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ED - Intubation - Pediatric - Supplemental [6018]

ED - Intubation - Pediatric - Supplemental [6018] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Intubation - Pediatric - Supplemental [6018]
Intubation Assessment
Airway Timeout [197538]
Airway Timeout [RT0126] ONCE, Routine
Was airway timeout completed?
Was airway checklist completed?
Laboratory
Laboratory [189904]
BLOOD GASES AND O2 SATURATION [HCBGASOS] CONDITIONAL - RN COLLECT, Starting today For 3 Days,
Arterial, STAT
Indicate FIO2: FiO2 Per RN
If add on test, what should lab do if unable to add test to
previous specimen? Cancel
If Conditional, What Condition? Draw 30 minutes
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [186358]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE For 1 Occurrences, STAT
Current signs and symptoms? Intubated
What specific question(s) would you like answered by this
exam? Evaluate ET Tube
Relevant recent/past history? S/P Intubation
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Perform 30 minutes after order is signed
Intravenous Bolus Therapy
IV Fluids (Single Response) [201638]
sodium chloride 0.9% IV BOLUS [730003] 10-20 mL/kg, Intravenous, ONCE For 1 Doses
lactated ringers IV BOLUS [730001] 10-20 mL/kg, Intravenous, ONCE For 1 Doses
Medications - Intubation
Appropriate use if paralysis with succinylcholine or currently not paralyzed
Pre-Induction Agents [201671]
FENTanyl (SUBLIMAZE) injection RANGE [750047] 0.5-2 mcg/kg, Intravenous, ONCE PRN For 1 Doses, pain,
Analgeisa for Sedation, for 1 Minutes
lidocaine PF 2 % injection - Maximum Dose = 100 mg
[140345]
1.5 mg/kg, Intravenous, ONCE For 1 Doses
Give 3-5 minutes prior to intubation
atropine injection [800178] 0.02 mg/kg, Intravenous, ONCE PRN For 1 Doses,
bradycardia
Induction Agents (Single Response) [201674]
etomidate (AMIDATE) 2 mg/mL 10mL vial STOCK VIAL
[790016]
0.15-0.3 mg/kg, Intravenous, ONCE PRN For 2 Hours,
Sedation for intubation induction, for 1 Minutes
ketAMINE injection [800191] 1-2 mg/kg, Intravenous, ONCE PRN For 2 Hours, sedation for
intubation induction
propofol (DIPRIVAN) 10 mg/mL IV BOLUS [730017] 1-3 mg/kg, Intravenous, ONCE PRN For 2 Hours, Sedation
for intubation induction
midazolam (VERSED) injection [800197] 0.1-0.2 mg/kg, Intravenous, ONCE PRN For 2 Hours,
sedation, Sedation of intubation induction
Paralytics (Single Response) [201675]
succinylcholine (ANECTINE) 20 mg/mL 10 mL STOCK
vial [790064]
1-2 mg/kg, Intravenous, ONCE PRN For 2 Hours, Paralysis
rocuronium (ZEMURON) 50 MG/5ML vial [133817] 0.6-1.2 mg/kg, Intravenous, ONCE PRN For 2 Hours,
Paralysis, for 1 Minutes
Post Intubation Analgesia/Sedation
Page 1 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/18/2016 2:45:18 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

