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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98377-en.cckm

201710286

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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 - Shortness of Breath - Adult [4928]

ED - Shortness of Breath - Adult [4928] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Shortness of Breath - Adult [4928]
Laboratory
Labs [133267]
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?
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, STAT
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?
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?
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?
D-DIMER, QUANT [GM1332] 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?
B-TYPE NATRIURETIC PEPTIDE [XBNP] 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?
BLOOD GASES [HCBGAS] STAT, Starting today 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?
MAGNESIUM [MAG] 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 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

PHOSPHATE [PHOS] 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?
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?
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?
Diagnostic Tests and Imaging
Cardiology [140067]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, STAT
Reason for exam: CHEST PAIN
ECG (Repeat) [EKG0008] ONCE, Starting today For 1 Occurrences, STAT
Reason for exam: CHEST PAIN
2 hours after first Troponin
General Radiology [133268]
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
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, 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
Page 2 of 6
Printed by STRAKA, KEVIN F [KFS1] at 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

CT ANGIO CHEST PE PROTOCOL [R71275A] 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.
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:
NM LUNG VENTILATION & PERFUSION SCAN
[R78588]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
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.
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant or breastfeeding?
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):
Transport Method: Floor Determined/Entered
Page 3 of 6
Printed by STRAKA, KEVIN F [KFS1] at 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

MRA CHEST W OR W/ O CONTRAST [R71555] 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?
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:
NM Myocardial Perfusion Rest and Stress
[117122]
Stress Test order. Nuclear routine This panel is the IP Level II Chest Pain and
Both orders are required for stress testing. Do not remove the orders.
Page 4 of 6
Printed by STRAKA, KEVIN F [KFS1] at 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

NM MYOCARDIAL PERFUSION REST &
STRESS (SPECT) W WALL MOTION &
EJECTION FRACTION [R78452]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms?
Reason for exam:
What specific question(s) would you like answered
by this exam?
Relevant recent/past history?
Is patient pregnant or breastfeeding?
What form of stress is to be performed?
Is the patient ready for discharge today, pending the
results of the stress test?
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.
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.
Last patient weight? (will auto pull in value and date
in comment):
Last patient height? (will auto pull in value and date
in comment):
BMI (will auto pull in value):
Transport Method:
Exercise or Drug Stress Test (with Nuclear
Medicine) [EKG0007]
ONCE, Routine
Current signs and symptoms?
Reason for exam:
What specific question(s) would you like answered
by this exam?
Relevant recent/past history?
Is patient pregnant or breastfeeding?
What form of stress is to be performed?
Is the patient ready for discharge today, pending the
results of the stress test?
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.
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.
Last patient weight? (will auto pull in value and date
in comment):
Last patient height? (will auto pull in value and date
in comment):
BMI (will auto pull in value):
Transport Method:
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?
Page 5 of 6
Printed by STRAKA, KEVIN F [KFS1] at 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

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
Medications [133271]
furosemide (LASIX) intraVENOUS [800046] Intravenous, ONCE For 1 Doses
nitroglycerin (NITROSTAT) sublingual tab [40283] 0.4 mg, Sublingual, ONCE For 1 Doses
nitroglycerin (NITRO-BID) 2% ointment [40285] 1 inch, Transdermal, ONCE For 1 Doses
nitroglycerin 50 mg in dextrose 5% 250 mL
infusion [51611]
Intravenous, CONTINUOUS
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
Intravenous, ONCE For 1 Doses
Patient Care Orders
Vital Signs [140076]
Vital Signs [NURMON0013] EVERY 1 HOUR, Starting today, STAT
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [140075]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication:
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Respiratory [133274]
Pulse Oximetry on Room Air - Once
[NURMON0009]
ONCE, Starting today For 1 Occurrences, STAT
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, STAT
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, STAT
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 93
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
Initiate Adult Asthma or Recurrent Wheezing
Protocol [192236]
Respiratory Care Protocol - Asthma [RT0060] Routine
RT to Provide Asthma Education to Patient
[RT0125]
ONCE, Routine
Page 6 of 6
Printed by STRAKA, KEVIN F [KFS1] at 10/13/2017 11:52:28 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org