Unique Plan Description: ED STROKE, ACUTE
Plan Selection Display: ED STROKE, ACUTE
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2023-07-25 15:10:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-02 15:03:20
Available at all facilities: Yes

ED STROKE, ACUTE
Vital Signs
	Vital Signs
		Q15MIN, 1, hr
			Comment: If stable, may change to hourly
	Neurological Assessment-Focused
		Q15MIN, 1, hr
			Comment: If stable, may change to hourly
	Weight
		T;N
Activity
	Elevate head of bed
		Elevate head of bed 30 degrees
Diet
	NPO
		T;N
Laboratory
	CBC with Diff
		Stat, spec type = Blood, Stroke Alert
	Comprehensive Metabolic Panel
		Stat, spec type = Blood, Stroke Alert
	INR - MH/WH/JE
		Stat, spec type = Blood, Stroke Alert
	PTT - MH/WH/JE
		Stat, spec type = Blood, Stroke Alert
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood, Stroke Alert
		T;N, Stat, spec type = Therapeutic Blood, Stroke Alert
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood, Stroke Alert
	HGB A1C
		T;N, spec type = Blood
	Lipid Panel
		T;N, spec type = Blood
	Ethanol Level
		Stat, spec type = Blood, Stroke Alert
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood, Stroke Alert
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine, Stroke Alert, Stroke Alert
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine, Stroke Alert, Stroke Alert
	Pregnancy Test Whole Blood - JE
		Stat, spec type = Blood
	hs Troponin I - FH
		Stat, spec type = Blood, Stroke Alert
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood, Stroke Alert
	Toxicology Screen DAU - MH/WH/JE
		Stat, Stat, spec type = Urine, Stroke Alert, Stroke Alert
	Drug Screen Urine - FH
		Stat, Stat, Urine Random, spec type = Urine, Stroke Alert, Stroke Alert
	Beta-HCG Quantitative - Pregnancy
		Stat, spec type = Blood, Stroke Alert
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood, Stroke Alert
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood, Stroke Alert
	Frozen Plasma
		T;N, Stat, Today, 4, No Requirements, To be Transfused
	Platelet Pheresis
		Stat, spec type = No Collection
Diagnostic Tests
Cardiology
	ECG in ED
		Stat, Indication: Stroke
			Comment: after brain imaging completed
Radiology
	CT Head w/o Contrast for Stroke Alert
		Stat, CVA
	CTA Head and Neck for Stroke Alert
		T;N, Stat, CVA
	CTP Head for Stroke Alert
		T:N, Stat, CVA
	CT Head w/o Contrast for Stroke Alert
		Stat, CVA
	CT Head w/o Contrast
		Stat, Mental Status Change
			Comment: Priority Read
	Chest 1 View
		Stat
			Comment: after brain imaging completed
IV Solutions

	niCARdipine 20mg/NS 200mL
		200 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained the Goal parameter SBP <220mmHg, DBP <120 mmHG for ischemic stroke unless administering tPA or candidate for tPA or hemorrhagic stroke. Discontinue order after 12hr if patient does not require IV re-initiation.
		20 mg, EVERY BAG, 5 mg/hr
	nicardipine 20mg/NS 200mL premix
		20 mg, EVERY BAG, 5 mg/hr
		200 mL, IV, STAT, Duration: 1 Dose(s)/Time(s), Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained the Goal parameter SBP <220mmHg, DBP <120 mmHG for ischemic stroke unless administering tPA or candidate for tPA or hemorrhagic stroke. Discontinue order after 12hr if patient does not require IV re-initiation.
Medications
	labetalol  injection
		10 mg = 2 mL, Injection, IV PUSH, Once, STAT
			Comment: Goal Parameter SBP<220mmHG, DBP < 120 mmHg for ischemic stroke unless administering, or candidate for tPA
	ondansetron
		4 mg, Injection, IV PUSH, Once, STAT, duration: 4 hr
	LORazepam Injectable
		1 mg, Injection, IV Push, Once, STAT
			Comment: For agitation/imaging
Patient Care
	ED Cardiac Telemetry Monitoring
		T;N
	Continuous Pulse Oximetry by Nurse
		T;N
	Oxygen Therapy, Nurse to Administer
		T;N, Via Nasal Cannula, Titrate->Keep Sats>/= to 94 %
	Glucose POC - RN
		T;N
	Complete NIH Stroke Assessment
		T;N
	Peripheral Lock-Insert
		T;N, Once
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: stroke
	Consult Neurologist
		Reason for Referral: stroke
	Consult Tele Neurology (JEFH)
		Reason for Referral: Diagnosis: Stroke/suspected stroke, now

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