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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98387-en.cckm

201606176

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100

UWHC,UWMF,

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

ED - Trauma Treatment - Pediatric [5590]

ED - Trauma Treatment - Pediatric [5590] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Trauma Treatment - Pediatric [5590]
Laboratory
Pediatric Trauma Labs [192213]
SELECT panel below if patient evaluation warrants Baseline Pediatric Trauma Labs
Baseline Pediatric Trauma Labs [192214]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT 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.
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
GLUCOSE [GLU] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN [BUN] STAT - RN COLLECT 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 [CRET] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CALCIUM [CA] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AMYLASE [AMYL] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
LIPASE [LIPS] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AST/SGOT [AST] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ALT/SGPT [ALT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Additional Pediatric Trauma Labs [187775]
PTT [PTT] STAT - RN COLLECT 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 - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


previous specimen?
If Conditional, What Condition?
RETICULOCYTE COUNT [RET] STAT - RN COLLECT For 1 Occurrences, Routine
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 - RN COLLECT 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?
LACTATE [GM2255] STAT - RN COLLECT 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 - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL [TP] STAT - RN COLLECT 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 - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
MAGNESIUM [MAG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BILIRUBIN, DIRECT [DBIL] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
GGT [GGT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
LD, TOTAL [LDH] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CK, TOTAL [CPK] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AMMONIA [GM2200] STAT - RN COLLECT 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, QUANTITATIVE [BHCG] STAT - RN COLLECT For 1 Occurrences, Routine
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
OSMOLALITY [GM2215] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ALCOHOL [GM2440] STAT - RN COLLECT For 1 Occurrences, Routine
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 - RN COLLECT 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 - RN COLLECT 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 [SPREG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
FIBRINOGEN [GM1320] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Whole Blood [187780]
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] STAT - RN COLLECT 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 - RN COLLECT 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 - RN COLLECT 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 - RN COLLECT 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 - RN COLLECT 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, WHOLE BLOOD [HCWBNA] STAT - RN COLLECT 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 - RN COLLECT 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 - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


If Conditional, What Condition?
General Radiology
General Radiology [187795]
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
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
Head CT
For patients with signs of Altered Mental Status - including GCS 14 or less, signs of basilar skull fracture, or palpable
fracture [192683]
4.4% risk of clinically important traumatic brain injury
CT Recommended
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Trauma
What specific question(s) would you like answered by this
exam? Trauma
Relevant recent/past history? Trauma
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Is patient pregnant?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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
For LESS than 2 years of age withOUT signs of Altered Mental Status [192684]
If child has non-frontal hematoma, LOC greater than or equal to 5 seconds, not acting normally per parents, or severe
mechnism of injury
Consider OBSERVATION versus CT scan with consultation of Attending Physician
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Routine, Every 15 minutes times 4
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Routine
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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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
For 2 years of age or OLDER withOUT signs of Altered Mental Status [192685]
If child has history of LOC, vomiting, severe headache OR severe mechanism of injury
Consider OBSERVATION versus CT following consultation with Attending Physician
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Routine, Every 15 minutes times 4
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Routine
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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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
Spine CT
Spine CT [192728]
X-ray should be done prior to CT
Consult Neurosurgery for guidance regarding CT Imaging.
Pediatric C-spine Clearance for Conscious Patients URL: https://uconnect.wisc.edu/clinical/references/afch-
pediatric-resources/spine/resources/name-31770-en.file
Pediatric C-spine Clearance for Unconcious Patients URL: https://uconnect.wisc.edu/clinical/references/afch-
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pediatric-resources/spine/resources/name-31771-en.file
Pediatric Thoracic and Lumbar Spine Clearance for
Conscious Patients
URL: https://uconnect.wisc.edu/clinical/references/afch-
pediatric-resources/spine/resources/name-31772-en.file
Pediatric Thoracic and Lumbar Spine Clearance for
Unconscious Patients
URL: https://uconnect.wisc.edu/clinical/references/afch-
pediatric-resources/spine/resources/name-31773-en.file
CT CERVICAL SPINE W/ O IV CONTRAST [R72125] ONCE-RAD NEXT AVAILABLE 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 THORACIC SPINE W/ O IV CONTRAST [R72128] ONCE-RAD NEXT AVAILABLE, Routine
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 - NOTE: x-ray
should be done prior to CT [R72131]
ONCE-RAD NEXT AVAILABLE 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
General CT
General CT [187832]
CT CHEST W IV CONTRAST [R71260] ONCE-RAD NEXT AVAILABLE 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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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.
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
CT ABDOMEN PELVIS W IV CONTRAST [R07416] 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? Trauma
Relevant recent/past history? Trauma
Is patient pregnant?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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 ANGIO NECK - NOTE: Order for Penetrating Neck
Trauma [R70498]
ONCE-RAD NEXT AVAILABLE 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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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 MAXILLOFACIAL W/ O IV CONTRAST [R70486] ONCE-RAD NEXT AVAILABLE 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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
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
Diagnostic Tests
Cardiology [192729]
ECG - 12 Lead (PEDS) [EKG0014] ONCE For 1 Occurrences, Routine
Reason for exam:
Intravenous Therapy
IV Fluids - Bolus [192156]
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


