PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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Transcription:

DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int Neuro Checks Q15MINS Int Start IV/INT Insert 2 Large Bore IVs; one in right antecubital if possible ED Cardiac Monitor Blood Glucose Monitor POC ED_ONCE Complete NIH Stroke Scale Order CTA(CT Angio Head/Neck w/wo Contrast) and CTP(CT Cerebral Perfusion Analysis w/contrast) for NIH GREATER than 8 and symptom onset LESS than 12 hours ***(NOTE)*** Urine Pregnancy Test POC for women of child-bearing age and capacity Urine Pregnancy Test POC ED_ONCE Urinalysis with Microscopic STAT, URINE, ED_ONCE ED UA STAT, URINE, ED_ONCE Radiology CT Head w/o Contrast XR Chest *1 view AP Portable Supine AP Chest, Stat, Must be done after CT of Head. HOB flat except HOB 15-30 degrees if at risk for airway obstruction, aspiration, or increased ICP. Respiratory istat Notification istat Cartridge Type: Creatinine, STAT ichem8+ Stat, ED_ONCE Page 1 of 5

DRUG AND TREATMENT O2 Therapy. Nasal Cannula, 2, L NC. Titrate to keep O2 saturation greater than 94% Pulse Oximetry (Continuous) Special Instructions: Keep saturation greater than 94% Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. Cardiology EKG Standard Stat, CODE STROKE Consults Physician Consult Neurology, Code Stroke, STAT SUB Lab Orders Subphase (SUB)* Troponin CBC with Differential. PT INR PTT Sed Rate BMP Lipid Profile LFT's ED Rainbow Tubes (SUB)* ***(NOTE)*** May obtain extra blood tubes. Extra Blue Extra Gold Extra Green Extra Lavender Page 2 of 5

DRUG AND TREATMENT Extra Red ***(NOTE)*** Order CTA and CTP for NIH GREATER than 8 and symptom onset LESS than 12 hours CT Angio Head/Neck w/wo Contrast CT Cerebral Perfusion Analysis w/contrast Nursing Orders Flat in Bed HOB 15-30 degrees if risk for airway obstruction, aspiration, or increased ICP Elevate Head of Bed 30 Degrees Bedside Swallow Screen - Code Stroke Raise HOB to 90 degrees briefly to perform bedside swallow screen. Consult Speech therapy if patient fails screen. Medications aspirin 300 mg supp PR ED_ONCE (DEF)* Comments: DO NOT GIVE if intracranial hemorrhage OR candidate for Alteplase. May give PO only if bedside swallow screen passed. 325 mg tab PO ED_ONCE Comments: DO NOT GIVE if intracranial hemorrhage OR candidate for Alteplase. May give PO only if bedside swallow screen passed. nicardipine (Cardene 40 mg/ 200 ml pre-mix) IV bag, Clinical Instructions: Initiate at 5 mg/hr Comments: Increase rate by 2.5 mg/hr every 5-15 minutes to a MAX dose of 15 mg/hr. Titrate to maintain BP LESS THAN 185/110 mmhg prior to alteplase bolus, then maintain BP LESS THAN 180/105 mmhg. Hold for SBP LESS THAN 160 mmhg. labetalol 500mg/100mL IV Set (IVS)* Trandate 500 mg/100 ml IV drip (undiluted) IV TITRATE Comments: Begin infusion at 1 mg/min, titrate to max dose of 4 mg/min. Titrate to maintain BP LESS than 185/110 mmhg. Hold for SBP LESS than 160 mmhg. MAX dose of 300 mg in 24 hours. If ineffective notify ordering physician. IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 10 ml/kg IVPB bag ED_ONCE, Duration: 1 hour (DEF)* 5 ml/kg IVPB bag ED_ONCE, Duration: 1 hour Sodium Chloride 0.9% (NS) IV bag 100 ml/hour (DEF)* Comments: after initial bolus completed IV bag 50 ml/hour Comments: after initial bolus completed Page 3 of 5

DRUG AND TREATMENT ***(NOTE)*** If extra blood tubes have been ordered use the add on blood order below ED Add on Blood in Lab CBC BMP Partial Thromboplast Time Prothrombin INR, Troponin, Sed Rate, LFTs, Lipid Profile, Specimen in Lab ***(NOTE)*** If extra blood tubes or labs have not been ordered use subphase below SUB Lab Orders (SUB)* Troponin CBC with Differential. PT INR PTT Sed Rate BMP Lipid Profile LFT's Alcohol Serum C Reactive Protein Magnesium Level Phosphorus ***(NOTE)*** If the protocol lab tests have been ordered use subphase below SUB Additional Labs (SUB)* Alcohol Serum C Reactive Protein Page 4 of 5

DRUG AND TREATMENT Magnesium Level Phosphorus Toxicology Screen 12 - Urine STAT, URINE Consults Speech Therapy Consult For swallow evaluation if patient failed Bedside Swallow Screen. Consult order needs to be entered. Page 5 of 5

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