Fluid [236011]
[6530] Supplemental Order Set -Pediatric -Procedural Sedation -to IP Refer
CELL COUNT, SYNOVIAL FLUID [HCSYCC] 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?
CULTURE, BODY FLUID, AER/ANA WITH
GRAM STAIN [HCWABF]
STAT For 1 Occurrences, Routine, UWHC Only: Use
blood culture bottles for peritoneal, pericardial, pleural,
synovial and dialysate fluids.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Laboratory - Order for Female Patients Only [236012]
HCG, QUALITATIVE, URINE [UPREG] 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?
Laboratory - Urine [236013]
C TRACHOMATIS AND N GONORRHOEAE BY
AMPLIFIED PROBE TECHNIQUE [HCCGAPT]
STAT For 1 Occurrences, Routine, Unacceptable
sources include throat (or any oropharyngeal sites),
rectal and eye.
If the specimen is urine, then the patient should not
urinate for at least one hour prior to the collection of
urine specimen. Collect the first 10-50 mL into a urine
container.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Consults
Consults [236030]
CONSULT INTERVENTIONAL RADIOLOGY -
MUSCULOSKELETAL/PAIN (INPATIENT)
[CON0188]
ONCE
Modality Type: Interventional Radiology
Call back number:
Intent: Consult and Recommend (No Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Surgical Prophylaxis
For Clinically Stable, Non-Toxic Patients [224836]
oxacillin intraVENOUS - NOTE: Order for
Clinically Stable, Non-Toxic patients (Maximum
dose = 2 grams) [800065]
50 mg/kg, Intravenous, ONCE For 1 Doses
For Clinically Stable Patients With Concern for MRSA Infection [224835]
Page 10 of 11
Printed by STRAKA, KEVIN F [KFS1] at 11/20/2017 4:26:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

vancomycin (VANCOCIN) intraVENOUS - NOTE:
vanco intraVENOUS - NOTE: Order for Clinically
Stable Patients with Concern for MRSA Infection
(Maximun dose = 2 grams) [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
For Toxic, Ill-Appearing Patients With Suspected MRSA Infection [235975]
oxacillin-vancomycin - Note: Order for Unstable,
+/- Blood Culture patients [236031]
oxacillin intraVENOUS [800065] 50 mg/kg, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to OR
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 6 HOURS
cefazolin -vanco - NOTE: Order for Toxic, Ill-
Appearing Patients with Suspected MRSA
Infection [236069]
cefazolin (ANCEF) intraVENOUS (Maximum
Dose = 2 g) [800000]
30 mg/kg, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to OR
vancomycin (VANCOCIN) intraVENOUS
(Maximum Dose = 2 g) [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
For Patients with Suspected Kigella (3 months - 3 years of age) or Non-Immunized Patients or Sexually
Active Teens [228220]
Ceftriaxone - Vancomycin - NOTE: Order if
suspected kingella (3 months - 3 years), or non-
immunized patient or sexually active teen patient
[236067]
ceftriaxone (ROCEPHIN) intraVENOUS
(Maximum Dose = 2 g) [800027]
50 mg/kg, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS
(Maximum Dose = 2 g) [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org