sodium chloride 0.9% BOLUS [730003] 20 mL/kg, Intravenous, ONCE For 1 Doses
lactated ringers BOLUS [730001] 20 mL/kg, Intravenous, ONCE For 1 Doses
IV Fluids - Maintenance [187758]
Maintenance rate calculation for infusion orders
(4mL/kg for 1st 10kg) + (2mL/kg for kg 11-20) + (1mL/kg for every kg over 20) = hourly rate.
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
lactated ringers infusion [38890] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
Medications
Initial Pain Management [192157]
FENTanyl (SUBLIMAZE) injection - NOTE: Suggested
Dose = 1-2 mcg/kg (Maximum 100 mcg/dose) [800187]
Intravenous, ONCE PRN For 1 Doses, Severe Pain
FENTanyl (SUBLIMAZE) 50 mcg/mL intraNASAL soln -
NOTE : (Maximum 100 mcg/dose) [785209]
1.5 mcg/kg, Nasal, ONCE PRN For 1 Doses, Severe Pain
Anxiolysis and Mild Sedation [192158]
midazolam (VERSED) injection - NOTE: Suggested
Dose - 0.05-0.1 mg/kg [800197]
Intravenous, EVERY 15 MINUTES PRN, sedation, Mild
sedation
midazolam (VERSED) 5 MG/ML intraNASAL soln
[785196]
0.3 mg/kg, Nasal, ONCE For 1 Doses
Continued Pain Management (Single Response) [192534]
HYDROmorphone PF (DILAUDID) injection - NOTE:
Suggested Dose - 0.015-0.02 mg/kg Maximum Dose = 1
mg [800120]
Intravenous, ONCE PRN For 1 Doses, Severe Pain
MORPHine PF injection - NOTE: Suggested Dose -
0.05-0.1 mg/kg Maximum Dose = 10 mg [800122]
Intravenous, ONCE PRN For 1 Doses, pain, Severe Pain
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
15 mg/kg, Oral, ONCE For 1 Doses
Anti-emetics [185198]
ondansetron (ZOFRAN ODT) disintegrating tab [64224] 4 mg, Oral, ONCE For 1 Doses
ondansetron (ZOFRAN) injection [800202] 0.15 mg/kg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Administer if unable to tolerate PO
Anti-infectives [187760]
cefuroxime (ZINACEF) intraVENOUS - NOTE: Maximum
dose of 1.5 g [800030]
50 mg/kg, Intravenous, ONCE For 1 Doses
Rapid Sequence Intubation - PREMEDICATION [192536]
Atropine: Consider if age < 8 years or increased secretions
Lidocaine: Consider if increased ICP
Fentanyl: Consider if increased ICP
atropine injection [800178] 0.02 mg/kg, Intravenous, ONCE For 1 Doses
Minimum dose 0.1 with max dose 0.5 mg child, 1 mg
adolescent
lidocaine (XYLOCAINE-CARDIAC) injection [39041] 1.5 mg/kg, Intravenous, ONCE For 1 Doses
FENTanyl (SUBLIMAZE) 0.05 MG/ML injection [37424] 1 mcg/kg, Intravenous, ONCE For 1 Doses, for 1 Minutes
Rapid Sequence Intubation - SEDATION [192535]
Etomidate: Caution if adrenal suppression or septic shock
Midazolam: Caution of hypotension
Ketamine: Consider if bronchospasm. Caution if increase ICP or globe/eye injury
Propofol: Caution if hypotension
etomidate (AMIDATE) 2 mg/mL 10mL vial STOCK VIAL
- NOTE: Suggested Dose - 0.2-0.4 mg/kg [790016]
Intravenous, ONCE For 1 Doses, for 1 Minutes
midazolam (VERSED) injection - NOTE: Suggested
Dose - 0.1-0.3 mg/kg [800197]
Intravenous, ONCE For 1 Doses
ketAMINE injection [800191] 2 mg/kg, Intravenous, ONCE For 1 Doses
propofol (DIPRIVAN) 10 mg/mL IV BOLUS [730017] 2 mg/kg, Intravenous, ONCE For 1 Doses
Rapid Sequence Intubation - PARALYSIS (Single Response) [187770]
Succinylcholine: Do NOT use if Hyperkalemia, malignant hyperthermia, neuromuscular disease
Rocuronium: Longer acting, less side effect
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


