Therapeutic Hypothermia for Post Cardiac Arrest Plan Initial Orders
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- Adam Norman
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1 Arrest Plan Initial Orders Weight Allergies Therapeutic Hypothermia Guidelines ***Required to continue with ordering Plan.*** Strict Intake and Output q1h, throughout cooling and re warming. Set Up for Arterial Line Placement Supplies at Bedside: Insertion Tray Set Up for Central Line Placement Other, Alsius CoolGard Catheter, Supplies at Bedside: Insertion Tray Insert Gastric Tube Nasogastric NG, To: Low Intermittent Suction Orogastric OG, To: Low Intermittent Suction If patient has existing NG/OG tube: Maintain Gastric Tube Maintain Nasogastric NG, Low Intermittent Suction Maintain Orogastric OG, Low Intermittent Suction Insert Urinary Catheter Foley, with CBT Monitor Criticore, for CBT Monitoring. Monitoring Core Body Temperature Monitoring Utilize Bladder and Trans Esophageal Thermometers for CBT. Devices should display a difference of < 2 degress C. Utilize 2 devices for CBT monitoring (bladder, trans esophageal, rectal and/or PA catheter) Devices should display a difference of < 2 degress C. End Tidal CO2 Monitoring (ETCO2 Monitoring) Communication Notify Nurse (DO NOT USE FOR MEDS) DO NOT Bathe patient during cooling or re warming. Notify Provider (Misc) Reason: Urine output <0.5 ml/kg/hr, recurrent cardiac arrhythmias, seizures, abnormal lab values, pupil changes, hemodynamic instability, s/s of fluid overload. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed..medication Management Start date T;N ***DO NOT use electrolyte replacement meds.*** ***DC all potassium replacements at least 1 hour prior to re warming.*** Consults/Referrals Order Taken by Signature: Page: 1 Arrest Plan Version: 1 Effective on: 06/05/13 **
2 Arrest Plan Initial Orders Consult MD Service: Internal Medicine General, Reason: Arterial Line Placement Service: Internal Medicine General, Reason: Alsius CoolGard Catheter Placement Service: Internal Medicine General, Reason: Arterial and Alsius CoolGard Catheter Placement....Additional Orders Order Taken by Signature: Page: 2 Arrest Plan Version: 1 Effective on: 06/05/13 **
3 Arrest Plan Initial Orders ICU Sedation Med Plan Utilize the Richmond Agitation Sedation (Utilize the Richmond Agitation Sedation Scale) ***See Reference Text*** Perform Awakening Trial Daily ***See Reference Text for Protocol*** ICU Pain/Agitation/Delirium Reference ***See Reference Text*** Brain Function Monitoring 2 to 4 Channel EEG. Communication Notify Nurse (DO NOT USE FOR MEDS) Assess patient s sedation and pain level every 4 hours. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ***SEDATE MEDICATIONS SHOULD ONLY BE GEN AFTER PAIN IS ADEQUATELY CONTROLLED*** If delirium noted give: haloperidol 5 mg, Push, inj, q2h, PRN agitation Notify physician if more than a 100 mg is administered over 48 hours. Initial Dose morphine 2 mg, Push, inj, q10min, PRN pain Administer until pain level is less than 4/10. fentanyl 50 mcg, Push, inj, q10min, PRN pain Administer until pain level is less thatn 4/10. HYDROmorphone 0.25 mg, Push, inj, q5min, PRN pain Administer until pain level is less than 4/10. propofol 25 mg, Push, inj, ONE TIME midazolam 2 mg, Push, inj, q20min, PRN sedation Administer to achieve sedation goal. LORazepam 2 mg, Push, inj, q20min, PRN sedation Administer to achieve sedation goal. Intermittent Dose Order Taken by Signature: Page: 3 Arrest Plan Version: 1 Effective on: 06/05/13 **
4 Arrest Plan Initial Orders ICU Sedation Med Plan morphine 2 to 4 mg, Push, inj, q2h, PRN pain To maintain pain level less than 4/10. May increase 1 mg every 2 hours to a maximum of 4 mg. fentanyl 50 mcg, Push, inj, q2h, PRN pain Administer to maintain pain level less than 4/10. HYDROmorphone 1 mg, Push, inj, q4h, PRN pain To maintain pain level less than 4/10. midazolam 2 mg, PB, inj, q1h, PRN sedation Administer to maintain sedation goal. LORazepam 2 mg, Push, inj, q2h, PRN sedation Administer to maintain sedation goal. Continuous Infusion morphine 100 mg/100 ml NS Titrate to a pain level less than 4/10. Final concentration = 1 mg/ml.. Start at rate: mg/hr fentanyl 1000 mcg/100 ml NS Titrate to a pain level less than 4/10. Final concentration = 10 mcg/ml. Start at rate: mcg/hr HYDROmorphone 20 mg/100 ml NS Titrate in 0.5 mg increments to maintain a pain level less then 4/10. Start at rate: mg/hr propofol 1,000 mg/100 ml Start at rate: mcg/kg/min ***Midazolam should NOT be used in patinets with creatinine >2 and/or for more than 72 hours*** Order Taken by Signature: Page: 4 Arrest Plan Version: 1 Effective on: 06/05/13 **
