Unique Plan Description: ED PE/DVT Heparin High Dose PTT (MH WH)
Plan Selection Display: ED PE/DVT Heparin High Dose PTT (MH WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-04-23 10:01:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-23 10:01:00
Available at all facilities: No

ED PE/DVT Heparin High Dose PTT (MH WH)
Laboratory
STAT Lab
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T;N+360, Routine, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
Diagnostic Tests
Radiology
	CTA Chest Pulmonary Arteries
		Stat, Pulmonary Emboli
IV Solutions

	HEParin 25,000 units/premixed diluent 250 mL
		25,000 units, EVERY BAG, 18 unit/kg/hr
		250 mL, IV, STAT, 1 Dose(s)/Time(s)
			Comment: conc: 100 units/mL. Titrate according to High Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg1) PTT < 52 seconds, bolus 70 units/kg & increase rate by 4 units/kg/hr.2) PTT = 52-64 seconds, bolus 35 units/kg & increase rate by 2 units/kg/hr.3) PTT = 65-110 seconds, (therapeutic range) Do not give bolus & do not change rate.4) PTT = 111-135 seconds, do not bolus. Decrease rate by 2 units/kg/hr.5) PTT = 136 seconds or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr. Document all rate changes on the Titrated Medication Flowsheet while in ED. Upper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber
Medications
	HEParin 1000 units/mL injectable soln
		35 units/kg, Injection, IV Push, Once, T;N+360
			Comment: PTT = 52-64 seconds. Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED.  (MAXIMUM bolus = 3800 units)
		70 units/kg, Injection, IV Push, Once, T;N+360
			Comment: PTT < 52 seconds Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED.  (MAXIMUM bolus = 7700 units)
		70 units/kg, Injection, IV Push, Once, STAT
			Comment: Patient on high dose heparin protocol. Pharmacy to calculate dose. While in ED.  (MAXIMUM bolus = 7700 units)
Patient Care
	Notify MD
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: PE/DVT

*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