Pain [201679]
FENTanyl (SUBLIMAZE) injection [800187] 1 mcg/kg, Intravenous, EVERY 15 MINUTES PRN, pain
Agitation (Single Response) [201681]
Infusion Options
1st line - Propofol
2nd line - Midazolam
Propofol Infusion [192538]
propofol (DIPRIVAN) 10 mg/mL IV BOLUS [730017] 1-2 mg/kg, Intravenous, PRN, Sedation - Use only if
propofol being initiated or dose increased.
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 25-125 mcg/kg/min, Intravenous, CONTINUOUS
Midazolam Infusion [201687]
midazolam (VERSED) injection [106489] 0.05-0.1 mg/kg, Intravenous, EVERY 15 MINUTES PRN,
Agitation/Sedation
If patient fails to respond after 3 doses in an hour consider
starting continuous infusion
midazolam (VERSED) infusion PEDS [800154] 0.025-0.2 mg/kg/hr, Intravenous, CONTINUOUS
Extended Chemical Paralysis - Post Intubation Analgesia/Sedation
Appropriate for use if paralysis with rocuronium or vecuronium
Pain [201691]
Fentanyl [201698]
FENTanyl (SUBLIMAZE) injection - Maximum Dose = 50
mcg [800187]
0.5-2 mcg/kg, Intravenous, EVERY 20 MINUTES PRN For
4 Doses, Pain/Agitation
FENTanyl (SUBLIMAZE) injection - Maxumum Dose =
50 mcg [800187]
0.5-2 mcg/kg, Intravenous, EVERY 20 MINUTES For 4
Doses
Hold for SBP<90. If patient spontaneously moving hold
scheduled doses if pain controlled.
Agitation [201694]
Midazolam Scheduled Bolus [202655]
midazolam (VERSED) injection - Maxmum Dose = 4 mg
[800197]
0.1 mg/kg, Intravenous, EVERY 20 MINUTES For 4 Doses
Use if scheduled dose not adequately sedating patient.
midazolam (VERSED) injection - Maximum Dose = 4 mg
[800197]
0.05 mg/kg, Intravenous, EVERY 20 MINUTES PRN For 4
Doses, sedation, Agitation
Use scheduled dose not adequately sedating patient
Midazolam Infusion [202663]
midazolam (VERSED) injection - Maximum Dose = 4 mg
[800197]
0.1 mg/kg, Intravenous, ONCE For 1 Doses
midazolam (VERSED) infusion PEDS - Maxmum Dose =
10 mg/hr [800154]
0.025-0.2 mg/kg/hr, Intravenous, CONTINUOUS
Propofol Infusion [192538]
propofol (DIPRIVAN) 10 mg/mL IV BOLUS [730017] 1-2 mg/kg, Intravenous, PRN, For initiation prior to infusion
and as needed for sedation
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 25-125 mcg/kg/min, Intravenous, CONTINUOUS
Patient Care Orders
Activity (Single Response) [201757]
Elevate Head Of Bed [NURACT0002] Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options: At all times
Routine, CONTINUOUS
Cervical Spine Precautions [PRECAU0005] CONTINUOUS, Routine, Cervical Spine Precautions:
Cervical collar at all times.
No pillow behind head.
No lifting anything greater than 10 pounds.
No lifting of arms over head.
Page 2 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/18/2016 2:45:18 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

Thoracic/Lumbar Spine Precautions [PRECAU0009] CONTINUOUS, Routine, Thoracic/Lumbar Spine
Precautions:
Head of bed less than 30 degrees unless otherwise stated.
Head of bed flat for log rolling side to side.
Non-Categorized Patient Care Orders [201758]
Mechanical Ventilation - Pediatric [147629]
For patients 6 years and older SELECT the order for Chlorhexidine.
chlorhexidine (PERIDEX) 0.12 % soln MULTIDOSE -
NOTE: For Patients 6 years of age or older [792004]
15 mL, Mouth/Throat, 2 X DAILY
Use to swab oral cavity. D/C when patient no longer on
ventilation.
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine
Mechanical Ventilation - Peds [RT0090] CONTINUOUS, Routine, For ADULT patients order
chlorihexidene gluconate (PERIDEX) 0.12% soln 15 mL to
swab oral cavity 2x daily while on ventilation.
Ventilator Management:
Wean Peds:
Mode:
Set Rate/Min:
Tidal Volume Multiplier: 7
PEEP (cmH2O):
FiO2 (%):
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
artificial tears PF ophthalmic ointment [157764] Eyes (Each), PRN, Irritation
Adminster to each eye every 2-4 hours as needed. For use
while patient is mechanically ventilated and sedated.
Please refer to ocular care algorithm.
Ventilator Associated Peneumonia (VAP Precautions)
[NURCOM0022]
SEE COMMENTS, Ventilator Associated Pneumonia
Precautions
Suction Airway [NURTAD0017] PRN, Routine
Location: Tracheal
ETCO2 Monitoring [RT0006] CONTINUOUS, Routine
OG Tube Placement - Pediatric [121660]
Insert and Maintain Orogastric Tube [NURTAD0015] CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Check Residual:
Does this need to be inserted/placed?
Device Status:
Recommendations for flush quantity:
For patients < 30 kg, use 1mL of fluid per 1 kg.
For patients >30 kg, 30 mLs of fluid should be sufficient.
In general, consider the amount of fluid needed to clear the
tube and patient’s fluid status before determining flush
quantity.
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Evaluate orogastric 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):
Page 3 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/18/2016 2:45:18 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate orogastric tube
placement. The location of orogastric 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
NG Tube Placement - Pediatric [121658]
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:
Recommendations for flush quantity:
For patients < 30 kg, use 1mL of fluid per 1 kg.
For patients >30 kg, 30 mLs of fluid should be sufficient.
In general, consider the amount of fluid needed to clear the
tube and patient’s fluid status before determining flush
quantity.
lidocaine-oxymetazoline 3%-0.01% (PEDS) nasal spray
[785104]
Nasal, ONCE For 1 Doses
For numbing prior to feeding 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] CONDITIONAL For 3 Days, 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 GUETZLAFF, SCOTT F [SFG091] at 5/18/2016 2:45:18 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org