Unique Plan Description: ED Therapeutic Hypothermia (MH WH), Diagnostic Temp Mgmt
Plan Selection Display: ED Therapeutic Hypothermia (MH WH), Diagnostic Temp Mgmt
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-12-05 11:00:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:28:13
Available at all facilities: No

ED Therapeutic Hypothermia (MH WH), Diagnostic Tem
Admit/Discharge/Transfer
	Transfer to Critical Care (WH JE)
		
	ED Request for Bed
		
Vital Signs
	Vital Signs
		T;N, Q15MIN
Diet
	NPO
		T;N
Laboratory
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Lactate
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
			Comment: if woman of child bearing age.
Diagnostic Tests
	Chest 1 View
		T;N, Stat, Myocardial Infarct
			Comment: Hypothermia post cardiac arrest protocol
	ECG in ED
		T;N, Stat, Indication: Post ACLS/Medical Emergency
	CT Head w/o Contrast
		T;N, Stat, Loss of Consciousness
			Comment: If possible, a non contrasted Head CT should be obtained. Do NOT delay cooling for this. Hypothermia post cardiac arrest protocol
IV Solutions
	Sodium Chloride 0.9%
		2,000 mL, IV, STAT, Bolus
	Levophed 4 mg/D5W 250 mL
		4 mg, EVERY BAG, 8 mcg/min
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 1 mcg/min, Increment Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 30 mcg/min
			Comment: **LEVOPHED** Concentration: 16mcg/mL .  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 Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	Levophed 4mg/D5W 250mL Premix
		4 mg, EVERY BAG, 8 mcg/min
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Increment Increase: 1 mcg/min, Increment Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 30 mcg/min
			Comment: **LEVOPHED** Concentration: 16mcg/mL .  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 Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	Levophed 8mg/D5W 250mL Premix
		250 mL, IV, STAT, Increment Increase: 1 mcg/min, Increment Decrease: 1 mcg/min, Increment Freq: 3 min(s), Max Dose: 30 mcg/min
			Comment: **LEVOPHED** Concentration: 32mcg/mL .  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 Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
		8 mg, EVERY BAG, 8 mcg/min
	nitroglycerin 50 mg/D5W 250 mL Premix IV
		50 mg, EVERY BAG, 5 mcg/min
		250 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Maintain Parameter Goal: SBP> 90, Increment Increase: 5 mcg/min, Increment Decrease: 5 mcg/min, Increment Freq: 5 min(s), Max Dose: 200 mcg/min
Patient Care
	Obtain Consent/Permit for:
		T;N, Targeted Temperature Management
			Comment: Therapeutic Hypothermia
	Cold Therapy
		T;N, Ice bag
			Comment: ONCE, immediately apply ice packs apply to armpits, and groin.
	Foley Catheter
		T;N, Foley, Insert, Accurate output hemodynamically unstable
			Comment: use temperature sensing catheter
	GI Tube
		T;N, OG, Insert, Once
	Passive Convective Cooling
		T;N, Expose patient, dampen skin, cooling fan; ice packs applied to axilla/groin/torso/neck/limbs
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: Acute Cardiac Arrest
	Consult Pulmonologist
		Reason for Referral: Therapeutic Hypothermia

*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