/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-98381-en.cckm

201712354

page

100

UWHC,UWMF,

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

ED - Trauma Treatment - Adult [647]

ED - Trauma Treatment - Adult [647] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Trauma Treatment - Adult [647]
Laboratory
Hematology [8329]
TYPE AND SCREEN [HCTS] STAT, Starting today For 1 Occurrences, STAT, 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.
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
PTT [PTT] 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?
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?
FIBRINOGEN [GM1320] 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?
HEMATOCRIT [HCT] 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?
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] 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?
WHITE CELL COUNT [WBC] 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?
PLATELET COUNT [PLT] 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?
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?
RETICULOCYTE COUNT [RET] 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 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Chemistry [8328]
BASIC METABOLIC PANEL - Glucose, BUN,
Creatinine, Calcium, Electrolytes(Na, K, Cl,
Carbon Dioxide, Anion Gap) [BMET]
STAT, Starting today For 1 Occurrences, STAT, 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?
BUN [BUN] 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?
ELECTROLYTES, WHOLE BLOOD
[HCWBLYTS]
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?
CREATININE, WHOLE BLOOD [HCWBCRET] 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?
GLUCOSE, WHOLE BLOOD [HCWBGLU] 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?
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
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 AND O2 SATURATION
[HCBGASOS]
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?
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?
SODIUM, WHOLE BLOOD [HCWBNA] 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?
POTASSIUM, WHOLE BLOOD [HCWBK] 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?
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] 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?
CHLORIDE, WHOLE BLOOD [HCWBCL] 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 2 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

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?
METHEMOGLOBIN [XMHGB] 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?
CARBON MONOXIDE [GM2350] 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?
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?
PROTEIN, TOTAL [TP] 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?
ALBUMIN [ALB] 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?
AST [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?
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?
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?
BILIRUBIN, DIRECT [DBIL] 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?
GGT [GGT] 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?
LD, TOTAL [LDH] 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 3 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CK, TOTAL [CPK] 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?
AMYLASE [AMYL] 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?
AMMONIA [GM2200] 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?
BETA-HYDROXYBUTYRATE [XBOH] 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?
CORTISOL [CORT] 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 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?
FOLATE [FOL] 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?
HEMOGLOBIN A1C [HA1C] 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?
IRON [FE] 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?
MONO TEST [MSP] 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 4 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

OSMOLALITY [GM2215] 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?
POTASSIUM [K] 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?
PRE-ALBUMIN [XPRALB] 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?
SODIUM [NA] 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?
T4, TOTAL [T4] 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?
TSH [TSH] 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?
URIC ACID [URIC] 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?
VITAMIN B12 [B12] 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?
Toxicology/Urine [8330]
ALCOHOL [GM2440] 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?
CARBAMAZEPINE [TEG] 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?
PHENOBARBITAL [PHEN] 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?
ACETAMINOPHEN [GM2485] ONCE, 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?
DIGOXIN [DIG] 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?
PHENYTOIN [DIL] 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 5 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

LITHIUM [LI] 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?
VALPROATE [DEP] 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?
DRUG SCREEN, URINE [HCUPNL] STAT, Starting today For 1 Occurrences, STAT, Test
includes: Amphetamines/Methamphetamines,
Barbiturates, Benzodiazepine, Cocaine, and Opiates
(primarily targets morphine, codeine, and heroin).
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, 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?
If a patient is unable to provide a urine sample after
120 minutes from time of arrival, the RN will Straight
cath the patient for the sample provided the patient
does not refuse.
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?
COCAINE, URINE SCREEN [HCCOCMET] 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?
Diagnostic Tests and Imaging
General Radiology [6577]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
X-RAY PELVIS 1-2 VIEWS [R72170] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Page 6 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

