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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98383-en.cckm

201711334

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

ED - Coronary CT Angiography - Adult - Procedure [5225]

ED - Coronary CT Angiography - Adult - Procedure [5225] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Coronary CT Angiography - Adult - Procedure [5225]
for Adult Patients OnlyIntended
Pre-Angiography Patient Care Orders
Vital Signs [31367]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On arrival.
After Oral Metoprolol [31368]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 2, then every 30 minutes after
oral metoprolol administration.
After Intravenous Metoprolol Administration [31369]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 5 minutes times 3, then every 15 minutes times
3 after intravenous metoprolol administration.
After Diltiazem Administration [186775]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 10 minutes times 3 then every 15 minutes times
2 after intravenous diltiazem administration.
Contingency Parameters [31374]
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/27/2017 5:14:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm): 45
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Irregular heart rate is identified,,If maximum IV
metoprolol (50 mg) is reached,,or if systolic blood
pressure less than 100 mmHg,,Previous adverse
reaction to nitroglycerin,Current use of PDE inhibitors
(sildenafil, tadalafil),,Patient has history of NON-
anaphylactic reaction (hives, itching, rash) to contrast
dye and has NOT taken methylprednisilone prior to
procedure,,Patient has history of anaphylactic reaction
(airway compromise)
Notify Cardiology Attending
Pre-Angiography - Medications
Premedications for Needle Insertion [106310]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion
- see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/27/2017 5:14:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Intravenous Therapy [31356]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Insert 16-18 gauge intravenous catheter in antecubital
or larger vein (right preferred).
Attach high pressure 3 inch extension or high
pressure stopcock [NURVAD0053]
ONCE, Starting today For 1 Occurrences
Oral Metoprolol Protocol [153696]
metoprolol tartrate (LOPRESSOR) tab [39632] 100 mg, Oral, ONCE PRN For 1 Doses, for resting
heart rate GREATER than 70 beats/minute one hour
prior to procedure
If systolic blood pressure less than 100 mmHg,
consider adjusting dose of beta blocker according to
protocol. Administer after radiology tech calls that
study has been protocoled.
metoprolol tartrate (LOPRESSOR) tab [39633] 50 mg, Oral, ONCE PRN For 1 Doses, for resting
heart rate BETWEEN 60 and 69 beats/min one hour
prior to procedure
If systolic blood pressure less than 100 mmHg,
consider adjusting dose of beta blocker according to
protocol. Administer after radiology tech calls that
study has been protocoled.
IV Metoprolol [147181]
metoprolol (LOPRESSOR) injection [800274] 5 mg, Intravenous, EVERY 5 MINUTES PRN For 10
Doses, for heart rate greater than 60 beats/minute.
Administer first IV dose if indicated, 4 minutes after
PO dose of metoprolol is administered. If systolic
blood pressure less than 100 mmHg, consider
adjusting dose of beta blocker according to protocol.
If maximum of metoprolol is not reached and heart
rate is less than 60 beats per minute achieved,
transport remaining metoprolol to Radiology.
Nitroglycerin - The following medications are contraindicated for nitroglycerin administration (sildenafil,
vardenafil, tadalafil) [153697]
nitroglycerin (NITROSTAT) sublingual tab 0.4 mg
- 1st option [40283]
0.4 mg, Sublingual, SEE ADMIN INSTRUCTIONS
Administer medication just prior to bringing patient to
CT scanner. Hold if systolic blood pressure is less
than 100 mmHg, severe stenosis, previous intolerance
or if patient is on one of the following contraindicated
medications (sildenafil, vardenafil, tadalafil)
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/27/2017 5:14:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

nitroglycerin (NITROSTAT) sublingual tab - 2nd
option [40283]
0.4 mg, Sublingual, PRN, chest pain, See
Administration Instructions
Administer if 15 minutes elapsed from first dose of
nitroglycerin and scan not initiated. Hold if systolic
blood pressure is less than 100 mmHg, severe
stenosis, previous intolerance or if patient is on once
of the following contraindicated medications (sildenafil,
vardenafil, tadalafil).
Calcium Channel Blockers [210035]
diltiazem (CARDIZEM) injection - The Coronary
CT Angiography Procedure should be performed
20-35 minutes after diltiazem is given. Peak effect
of the medication is reached 20 minutes after
administration and the effect diminishes in
another 20-30 minutes. [135458]
20 mg, Intravenous, PRN
Administer 2 doses if necessary at least 20 minutes
apart to achieve a resting heart rate less than 60 bpm
while maintaining blood pressure 100 mmHg.
Post-Angiography - Medications
Post-Angiography [153698]
Note: [950018] ONCE For 1 Doses
Hold all metformin-containing products for 48 hours
post-angiography
Labs
Labs [153723]
TROPONIN [GM2447] CONDITIONAL, Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw 2 hours after the first Troponin
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [153702]
CTA CORONARY ARTERIES [R0146T] 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.
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: Floor Determined/Entered
CT CHEST LIMITED W IV CONTRAST DURING
CTA CORONARY [R71260B]
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.
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: Floor Determined/Entered
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/27/2017 5:14:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org