succinylcholine (ANECTINE) injection - NOTE:
Suggested Dose 1-2 mg/kg [42431]
Intravenous, ONCE For 1 Doses
rocuronium (ZEMURON) 50 MG/5ML vial [133817] 1 mg/kg, Intravenous, ONCE For 1 Doses, for 1 Minutes
Post-Intubation Sedation and Analgesia [192540]
Fentanyl [192405]
FENTanyl (SUBLIMAZE) 0.05 MG/ML injection [37424] 1 mcg/kg, Intravenous, ONCE For 1 Doses, for 1 Minutes
FENTanyl (SUBLIMAZE) 0.05 MG/ML injection [37424] 1 mcg/kg, Intravenous, PRN, Sedation, for 1 Minutes
Propofol [192538]
propofol (DIPRIVAN) 10 mg/mL IV BOLUS [730017] 1 mg/kg, Intravenous, PRN, Sedation
propofol (DIPRIVAN) 10 mg/mL infusion [46335] 25-125 mcg/kg/min, Intravenous
Midazolam [192539]
midazolam (VERSED) injection [106489] 0.1 mg/kg, Intravenous, EVERY 5 MINUTES PRN,
Sedation
midazolam (VERSED) infusion PEDS [800154] Intravenous, CONTINUOUS
Vasopressors [187773]
DOPamine (INTROPIN) infusion PEDS [800137] 10 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT titrate. Contact MD for instructions.
norepinephrine (LEVOPHED) infusion PEDS [800160] 0.05 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT titrate. Contact MD for instructions.
epiNEPHrine infusion PEDS [800138] 0.05 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT titrate. Contact MD for instructions
Hyperosmolar (Single Response) [192543]
Intravenous Hypertonic Sodium Chloride – Adult and
Pediatric – Inpatient– Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/medications/resources/name-28571-
en.file
mannitol 20 % IV BOLUS - NOTE: Suggested dose 0.5 -
1.0 g/kg [730016]
Intravenous, ONCE For 1 Doses
sodium chloride HYPERTONIC 3 % IV BOLUS - NOTE:
Suggested dose 3-5 mL/kg Maximum Dose = 250 mL
[730019]
Intravenous, ONCE For 1 Doses
Tetanus (Single Response) [192542]
Vaccination History Clean, minor wounds All Other Wounds
Td* TIG Td* TIG
Unknown or less than 3 doses Yes No Yes Yes
3 or more doses No+ No No** No
*Tdap may be substituted for Td if the person has not previously received Tdap and is 10 year or older
+Yes, if more than 10 years since last dose
**Yes, if more than 5 years since last dose
VPD Surveillance Manual: Tetanus Vaccine
Recommendations
URL: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-
tetanus.pdf
diphtheria-tetanus-pertussis vaccine (DTaP PEDS-
INFANRIX) injection susp [55449]
0.5 mL, Intramuscular, ONCE For 1 Doses
tetanus-diphtheria-pertussis vaccine (Tdap) 5-2.5-18.5
LF-MCG/0.5 injection susp [107297]
0.5 mL, Intramuscular, ONCE For 1 Doses
tetanus immune globulin (HYPERTET) injection [42701] 250 units, Intramuscular, ONCE For 1 Doses
Supplemental Orders - BLOOD TRANSFUSION
For Massive Blood Transfusion call 263-8367
Massive Transfusion Prodedure Policy URL: https://uconnect.wisc.edu/policies/clinical/uwhc-
clinical/uwhc-wide/patient-care/894.policy
Tests [100542]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, 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
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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.
Tests [100543]
TYPE AND SCREEN, NEONATAL [HCNTS] STAT - RN COLLECT, 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?
Blood Products [12026]
Red Blood Cells (Adult) [BLB0006] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe)
1 Red Blood Cell Unit ~ 350 mL.
Plasma (Adult) [BLB0003] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Platelets (Adult) [BLB0004] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
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CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
1 Single Donor Unit ~ 200-250 mL.