X-RAY CERVICAL SPINE 2-3 VIEWS [R72040] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
X-RAY THORACIC SPINE 2 VIEWS [R72070] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
X-RAY LUMBAR SPINE 2-3 VIEWS [R72100] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
CTA TRAUMA CHEST & CT ABD/PELVIS W
[241321]
CT TRAUMA CHEST W IV CONTRAST
[R71260D]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered
by this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT Trauma Chest W IV & CT Trauma
Abdomen/Pelvis W IV to be scheduled together.
CT TRAUMA ABDOMEN PELVIS W IV
CONTRAST [R07416A]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Can pt be given oral contrast?
Current signs and symptoms? Trauma
What specific question(s) would you like answered
by this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT Trauma Chest W IV & CT Trauma
Abdomen/Pelvis to be scheduled together.
Page 7 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT CERVICAL SPINE W/ O IV CONTRAST
[R72125]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT THORACIC SPINE W/ O IV CONTRAST
FROM PRIOR CT DATA SET [R72128A]
ONCE-RAD NEXT AVAILABLE, Starting today 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.
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 LUMBAR SPINE W/ O IV CONTRAST FROM
PRIOR CT DATA SET [R72131A]
ONCE-RAD NEXT AVAILABLE, Starting today 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.
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/ O IV CONTRAST
[R70486]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
Page 8 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CT ANGIO NECK [R70498] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT THORACIC SPINE W/ O IV CONTRAST
[R72128]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
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
CT LUMBAR SPINE W/ O IV CONTRAST
[R72131]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
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
CT TRAUMA CHEST W IV CONTRAST
[R71260D]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
Page 9 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CT TRAUMA CHEST W/O IV CONTRAST
[R71250F]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Radiology Specialty Area: CT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT ABDOMEN W & W/ O IV CONTRAST - UWH
[240383]
CT ABDOMEN W & W/ O IV CONTRAST
[R74170]
ONCE-RAD NEXT AVAILABLE, Routine
Can pt be given oral contrast?
Current signs and symptoms? Trauma
What specific question(s) would you like answered
by this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT PELVIS W & W/ O IV CONTRAST [R72194] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
CT ABDOMEN PELVIS W & W/ O IV CONTRAST
[R07033]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Can pt be given oral contrast?
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Trauma
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: Floor Determined/Entered
Intravenous Therapy
IV Fluids [7035]
sodium chloride 0.9% BOLUS [730003] Intravenous, ONCE For 1 Doses
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
lactated ringers BOLUS [730001] Intravenous, ONCE For 1 Doses
lactated ringers infusion [38890] Intravenous, CONTINUOUS
Medications
Page 10 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Parental Opiod Analgesics [140472]
FENTanyl PF injection [800187] Intravenous, ONCE For 1 Doses
HYDROmorphone PF (DILAUDID) injection
[800120]
Intravenous, ONCE For 1 Doses
MORPHine PF injection [800122] Intravenous, ONCE For 1 Doses
Anti-emetics [140475]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
Anti-infectives [140476]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ONCE For 1 Doses
gentamicin (GARAMYCIN) intraVENOUS
[800049]
Intravenous, ONCE For 1 Doses
RSI Medications [140477]
etomidate (AMIDATE) vial [56527] Intravenous, ONCE For 1 Doses, for 1 Minutes
succinylcholine (ANECTINE) injection [42431] Intravenous, ONCE For 1 Doses
vecuronium (NORCURON) 10 mg STOCK vial
[46843]
Intravenous, ONCE For 1 Doses
Vasopressors [140478]
DOPamine (INTROPIN) 800 mg in dextrose 5%
250 mL infusion [50506]
2-20 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult - Inpatient Delegation
Protocol
norepinephrine (LEVOPHED) infusion [700247] 0.01-2 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult - Inpatient Delegation
Protocol
phenylEPHRINE(NEO-SYNEPHRINE) infusion
[700258]
0.1-5 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult - Inpatient Delegation
Protocol
Non-categorized [140479]
midazolam (VERSED) injection [800197] Intravenous, ONCE For 1 Doses
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, Delirium in Mechanically Ventilated
Adult Intensive Care Patient Delegation Protocol to
achieve ordered goal RASS score (or other
parameter)
midazolam (VERSED) infusion [700236] Intravenous, CONTINUOUS
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, Delirium in Mechanically Ventilated
Adult Intensive Care Patient Delegation Protocol
propofol (DIPRIVAN) 10 mg/mL infusion [800260] Intravenous, CONTINUOUS
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, Delirium in Mechanically Ventilated
Adult Intensive Care Patient Delegation Protocol
tetanus-diphtheria toxoids ADULT (TENIVAC)
injection [46712]
0.5 mL, Intramuscular, ONCE For 1 Doses
mannitol 20 % IV BOLUS [730016] Intravenous, ONCE For 1 Doses
labetalol injection [800192] 20 mg, Intravenous, ONCE For 1 Doses
Bed Request
BED REQUEST ORDER [91524]
Page 11 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Bed Request [ADT0007] Admit to:
Patient Class:
Procedure?
Will the patient require special placement due to
ISOLATION Precautions?
Is the patient currently a Department of Corrections
(DOC) Inmate?
Is a nursing assessment for CONSTANT
OBSERVATION recommended?
Is the patient currently a resident of CWC or Mendota
Mental Health (MMHI)?
Will the patient go directly to the OR from the ED?
Could this patient have ACS/MI?
Does the patient require CARDIAC MONITORING for
transport?
Admitting Provider?
Attending Provider?
Would this patient be appropriate for admission to the
ED Clinical Decision Unit in lieu of a hospital admit or
discharge?
Page 12 of 12
Printed by STRAKA, KEVIN F [KFS1] at 12/19/2017 3:58:13 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org