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Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Nursing Orders Elevate Head of Bed GEN Nasogastric/Orogastric Tube Insertion(SUB)* ***Reminder: Order GEN Nasogastric/Orogastric Tube Insertion(SUB) as a separate form*** Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley)(SUB) as a separate form*** Medications acetaminophen (Tylenol) 650 mg tab PO, PRN Fever GREATER than 100 F (DEF)* 650 mg supp PR, PRN Fever GREATER than 100 F Anti-convulsants diazepam (Valium) 10 mg inj IV PUSH fosphenytoin (Cerebyx) 18 PE/kg bag IVPB lorazepam (Ativan) 1 mg inj IV PUSH levetiracetam (Keppra) 1 g iv IVPB IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 1,000 ml IVPB bag Comments: Infuse over: 1 hour Sodium Chloride 0.9% (NS) IV bag 250 ml/hour (DEF)* IV bag 150 ml/hour IV bag 100 ml/hour ***(NOTE)***If extra blood tubes have been sent use add on blood in lab order below ED Add on Blood in Lab BMP CBC CK CKMB Troponin Liver Profile, Specimen in Lab ***(NOTE)***If labs or extra blood tubes have not been ordered use subphase below SUB Lab Orders(SUB)* Page 1 of 5

***(NOTE)***If the protocol lab tests have been ordered use subphase below SUB Additional Labs(SUB)* Toxicology Screen 12 - Urine URINE, Blood Culture BLOOD - PERIPHERAL, (DEF)* BLOOD - PERIPHERAL, Q5MINS Int, 2 times BLOOD - LINE, BLOOD - LINE, Q5MINS Int, 2 times Urine Culture URINE, CLEANCATCH, (DEF)* URINE, CATHETER, Sputum Culture SPUTUM, Radiology XR Chest *2 view PA and LAT CT Head w/wo Contrast CT Head w/ Contrast CT Head w/o Contrast Respiratory ABG/VBG Notification SUB Protocol Nursing Orders Initiate Protocol SUB Protocol Start INT Neuro Checks Q1H Int, 4 times, Reassess with physician after 4th time ED Capillary Glucose POC ED Cardiac Monitor ED Urine Pregnancy POC for females of child-bearing age and capacity(note)* ED Urine Pregnancy POC ED Notify Provider Vital Signs Temperature > 101.5, Temperature < 98, HR > 110, HR < 60, SBP > 180, SBP < 90, RR > 20, RR < 8, SpO2 < 94 Urinalysis with Microscopic URINE, Page 2 of 5

Radiology Chest 1 view PA or AP only confusion, Pending Discharge - No, Respiratory Pulse Oximetry (Continuous) Special Instructions: If oxygen saturation LESS THAN 94%, initiate O2 Therapy order, PRN Order, 1, day Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. O2 Therapy. Nasal Cannula, 2, Titrate to maintain oxygen saturation equal to or greater than 94% Cardiology ECG Standard SUB Protocol Lab Orders Complete Blood Count Basic Metabolic Panel Liver Profile Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, SUB Lab Orders Complete Blood Count Basic Metabolic Panel Liver Profile Acetaminophen Level Alcohol Serum Comprehensive Metabolic Panel Page 3 of 5

Hepatic Function Panel Lactic Acid Magnesium Level Partial Thromboplast Time Prothrombin INR Phosphorus Salicylate Level Thyroid Stimulating Hormone Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, SUB Additional Labs Acetaminophen Level Alcohol Serum Comprehensive Metabolic Panel Hepatic Function Panel Lactic Acid Magnesium Level Partial Thromboplast Time Prothrombin INR Page 4 of 5

Phosphorus Salicylate Level Thyroid Stimulating Hormone Page 5 of 5

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