Unique Plan Description: ED OVERDOSE ALCOHOL INTOXICATION
Plan Selection Display: ED OVERDOSE ALCOHOL INTOXICATION
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 21:07:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-05-02 14:25:08
Available at all facilities: Yes

ED OVERDOSE ALCOHOL INTOXICATION
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Ethanol Level
		Stat, spec type = Blood
	Acetaminophen Level
		Stat, spec type = Blood
	Salicylate Level
		Stat, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, spec type = Urine
			Comment: change the indwelling catheter prior to obtaining specimen if catheter in place greater than 2 weeks, or unknown.
	Toxicology Screen DAU - MH/WH/JE
		Stat, Stat, spec type = Urine
	Drug Screen Urine - FH
		Stat, spec type = Urine
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
	Pregnancy Test Whole Blood - JE
		Stat, spec type = Blood
	Frozen Plasma
		Stat, spec type = No Collection
	Beta-HCG Quantitative - Pregnancy
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Lactate
		Stat, spec type = Blood
	Blood Gases VENOUS (VBG)
		T;N, Stat, spec type = Blood
	Beta-Hydroxybutyrate (Inpatient)
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
	hs Troponin I - FH
		Stat, spec type = Blood
	TSH
		Stat, spec type = Blood
Diagnostic Tests
Radiology
	CT Head w/o Contrast
		Stat, Mental Status Change
	Chest 1 View
		Stat
Cardiology
	ECG in ED
		Stat, Indication: Overdose/Suspected Overdose
IV Solutions

	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 999 ml/hr
		1,000 mL, IV, STAT, 75 ml/hr
		1,000 mL, IV, STAT, 100 ml/hr
		1,000 mL, IV, STAT, 125 ml/hr
		1,000 mL, IV, STAT, 500 ml/hr
	Banana Bag IV
		100 mg, EVERY BAG
		1,000 mL, EVERY BAG
		1 mg, EVERY BAG
		10 mL, IVPB, Once, STAT, 999 ml/hr, duration: 1 Dose(s)/Time(s)
	naloxone 2mg/NS 500mL
		500 mL, IV, STAT
			Comment: Concentration = 4mcg/mL, starting dose 0.4mg/hr. Notify provider for any dose/rate change needed.
		2 mg, EVERY BAG, 0.4 mg/hr
Medications
	fomepizole
		15 mg/kg, INT, IVPB, Once
		Narcan Dosing Information: Adult dosing: 0.4-2mg IV, IM, or Subq up to a total dose of 10mg; Children greater or equal to 5 years or weighing greater than 20kg: 2mg IV or intraosseous. May repeat every 2-3 minutes until sufficient response. Neonates: 0.01(NOTE)*
	Narcan
		0.4 mg, Injection, IV PUSH, Once, STAT
		0.4 mg, Injection, IM-Intramuscular, Once, STAT
	flumazenil
		0.2 mg, Injection, IV Push, Once, STAT
			Comment: initial dose
		0.3 mg, Injection, IV Push, Once, STAT
			Comment: additional dose 30 seconds after initial dose
		0.5 mg, Injection, IV Push, Once, STAT
			Comment: further doses every minute max of 5mg
	ondansetron
		4 mg, Injection, IV Push, Once, STAT
	Actidose Plus Sorbitol 25 g oral suspension
		120 mL, Suspension, By Mouth, Once, STAT
	Actidose Plus Sorbitol 50 g oral suspension
		240 mL, Suspension, By Mouth, Once, STAT
	Actidose-Aqua 25 g oral suspension
		25 gm, Suspension, By Mouth, Once, STAT
	Actidose-Aqua 50 g oral suspension
		50 gm, Suspension, By Mouth, Once, STAT
	Dextrose 50%
		25 mL, Injection, IV Push, Once, STAT
		50 mL, Injection, IV Push, Once, STAT
	glucagon
		5 mg, Injection, IV PUSH, Once, STAT
	Vitamin B1
		100 mg, Injection, IV Push, Once, STAT
		100 mg, Injection, IM-Intramuscular, Once, STAT
	Vitamin B1 (FH)
		100 mg, INT, IVPB, Once, STAT
	atropine
		0.5 mg, Injection, IV PUSH, Once, STAT
		1 mg, Injection, IV PUSH, Once, STAT
		2 mg, Injection, IV PUSH, Once, STAT
	methylene blue IVPB
		1 mg/kg, INT, IVPB, Once, Other- type in, STAT
	DigiFab
		40 mg, INT, IVPB, Once, STAT
	Ativan
		2 mg, Injection, IV Push, Once, STAT
		1 mg, Injection, IV Push, Once, STAT
	Vitamin K IVPB
		10 mg, Solution-Injection, IVPB, Once, STAT
		5 mg, Solution-Injection, IVPB, Once, STAT
	sodium bicarbonate 8.4%
		1 mEq/kg, Injection, IV Push, Once, STAT
		0.5 mEq/kg, Injection, IV Push, Once, STAT
		Oral ETOH Vitamin Replacement(NOTE)*
	folic acid
		1 mg, Tab, By Mouth, Once
	thiamine
		100 mg, Tab, By Mouth, Once
	multivitamin Oral Tablet
		1 TAB, By Mouth, Once, STAT
	PHENobarbital IVPB
		4 mg/kg, INT, IVPB, Once, STAT, infuse over 15 min(s)
			Comment: Dose #1 of 3.  Give over 15 min; Dose using ideal body weight; Hold for RR< 10, or RASS <-2. Prepare in 50mL NS.
		3 mg/kg, INT, IVPB, Q45MIN, for withdrawal symptoms, infuse over 15 min(s), T;N+45, duration: 2 Dose(s)/Time(s)
			Comment: Doses #2 & #3 of 3.  Give over 15min; Dose using ideal body weight; Hold for RR< 10, or RASS <-2; Prepare in 50mL NS.
Patient Care
	Alcohol Withdrawal Assessment ED
		T;N, every 4 hours if alcohol withdrawal score is 1-5, every 2 hours if alcohol withdrawal score is 6-10, every 1 hour if alcohol withdrawal score >11. Reassess alcohol withdrawal score with each set of vital signs. Notify provider of each AWS
	ED Cardiac Telemetry Monitoring
		T;N, Once
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Oxygen Therapy, Nurse to Administer
		T;N
	Glucose POC - RN
		T;N, Once
	Foley Catheter
		T;N, Insert, Once
	Enteral Tube
		T;N, Per Nasogastric Tube (NG), Connect to low intermittent suction | Insert, X Ray, Once
	OG Tube
		T;N, Connect to low intermittent suction | Insert, Once
	Notify
		T;N, Contact Poison Control
	Bladder Scan
		T;N, Once
	Straight Catheter
		T;N, Insert, Once
	Suicide Precaution Allowances
		T;N
Therapies
	End Tidal CO2 (ETCO2) Monitoring
		T;N, Q6H-Sch
Consults/Follow-up
	Consult Behavioral Health
		Reason for Referral: Overdose/alcohol intoxication
	Consult Hospitalist
		Reason for Referral: Overdose/alcohol intoxication
	Consult Intensivist
		Reason for Referral: Overdose/alcohol intoxication

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