Unique Plan Description: ONC immune Effector Cell Neurotoxicity Management
Plan Selection Display: ONC immune Effector Cell Neurotoxicity Management
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-04-19 14:36:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-19 14:36:00
Available at all facilities: Yes

ONC immune Effector Cell Neurotoxicity Management
Activity
	Up with Assistance
		
Diet
	NPO
		Strict
			Comment: Until cleared by speech after swallow study
Diagnostic Tests
	MRI Brain w & w/o Contrast
		T, Stat
	EEG
		T, Priority Stat
			Comment:  Notify neurohospitalist if EEG ordered (so team knows to look for it to read it). If no seizures on EEG, continue prophylactic levetiracetam If EEG shows focal or generalized convulsive or nonconvulsive seizure or convulsive status epilepticus refer to further management as in grade 3 and 4 ICANS
	MRI Brain w & w/o Contrast
		T;N, Stat
			Comment: If focal deficits are noted
	CT Head w & w/o Contrast
		T;N, Stat
			Comment: If unable to perform MRI of brain
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 1 Dose(s)/Time(s), 125 ml/hr
		1,000 mL, IV, 1 Dose(s)/Time(s), 100 ml/hr
Medications
Grade 1
	dexAMETHasone
		10 mg, Injection, IV Push, Once
			Comment: Grade 1:  Reassess in 6 hours or earlier if clinically indicated
	LORazepam
		0.25 mg, Injection, IV Push, Q8H
			Comment: After EEG is completed
		0.5 mg, Injection, IV Push, Q8H
			Comment: After EEG is completed
	Haldol  injectable
		0.5 mg, Injection, IV Push, Q6H
			Comment: May use instead of Lorazepam for agitated patients with careful monitoring; after EEG is completed
	tocilizumab
		8 mg/kg, INT, IVPB, Once
			Comment: Dose to not exceed 800mg.  For persistent fever lasting greater than 3 days (Maximum of 4 doses total over the entire course of CRS and ICANS)
Grade 2
	dexAMETHasone
		10 mg, Injection, IV Push, Q12H
			Comment: Grade 2
Patient Care

	Complete ICE Assessment Tool
		Q6H-Sch
	Aspiration Precautions
		
Consults/Follow-up
	Consult Neuro Hospitalist
		
	Consult Speech Language (MH), Evaluate and Treat
		Swallowing
			Comment: Swallow study
	Pharmacy Consult
		Evaluate for preexisting medications that may cause central nervous system depression and discontinue
		Convert all oral medications and/or nutrition to IV if swallowing is impaired

*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