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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98366-en.cckm

201709272

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UWHC,UWMF,

Tools,

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

ED - Gastrointestinal Bleed - Adult [325]

ED - Gastrointestinal Bleed - Adult [325] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Gastrointestinal Bleed - Adult [325]
Laboratory
Labs [6600]
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?
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?
LIPASE [LIPS] 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?
PROTHROMBIN TIME/INR [PT] 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?
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?
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?
TROPONIN [GM2447] 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?
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 Bank
Tests [100542]
TYPE AND SCREEN [HCTS] STAT, Starting today For 1 Occurrences, Routine, As
good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2
packed RBCs on all patients with antibodies to ensure
blood would be available in the event it is needed. If
you would like to opt out of this automatic order for this
patient please contact the UWHC Blood Bank at (608)
263-8367 or The American Center Lab at (608) 234-
6600 as appropriate.
Diagnostic Tests and Imaging
Cardiology [140482]
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, STAT
Reason for exam:
General Radiology [6563]
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:58:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

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
X-RAY CHEST AP VIEW [R71010] 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 ABDOMEN >= 2 VIEWS [R74020] 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 ABDOMEN AP VIEW (KUB) [R74000] 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
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 H2 Blockers/PPI [6250]
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:58:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

pantoprazole (PROTONIX) injection 80 mg
[800119]
80 mg, Intravenous, ONCE For 1 Doses
pantoprazole (PROTONIX) in sodium chloride 0.9
% 250 mL infusion [700253]
8 mg/hr, Intravenous, CONTINUOUS
GI Vascular Meds [6251]
octreotide (SANDOSTATIN) injection [800200] 25 mcg, Intravenous, ONCE For 1 Doses
octreotide (SANDOSTATIN) injection [800200] 50 mcg, Intravenous, ONCE For 1 Doses
octreotide (SANDOSTATIN) 500 mcg in dextrose
5 % 250 mL infusion [700248]
Intravenous, CONTINUOUS
Analgesics [133323]
MORPHine injection [39801] 4 mg, Intravenous, ONCE For 1 Doses, for 4 Minutes
MORPHine injection [39801] 8 mg, Intravenous, ONCE For 1 Doses, for 4 Minutes
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
1st line therapy
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
2nd line therapy. Administer if patient unable to
tolerate orally.
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, ONCE For 1 Doses
Anti-infectives [198682]
ceftriaxone (ROCEPHIN) intraVENOUS - NOTE:
Order if gastrointestinal bleed with cirrhosis
[800027]
1 g, Intravenous, ONCE For 1 Doses
Patient Care Orders
Vital Signs [140483]
Vital Signs [NURMON0013] EVERY 1 HOUR For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Orthostatic Vital Signs [NURMON0007] ONCE For 1 Occurrences, Routine
Patient Monitoring [140485]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication:
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Nutrition [6726]
Diet NPO except medications [NURDIE0012] CONTINUOUS, Routine
Diet: NPO (Except medications)
Respiratory [140484]
Pulse Oximetry [NURMON0009] ONCE For 1 Occurrences, Routine
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device:
Attempt to Wean Off Oxygen?
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:58:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Non Categorized Patient Care Orders [133322]
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Recommendations for flush quantity:
For adult patients, 30 mLs of fluid should be
sufficient.
lidocaine-oxymetazoline 4%-0.05% (ADULT)
nasal spray [785081]
2 spray, Nasal, ONCE For 1 Doses
For numbing prior to nasal tube insertion.
Slowly spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of
throat spraying the anterior nostril and wait 30-60
seconds before introducing more local
anesthetic into the nostril. Caution: Entire bottle
should not be used for insertion of tube. Discard
excess solution when procedure completed.
X-RAY ABDOMEN AP VIEW (KUB) [R74000] 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? Evaluate nasogastric tube placement
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
If Conditional, What Condition? Evaluate nasogastric
tube placement. The location of nasogastric 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
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:58:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org