5 Arrest Plan Initial Orders ICU Sedation Med Plan midazolam 100 mg/100 ml NS Titrate by 1 mg/hr every 10 minutes to RASS goal. **Maximum dose is 0.2mg/kg/hr** Start at rate: mg/hr LORazepam 40 mg/250 ml D5W Start at rate: mg/kg/hr Usual maintenance rate of mg/kg/hr. Recommended maximum dose of 10 mg/hr. Titrate by 1 mg/hr every hour to sedation goal. 1 ea, Every Bag dexmedetomidine 200 mcg/50 ml Final concentration =4 mcg/ml. Usual dose range is mcg/kg/hr. Start at rate: mcg/kg/hr Laboratory ***If patient remains on a Propofol infusion after 48 hours monitor Triglycerides now and every 3 days until propofol discontinued.*** Triglycerides Notify Provider (Misc) (Notify Provider of Results) Reason: Triglyceride Level > 400 mg/dl Order Taken by Signature: Page: 5 Arrest Plan Version: 1 Effective on: 06/05/13 **
6 Arrest Plan Initial Orders ICU Paralytic Plan Brain Function Monitoring (Apply SEDline Monitor) Maintain from for optimal range of sedation/anesthesia. Change monitor strip every 24 hours to maintain skin integrity and optimal functioning of monitoring system Protocol Neuromuscular Blocking Agent Protocol Peripheral Nerve Stimulator Protocol Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ocular lubricant (Lacri Lube S.O.P. ophthalmic ointment) 1 app, both eyes, ophth oint, As Needed, PRN dry eyes Paralytic Titrate Train of Four to be 2/4 twitches. Perform Train of Four (TOF) every 30 minutes during initiation until desired TOF is reached and every 4 hours throughout duration of therapy to maintain ordered TOF. ***Do not perform wake up trials while patient is on paralytic*** vecuronium 10 mg, Push, inj, ONE TIME 0.08 mg/kg, Push, inj, ONE TIME 0.1 mg/kg, Push, inj, ONE TIME vecuronium 100 mg/100 ml NS Final Concentration = 1 mg/ml (1,000 mcg/ml). Start at rate: mcg/kg/min Order Taken by Signature: Page: 6 Arrest Plan Version: 1 Effective on: 06/05/13 **
7 Arrest Plan Cooling Phase ***Recommended Start time of Re Warming Phase is hours after initialization of Cooling Phase.*** Utilize cooling phase orders to achieve a goal CBT of 33 C (Range of C) within 4 6 hours of ROSC. Hypothermic Cooling Device Device: Alsius Device: Arctic Sun Device: Manual Cooling Vital Signs Per Unit Standards, q15min during cooling then q1h afterward. Patient Activity Bedrest, Bed Position: HOB >/= 30 degrees Apply Ice To: Neck, Groin, and Axillae., If Central Venous Catheter and/or Alsius CoolGard Are not available at ICU Admission. Solutions If using manual cooling method use NS chilled to 4 degrees C. NS (Normal Saline), ml/hr NS (NS (Cold Saline)), ml/hr Laboratory CBC with Differential Prothrombin Time with INR PTT Basic Metabolic Panel Calcium Level Magnesium Level Phosphorus Level CK CKMB Order Taken by Signature: Page: 7 Arrest Plan Version: 1 Effective on: 06/05/13 **
8 Arrest Plan Cooling Phase Troponin T Culture Blood (Blood Culture) Blood, Timed, T;N+720 Culture Blood (Blood Culture) Blood, Timed, T;N+735 Order Taken by Signature: Page: 8 Arrest Plan Version: 1 Effective on: 06/05/13 **
9 Arrest Plan Re Warming Phase Target Re Warming CBT is C, to be obtained 6 8 hours after initiation of re warming protocol (0.25 C per hour). Vital Signs Per Unit Standards, q30 min during re warming, then q1h for 12 hour following re warming, then q12h. Communication Notify Nurse (DO NOT USE FOR MEDS) Remove ice packs from patients body and dc additional cooling methods. Place 1 2 warm blankets on patient. Stop replacing blankets once 36.1 C is reached. Notify Nurse (DO NOT USE FOR MEDS) Monitor closely for rebound hyperthermia. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. acetaminophen 650 mg, per tube/po, tab, q4h, PRN pain/fever Do not exceed 4000 mg of acetaminophen per day from all sources. meperidine 12.5 mg, Push, inj, q5min, PRN pain, x 2 dose Order Taken by Signature: Page: 9 Arrest Plan Version: 1 Effective on: 06/05/13 **
PICU Therapeutic Hypothermia Post Cardiac Arrest Re Warming Phase
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(31189) Hypothermia Initiation Phase One
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Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.
![Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.](/thumbs/77/75931338.jpg "Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Latex allergy [ ]Other: [ ] Initiate Powerplan Phase, Phase: LEB NICU Sepsis Phase Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient
ADMIT GENERAL MEDICINE PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate Continuous Telemetry
Physician Orders ADULT: Head and Neck Postoperative Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Head and Neck Postoperative Phase, When to Initiate: Head and Neck Post Operative Phase, Monitor and Record T,P,R,BP,
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Med/Surg without Telemetry (1) (DEF)* Patient Status: Inpatient,
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOL USE OF PROPOFOL (DIPRIVAN) FOR VENTILATOR MANAGEMENT
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOL I. PURPOSE: To provide guidelines for the administration of Propofol, which is an anesthetic agent, indicated for the continuous intravenous
OB/GYN CESAREAN SECTION POST-OP PLAN - Phase: General Orders
- Phase: General Orders DETAILS Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode
GENERAL MEDICINE PLAN
GENERAL MEDICINE PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
LEB ED Triage Hx of DKA w Hyperglycemia Non Categorized Criteria for use: Patients less than 18 years of age with known or suspected Diabetes Mellitus and blood glucose greater than 300mg/dL.(NOTE)* Vital
ISCHEMIC STROKE/TIA PLAN
ISCHEMIC STROKE/TIA PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards, Every 15 min x 2 hrs; then every 30 min x 6 hrs; then every 1 hr x 16 hrs Perform Neurological
PEDIATRIC ARGININE CLONIDINE STIMULATION TEST PLAN
Diagnosis Weight Allergies Patient Care Arginine Clonidine Stimulation Test Guid (Arginine Clonidine Stimulation Test Guidelines) See Reference Guidelines. Vital Signs Routine, q1h, With BP, During the
Therapeutic Hypothermia. Jonas Cooper, MD MPH
Therapeutic Hypothermia Jonas Cooper, MD MPH Hypothermia in Cardiology Early cardiac surgery included cooling to 15 C and stopping all blood flow for one hour while surgery proceeded Belsey RH et al. Profound
CBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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.
OB/GYN ANTEPARTUM PLAN
OB/GYN ANTEPARTUM PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to Bedside Commode Only
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT *****ALSO ORDER SUB ACUTE DKA IV FLUIDS REGIMEN & SUB ACUTE ELECTROLYTE REPLACEMENT on separate forms ***** Condition/Status For purpose of this DKA Regimen, DKA is considered clear
Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis
of nurse 1. Admit under ward Attending Physician: Dr. Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests 2. On admission (if not already performed in Emergency Department or in Coronary
Card Open Heart POD1 POD3 Plan Post Op Day 1
Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit
IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015
Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing
Pediatric Intensive Care Unit (PICU) Pediatric Diabetic Ketoacidosis (DKA) Admission Order Set
Discontinue all previous orders Weight: kg DKA admit order set is for initial management Ongoing management required based on frequent reassessment of TFI, fluid balance and lab results. Admit to PICU
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
Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Acute MI/Acute Coronary Syndrome Adult Phase, When to Initiate: Acute MI/Acute Coronary Syndrome Adlt Phase Non Categorized
IR Central Venous Access [ ] Pre Procedure
![IR Central Venous Access [ ] Pre Procedure](/thumbs/90/104119758.jpg "IR Central Venous Access [ ] Pre Procedure")
IR Central Venous Access [1050200001] Pre Procedure Case Request/Scheduling Procedure Enter IR Case Request if not already completed (All hospitals except Grant Medical Center) [ ] Case Request IR Lab
Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Acute Diabetic Ketoacidosis Condition/Status ***(NOTE)*** For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS
morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)