/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-98361-en.cckm

20180119

page

100

UWHC,UWMF,

Tools,

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

ED - Abdominal Pain - Adult [617]

ED - Abdominal Pain - Adult [617] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Abdominal Pain - Adult [617]
Laboratory
Labs [135218]
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?
BILIRUBIN, TOTAL [TBIL] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
AST/SGOT [AST] 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?
ALT/SGPT [ALT] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
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?
LIPASE [LIPS] STAT, Starting today For 1 Occurrences, STAT
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, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUALITATIVE, URINE [UPREG] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUANTITATIVE [BHCG] STAT, Starting today For 1 Occurrences, STAT, This
test is not intended for aiding in the diagnosis of
cancer or for monitoring the treatment of cancer
patients.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LACTATE [GM2255] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TROPONIN [GM2447] STAT, Starting today For 1 Occurrences, STAT
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 STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

ESR [HCERWEST] 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?
C REACTIVE PROTEIN [CRPN] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
C TRACHOMATIS AND N GONORRHOEAE BY
AMPLIFIED PROBE TECHNIQUE [HCCGAPT]
STAT, Starting today 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?
VAGINITITIS/VAGINOSIS WORKUP [131622]
CULTURE, YEAST, VAGINAL WITH SMEAR
[HCYSTCS]
STAT For 1 Occurrences, Routine, Simultaneous
Testing for Culture, Trichmonas with Wet Prep;
Culture, Yeast, Vaginal with Smear; and Gram Stain
for Bacterial Vaginosis is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
TRICHOMONAS VAGINALIS BY AMPLIFIED
PROBE TECHNIQUE [TVAPT]
STAT For 1 Occurrences, Routine, This test is for
vaginal, endocervical and urine specimens. For
male urethral specimens see Trichomonas vaginalis
by TMA [UTVTMA].
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.
Simultaneous testing for Trichomonas vaginalis by
Amplified Probe Technique; Culture, Yeast, Vaginal
with Smear and Gram Stain for Bacterial Vaginosis
is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
GRAM STAIN VAGINAL FOR BACTERIAL
VAGINOSIS [HCGSVG]
STAT For 1 Occurrences, Routine, Simultaneous
Testing for Culture, Trichmonas with Wet Prep;
Culture, Yeast, Vaginal with Smear; and Gram Stain
for Bacterial Vaginosis is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Page 2 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Set up for Bimanual Pelvic Exam
[NURCOM0022]
ONCE
Diagnostic Tests and Imaging
General Radiology [6549]
X-RAY CHEST 2 VIEWS [R71046] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Radiology Specialty Area:
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 ABDOMEN 2 VIEWS [R74019] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
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 ABDOMEN SINGLE VIEW [R74018] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Radiology Specialty Area:
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 ABDOMEN PELVIS W IV CONTRAST
[R07416]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Can pt be given oral contrast?
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
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:
ED - Radiology Prep (Contrast) - Adult [133317]
exceedingly frail patients, cases with suspicion of high grade bowel obstruction, elderly or In
drink time for CT to 2 hours.UNSELECT G.I. lavage (GOLYTELY) and extend
Page 3 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

G.I. lavage (GOLYTELY) 236 G soln [103976] 1 L, Oral, ONCE For 1 Doses
Mix one 4 L container GI lavage powder with water
to fill line. Pour 1 Liter into graduated container and
add 30 mL iohexol to 1 Liter volume and mix.
Patient should drink 1000 mL over 60-90 minutes. If
scan is delayed have patient continue to drink slowly
until scan. May add Crystal Light lemonade powder
for flavor. Do NOT add ice.
iohexol (OMNIPAQUE) soln [785198] 30 mL, Oral, ONCE For 1 Doses
30 mL dose (ED): dilute in 1000 mL of Golytely
CT FLANK PAIN [R99992] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
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:
US ABDOMEN COMPLETE [R76700] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Radiology Specialty Area: ULTRASOUND
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
US ABDOMEN LIMITED [R76705] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
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 4 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

US PELVIS [R76856] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Radiology Specialty Area: ULTRASOUND
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
Intravenous Therapy
IV Fluids [133198]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, STAT
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9 % infusion BOLUS [730003] 1,000 mL, Intravenous, ONCE For 1 Doses
sodium chloride 0.9 % infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS
Medications
GI Medications [5954]
GI COCKTAIL ED PANEL [133321]
lidocaine (XYLOCAINE) 2 % soln [39044] 15 mL, Swish & Swallow, ONCE For 1 Doses
alum-mag-simeth (MYLANTA ES) 400-400-40
MG/5ML susp [44073]
30 mL, Oral, ONCE For 1 Doses
famotidine (PEPCID) tab [45134] 20 mg, Oral, ONCE For 1 Doses
Acetaminophen [233493]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE For 1 Doses
Analgesics - NSAIDS (Single Response) [140798]
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, ONCE For 1 Doses
ketOROLAC (TORADOL) injection [800050] 15 mg, Intravenous, ONCE For 1 Doses
ketOROLAC (TORADOL) injection [800050] 30 mg, Intramuscular, ONCE For 1 Doses
Analgesics - Parenteral Opioids (Single Response) [140799]
MORPHine PF injection [800122] 4 mg, Intravenous, ONCE For 1 Doses
MORPHine PF injection [800122] 8 mg, Intravenous, ONCE For 1 Doses
HYDROmorphone PF (DILAUDID) injection
[800120]
0.5 mg, Intravenous, ONCE For 1 Doses
HYDROmorphone PF (DILAUDID) injection
[800120]
1 mg, Intravenous, ONCE For 1 Doses
Antiemetics [133253]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, ONCE For 1 Doses
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, ONCE For 1 Doses
Patient Care Orders
Vital Signs [140458]
Page 5 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Vital Signs [NURMON0013] EVERY 1 HOUR, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [140471]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Nutrition [140459]
NPO except medications [NURDIE0012] CONTINUOUS, Routine
Diet: NPO,Other (Comment) (except medications)
Respiratory [6713]
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, STAT
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine
Page 6 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:10:08 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org