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/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-98159-en.cckm

201712349

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100

UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Neurosciences

IP - Pentobarbital Induction - Adult - Supplemental [1659]

IP - Pentobarbital Induction - Adult - Supplemental [1659] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Pentobarbital Induction - Adult - Supplemental [1659]
for Adult Patients OnlyIntended
We are currently experiencing a thiopental shortage. Pentobarbital replaces thiopental
in this order set during the shortage.
Patient Care Orders
Vital Signs [23294]
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 4, then every hour.
Patient Monitoring [23297]
Measure Intracranial Pressure [NURMON0040] SEE COMMENTS, Starting today, Routine, Every 15
minutes times 4, then every hour.
Measure Cerebral Perfusion Pressure
[NURMON0060]
SEE COMMENTS, Starting today, Every 15 minutes
times 4, then every hour.
Measure Central Venous Pressure
[NURMON0002]
EVERY 4 HOURS, Starting today, Routine
Measure Cardiac Output [NURMON0023] CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg):
Pulmonary Artery Diastolic Pressure (mmHg):
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output: Every 4 hours
Cardiac Output Method:
Cardiac Index:
Systemic Vascular Resistance:
Pulmonary Vascular Resistance:
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Page 1 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Measure Systemic Vascular Resistance
[NURMON0023]
CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg):
Pulmonary Artery Diastolic Pressure (mmHg):
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output:
Cardiac Output Method:
Cardiac Index:
Systemic Vascular Resistance: Every 4 hours
Pulmonary Vascular Resistance:
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Measure Cardiac Index [NURMON0023] CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg):
Pulmonary Artery Diastolic Pressure (mmHg):
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output:
Cardiac Output Method:
Cardiac Index: Every 4 hours
Systemic Vascular Resistance:
Pulmonary Vascular Resistance:
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Monitor Pulmonary Capillary Wedge Pressure
[NURMON0060]
SEE COMMENTS, Starting today, Every 4 hours.
Call MD for more than 2 screens with no electrical
activity on bedside EEG [NURCOM0022]
SEE COMMENTS, Monitor with vital signs.
Activity [23301]
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees): 30
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today
Turn Patient [NURACT0011] SEE COMMENTS, Starting today, Every 2 hours.
Page 2 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Range of Motion [NURACT0011] SEE COMMENTS, Starting today, Every 8 hours if
patient able to tolerate.
Apply Brace/Splint, Lower Body [NURTRT0009] CONTINUOUS, Starting today, Routine, If ordering a
Bledsoe Boot or Hip Abduction Brace, please contact
the cast room technician at 265-0746.
Type: PRAFO
Left/Right/Bilateral? Bilateral
Wearing schedule: Continuous
Non-Categorized Patient Care Orders [23317]
Glucose, POC [IPGLUCOSE] EVERY 6 HOURS, Starting today For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Contingency Parameters [23319]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 1 reading greater than 200
or 2 consecutive readings greater than 175 mg/dL.
Call for initiation of "Insulin Infusion - Adult -
Supplemental" order set
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Medications
Medications [23374]
Note: Discontinue sedation, analgesia and
neuromuscular blocking agents [950018]
ONCE For 1 Doses
Discontinue per protocol: Discontinuation of
Continuous Infusion Sedation, Analgesic and
Neuromuscular Blocking Agents after Induction of
Barbiturate Coma
artificial tears PF ophthalmic ointment [157764] Eyes (Each), EVERY 4 HOURS
Apply a thin layer to inside of lower lid
Prokinetic (Single Response) [242236]
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, EVERY 6 HOURS
metoclopramide (REGLAN) soln [800224] 10 mg, Nasogastric Tube, EVERY 6 HOURS
Stress Ulcer Prophylaxis [242237]
famotidine (PEPCID) intraVENOUS [800279] 20 mg, Intravenous, EVERY 12 HOURS
famotidine (PEPCID) tab [45134] 20 mg, Oral, 2 X DAILY
Pentobarbital [95541]
Page 3 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

pentobarbital (NEMBUTAL) injection - NOTE:
Suggested total loading dose 15 mg/kg [40837]
5 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested total loading dose is 15 mg/kg.
Give both pentobarbital injection and bag for a total
loading dose of 15 mg/kg.
If ordered IV: push rate 50 mg/minute.
Pharmacist - Please round dose to the nearest
100mg.
pentobarbital (NEMBUTAL) bolus bag - NOTE:
Suggested total loading dose is 15 mg/kg.
[770034]
10 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested total loading dose is 15 mg/kg.
Give both pentobarbital injection and bag for a total
loading dose of 15mg/kg.
Administer at a maximum rate of 50 mg/minute.
pentobarbital (NEMBUTAL) infusion [700435] 3 mg/kg/hr, Intravenous, CONTINUOUS
Vasopressors [23375]
DOBUTamine (DOBUTREX) 1000mg in dextrose
5% 250 mL infusion [51747]
2-20 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult Protocol. Initiate at 2
mcg/kg/min or current rate and titrate to maintain SBP
greater than goal referred to in notify provider orders
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 Protocol. Initiate at 2
mcg/kg/min or current rate and titrate to maintain SBP
greater than goal referred to in notify provider orders
norepinephrine (LEVOPHED) infusion [700247] 0.01-2 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult Protocol. Initiate at 0.01
mcg/kg/min or current rate and titrate to maintain SBP
greater than goal referred to in notify provider orders
phenylEPHRINE(NEO-SYNEPHRINE) infusion
[700258]
0.1-5 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult Protocol. Initiate at 0.25
mcg/kg/min or current rate and titrate to maintain SBP
greater than goal referred to in notify provider orders
Laboratory
Draw Daily While on Thiopental/Pentobarbital [23320]
ELECTROLYTES [LYTE] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GLUCOSE [GLU] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BUN [BUN] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CREATININE [CRET] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CALCIUM [CA] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 4 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

MAGNESIUM [MAG] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] NEXT AM For 7 Days, 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]
NEXT AM For 7 Days, Routine
Indicate FIO2: Per Protocol
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT AM For 7 Days, 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] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
THIOPENTAL [HCTPEN] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PENTOBARBITAL [HCPENT] NEXT AM For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Other Day, While on Thiopental/Pentobarbital [23321]
AST/SGOT [AST] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALT/SGPT [ALT] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GGT [GGT] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BILIRUBIN, TOTAL [TBIL] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 5 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

AMYLASE [AMYL] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LIPASE [LIPS] EVERY OTHER DAY, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN [ALB] EVERY OTHER DAY, Starting today For 7 Days,
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] CONDITIONAL For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [116728]
.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Miscellaneous Test - Propylene Glycol [RMISC] EVERY OTHER DAY, Starting 12/18/17 For 7 Days,
Routine
What lab test would you like to have performed?
Propylene Glycol
For questions I can be reached at: Page 22122 for
appropriate managing team
Indicate specimen source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Conditional Labs [23322]
Page 6 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

GLUCOSE [GLU] CONDITIONAL For 7 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw STAT every time
blood glucose monitoring (bedside) is less than 40 or
greater than 400 mg/dL
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [23323]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Barbiturate Coma
What specific question(s) would you like answered by
this exam? Evaluate for infiltrate
Relevant recent/past history? Significant brain
dysfunction
Is patient pregnant? Unknown
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
Bedside EEG [EEG0002] ONCE, Starting today For 1 Occurrences, Routine
Reason for Monitoring: Other (Comment) (Thiopental
coma)
Page 7 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 7:07:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org