All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
Cryoprecipitate (Adult) [BLB0005] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Fibrin Glue, mLs Needed:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
Cryoprecipitate is stored frozen as 5 pooled units (approx
120mL). Standard adult dose = 10 units. Suggested dose =
1 unit/10 kg.
Individual cryoprecipitate units are also available for fibrin
glue (approx 10-15 mL each).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Blood Product [12027]
Red Blood Cells (Pediatric) [BLB0013] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Has consent been obtained?
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Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe).
1 Red Blood Cell Unit ~ 350 mL. Suggested dose: 10 mL/kg
body weight.
Plasma (Pediatric) [BLB0010] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL. Suggested dose: 10-15 mL/kg body
weight.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Platelets (Pediatric) [BLB0011] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
Suggested dose = 10-20 mL/kg body weight for neonatal and
pediatric patients. For patients greater than 60 kg, suggested
dose is 1 Single Donor Unit. 1 Single Donor Unit = 200-250
mL. All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
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Cryoprecipitate (Pediatric) [BLB0012] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Cryoprecipitate Unit ~ 10-20 mL. Suggested dose: 1 Unit/10
kg body weight. If patient weighs less than 10 kg, give 1 Unit.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Transfusion [12028]
If ordering to transfuse a product, make sure the product is or has already been ordered.
Transfuse Red Blood Cells (Adult) [NURTRT0021] Starting today, Routine, Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe)
1 Red Blood Cell Unit ~ 350 mL.
Run Each Unit Over:
Transfuse Plasma (Adult) [NURTRT0031] Starting today, Routine, Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Run Each Unit Over:
Transfuse Platelets (Adult) [NURTRT0030] Starting today, Routine, Patient Weight
No data found for Wt
1 Single Donor Unit ~ 200-250 mL.
NURSING REMINDER: Call Blood Bank at 263-8367 30-60
minutes before transfusion to prepare products.
Run Each Unit Over:
Transfuse Cryoprecipitate (Adult) [NURTRT0032] Starting today, Routine, Patient Weight
No data found for Wt
Cryoprecipitate is stored frozen as 5 pooled units (approx
120mL). Standard adult dose = 10 units. Suggested dose =
1 unit/10 kg.
Individual cryoprecipitate units are also available for fibrin
glue (approx 10-15 mL each).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Run Each Unit Over:
Fibrin Glue, mLs Needed:
Transfusion [12029]
If ordering to transfuse a product, make sure the product is or has already been ordered.
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Transfuse Red Blood Cells (Pediatric) [NURTRT0035] Starting today, Routine, Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe).
1 Red Blood Cell Unit ~ 350 mL. Suggested dose: 10 mL/kg
body weight.
Run Over:
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Transfuse Plasma (Pediatric) [NURTRT0037] Starting today, Routine, Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL. Suggested dose: 10-15 mL/kg body
weight.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Run Over:
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Transfuse Platelets (Pediatric) [NURTRT0036] Starting today, Routine, Patient Weight
No data found for Wt
