Unique Plan Description: ED AFIB (MH/WH)
Plan Selection Display: ED AFIB (MH/WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-08-01 08:36:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-02-14 13:47:42
Available at all facilities: Yes

ED AFIB (MH/WH)
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
	ProBNP
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	TSH
		Stat, spec type = Blood
	Magnesium Level
		Stat, spec type = Blood
	Heparin Anti-Xa Heparin
		Stat, spec type = Blood
	Glucose POC - RN
		T;N
Diagnostic Tests
Diagnostics
	ECG in ED
		Stat, Indication: Arrhythmia
Radiology
	Chest 1 View
		Stat, Pain/Chest
	Chest 2 View
		Stat, Pain/Chest
IV Solutions

	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 500 ml/hr
	Cardizem 100 mg/100 mL NS Premix IV
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, STAT, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
			Comment: ACTIVATION REQUIRED PRIOR TO USE.  increase infusion to 15mg/hr if heart rate greater than or equal to 120 after second bolus. Discontinue Diltiazem infusion 1 hour after oral dose initiated.  Begin Tiazac 180 mg po when HR rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 5mg/hr. Begin Tiazac 240 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 10 mg/h.  Begin Tiazac 300 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 15 mg/hr.  Enter oral diltiazem order from Acute Atrial Fibrillation Powerplan.
Medications
	aspirin
		324 mg, Tablet-Chew, By Mouth, Once, STAT
		300 mg, Suppository, RECTALLY, Once, STAT
	Lopressor
		5 mg, Solution-Injection, IV Push, Q5MIN, STAT, duration: 3 Dose(s)/Time(s)
	Lovenox
		1 mg/kg, Syringe, SUBCUTANEOUS, Once, STAT
	Cardizem
		15 mg, Injection, IV Push, Once, STAT
		20 mg, Injection, IV Push, Once, STAT
		25 mg, Injection, IV Push, Once, STAT
		0.25 mg/kg, Injection, IV Push, Once, STAT
	Tiazac
		180 mg, Capsule-Extended-Release, By Mouth, Once, STAT
		240 mg, Capsule-Extended-Release, By Mouth, Once, STAT
		300 mg, Capsule-Extended-Release, By Mouth, Once, STAT
	verapamil
		10 mg, Injection, IV Push, Once, STAT
	apixaban
		5 mg, Tab, By Mouth, Once, STAT
	Pradaxa
		150 mg, Capsule, By Mouth, Once, STAT
	Xarelto
		20 mg, Tab, By Mouth, Once, STAT
Patient Care
	Avoid IM Injections if possible while on anticoagulants
		
	ED Cardiac Telemetry Monitoring
		T;N, Once
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, O2 @ 2L
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Obtain Consent/Permit for:
		Cardioversion
Therapies
	End Tidal CO2 (ETCO2) Monitoring
		
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: Arrhythmia
	Consult Hospitalist
		Reason for Referral: Arrhythmia

ED Peripheral Lock Insert with Flush
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush, 4 hr
Patient Care
	Peripheral Lock-Insert
		T;N, Once

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase