CBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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- Liliana Hall
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1 DRUG AND TREATMENT Non Categorized SUB ED Snakebite Protocol (SUB)* Non Categorized ***(NOTE)*** This plan is designed to be used as part of a larger plan, not independently. Please do NOT order individually. Vital Signs Vital Signs Q2H, 1, day, More frequently as needed ED Cardiac Monitor Nursing Orders Initiate Protocol ED Snakebite Protocol Identify the snake if possible, time of bite and remove jewelry on affected extremity Start IV/INT X 2 in unaffected limb Measure and Record Mark with an indelible marker and record the circumference of the bitten extremity, proximal to the bite and at one or more points, several inches closer to the trunk. Repeat and record every minutes to monitor progression of edema. Monitor for Monitor for one hour following completion of dose to determine if control of envenomation has been achieved Monitor for Monitor for shock, pain, swelling, weakness, paresthesia, taste fasciculation, nausea, vomiting, diarrhea, diaphoresis, difficulty swallowing, ecchymosis, erythema, and bleeding Elevate involved extremity, elevate involved extremity to heart level Review allergies including papaya, pineapple, ovine (sheep) serum or latex. If present consult pharmacist before administering CroFab. Do NOT apply ice/cold Do NOT apply tourniquet ***(NOTE)*** ED Urine Pregnancy POC for females of child-bearing age and capacity ED Urine Pregnancy POC ED_ONCE Urinalysis with Microscopic URINE, ED_ONCE Comments: Females-cath if vaginal bleeding or discharge. Obtain urines within 1 hour of arrival CBC with Differential. Page 1 of 6
2 DRUG AND TREATMENT Platelet Count PT INR PTT Fibrinogen Level Basic Metabolic Panel D Dimer Quantitative Troponin CKMB CK Total Type and Screen +360 Minutes CBC with Differential Minutes PT INR +360 Minutes PTT +360 Minutes Fibrinogen Level SUB ED Snakebite Protocol Labs (SUB)* CBC with Differential. Platelet Count PT INR PTT Page 2 of 6
3 DRUG AND TREATMENT Fibrinogen Level Basic Metabolic Panel D Dimer Quantitative Troponin CKMB CK Total Type and Screen +360 Minutes CBC with Differential Minutes PT INR +360 Minutes PTT +360 Minutes Fibrinogen Level ED Rainbow Tubes (SUB)* ***(NOTE)*** May obtain extra blood tubes. Extra Blue Extra Gold Extra Green Extra Lavender Extra Red Diet Diet Order Diet Order. Page 3 of 6
4 DRUG AND TREATMENT NPO No exceptions (DEF)* NPO except for ice chips, Clear Liquid Diet Order. NPO (DEF)* NPO except for ice chips Clear Liquid Diet Message Nursing Orders Notify Contact Poison Control for further assistance. Medications ***(NOTE)*** Initial Dose antivenin (crotalidate) polyvalent (Crofab) 4 g iv IVPB ED_ONCE (DEF)* 6 g iv IVPB ED_ONCE ***(NOTE)*** Additional Doses - If symptoms are not controlled within one hour of initial infusion, repeat initial dose every hour until controlled. antivenin (crotalidate) polyvalent (Crofab) 4 g iv IVPB Q1H, PRN Other (see comment) (DEF)* Comments: until snake bite symptoms controlled 6 g iv IVPB Q1H, PRN Other (see comment) Comments: until snake bite symptoms controlled ***(NOTE)*** After initial control achieved, additional 2 vial doses can be given every 6 hours up to 18 hours (3 doses). antivenin (crotalidate) polyvalent (Crofab) 2 g iv IVPB Q6H, Duration: 3 dose Antiemetics promethazine (Phenergan) 12.5 mg inj IV PUSH ED_ONCE, PRN Nausea/Vomiting Comments: If the patient has an IV infusing, the promethazine should be mixed in 20 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV infusing, the promethazine should be mixed in 50 ml bag of saline and administered over 15 minutes. Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. ondansetron (Zofran) 4 mg inj IV PUSH ED_ONCE, PRN Nausea/Vomiting Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. metoclopramide (Reglan) 10 mg inj IV PUSH ED_ONCE Page 4 of 6
5 DRUG AND TREATMENT IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 1,000 ml IVPB bag ED_ONCE (DEF)* 500 ml IVPB bag ED_ONCE 250 ml IV bag ED_ONCE Sodium Chloride 0.9% (NS) IV bag Rate: 100 ml/hour (DEF)* IV bag Rate: 150 ml/hour IV bag Rate: 250 ml/hour ***(NOTE)*** If the extra blood tubes have been ordered use add on blood order below ED Add on Blood in Lab CBC D Dimer BMP (Chem 7) Partial Thromboplast Time Prothrombin INR, Platelet Count; Fibrinogen; CKMB; CK Total; Type and Screen, Specimen in Lab ***(NOTE)*** If extra blood tubes have not been ordered use subphase below SUB ED Snakebite (Crofab) Lab Orders (SUB)* CBC with Differential. Platelet Count PT INR PTT Fibrinogen Level Basic Metabolic Panel D Dimer Quantitative Troponin CKMB CK Total Type and Screen +360 Minutes CBC with Differential Minutes PT INR Page 5 of 6
6 DRUG AND TREATMENT +360 Minutes PTT +360 Minutes Fibrinogen Level Page 6 of 6
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as
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