1 Single Donor Unit ~ 200-250 mL. Suggested dose = 10-20
mL/kg body weight for neonatal and pediatric patients. For
patients greater than 60 kg, suggested dose is 1 Single Donor
Unit.
NURSING REMINDER: Call Blood Bank at 263-8367 30-60
minutes before transfusion to prepare products.
Run Over:
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Transfuse Cryoprecipitate (Pediatric) [NURTRT0038] Starting today, Routine, Patient Weight
No data found for Wt
1 Cryoprecipitate Unit ~ 10-20 mL. Suggested dose: 1 Unit/10
kg body weight. If patient weighs less than 10 kg give 1 unit.
NURSING REMINDER: Call Blood Bank at 263-8367 30-60
minutes before transfusion to prepare products.
Run Over:
Analgesics [16447]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral
NOTE: Suggested dose 15 mg/kg/dose (Maximum 650
mg/dose)
Antihistamines (Single Response) [16449]
diphenhydramine (BENADRYL) injection - NOTE:
Suggested dose 0.5-1 mg/kg/dose (Maximum 25
mg/dose) [750044]
0.5-1 mg/kg, Intravenous, ONCE For 1 Doses, for 1 Minutes
NOTE: Suggested dose 0.5-1 mg/kg/dose (Maximum 25
mg/dose)
diphenhydramine (BENADRYL) elixir - NOTE:
Suggested dose 0.5-1 mg/kg/dose (Maximum 25
mg/dose) [36793]
Oral, ONCE For 1 Doses
NOTE: Suggested dose 0.5-1 mg/kg/dose (Maximum 25
mg/dose)
Steroids (Single Response) [16450]
hydrocortisone sod suc in sodium chloride 0.9% injection
- NOTE: Maximum Dose = 100 mg [800189]
1 mg/kg, Intravenous, ONCE For 1 Doses
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Bed Request
Bed Request Order [187821]
Bed Request [ADT0007] Admit to:
Patient Class:
Procedure?
Accommodation Code, if IMC request, please enter
Comments in field to the right:
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 SITTER 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?
Consults
Consults [192217]
Consult ENT Resident (ED Only) [CON0519] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Orthopedics (Inpatient) [CON0050] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Burn-MD (Inpatient) [CON0006] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Pediatric Neurosurgery (Inpatient) [CON0192] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Plastic Surgery (Inpatient) [CON0062] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Facial Trauma (ED Only) [CON0512] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Hand Surgery Resident (ED Only) [CON0513] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Patient Care orders
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Vital Signs [187836]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes x 4, then every 30 minutes x 2, then every 1
hour.
Patient Monitoring [187871]
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[139420]
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[NURMON0074]
CONTINUOUS, Routine, Please complete the Notify
Provider order below, including specification for apnea >
*** seconds. If indicated, order pulse oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider:
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds
Activity [192221]
Elevate Head Of Bed [NURACT0002] Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options: At all times
Routine, CONTINUOUS
Spinal Precautions [192222]
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., Position Patient -
Reverse
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.
Respiratory [187873]
Pulse Oximetry on Room Air [NURMON0009] ONCE For 1 Occurrences, Routine
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 93
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority