DO NOT THIN FROM HEALTH RECORD

(1)

Admission

To be initiated after neurological determination of death (Note)

Diet Communication Order

X

Initiate or continue nutritional support, when appropriate and possible

Communication Order

X

Stop enteral feeds on call to operating room and empty gastric residuals; clamp NG tube and leave insitu.

Activity Turn Patient

X

q2 hours.

Elevate Head of Bed

X

30 Degrees

Vital Signs Oxygen Saturation

greater than or equal to 92%

Mean Arterial Blood Pressure Target (mmHg)

X

70 - 90 mmHg mmHg

Transduce Central Venous Pressure Monitoring

q1 hour.

Central Venous Pressure Target

6 -10 mmHg

Patient Care Suctioning

X

q2 hours., and PRN, Tracheal

Invasive Temperature

X

(2)

To keep temperature 35.5 - 37 degrees celcius

Notify Provider

X

If urine output greater than 250 mL/hr or less than 30 mL/hr x 3 hours.

Nasogastric/Orogastric Tube Insertion

To Gravity /Straight Drainage

Arterial Line Care and Monitoring Communication Order

X

Keep urine output 0.5-3 mL/kg/hr / serum sodium greater than or equal to 130 and less than or equal to 150 mmol/L / normal ranges for potasium, calcium, magnesium, phosphate / blood glucose 6-10 mmol/L

Blood Glucose Target

X

6-10 mmol/L, for organ donation

Conditional If/Then

X

If serum sodium greater than 145 mmol/L, Then change maintenance IV to dextrose 5% and call MD

Respiratory Orders

Verify current ventilation settings to match the TGLN guidelines; Tidal volume measurements: Vt 6-8 mL/kg; PEE 8-10 cm H20; PIP less than or equal to 30 cm H20 (Note)

Ventilation Prescribed Parameters

Vent mode: Assist Control-Volume Mode, Tidal Volume: 6-8 mL/kg Predicted Body WT, PEEP: 10, pH: Other Comments - Notify Provider Fi02 greater than 50% or PEEP greater than 10 cm of water

Lung Recruitment Maneuver

Pressure/Duration: 30 cm of water for 30 seconds, PRN (Max 4 x 24 hours)

(3)

lactated ringers bolus

500 mL, injection, IV, as directed, PRN Other: See Comments

Comments - if SBP less than 100 mmHg or MAP less than 70 mmHg and CVP less than 10 mmHg, may repeat bolus if MAP and CVP remain below target

norepinephrine 8 mg in 250 mL dextrose 5% premix

dextrose 5% premix diluent (titrate)

Titration Range: 0-20 mcg/min, IV continuous, Contact Physician when high dose required

Comments - PRN for SBP less than 100 mmHg or MAP less than 70 mmHg

norepinephrine - additive 8 mg, Every Bag

vasopressin 100 units in 100 mL sodium chloride 0.9%

sodium chloride 0.9% (titrate)

Titration Range: 0- 1.8 unit/hr, IV continuous, TGLN guideline is 0-2.4 units/hr

vasopressin - additive 100 units

DOPamine 400 mg in 250 mL dextrose 5% premix

Titration Range: 5- 10 mcg/kg/min, IV continuous Comments - PRN for SBP less than 100 mmHg or MAP less than 70 mmHg and unresponsive to vasopressin an norepinephrine/ epinephrine (do not give if HR greater than 120 bpm)

DOPamine additive 400 mg

(4)

dextrose 5% in water (titrate)

Titration Range: 0-20 mcg/min, IV continuous EPINEPHrine - additive

4 mg

nitroglycerin 50 mg in 250 mL dextrose 5% premix

Titration Range: 0-200 mcg/min, IV continuous Comments - PRN for SBP greater than 160 mmHg and/or MAP greater than 90 mmHg

nitroglycerin -additive 50 mg

labetalol 100 mg in 100 mL sodium chloride 0.9%

sodium chloride 0.9% IV continuous, mg/min, titrate

Comments - PRN for SBP greater than 160 mmHg and/or MAP greater than 90 mmHg

labetalol - additive 100 mg

IV Fluid Bolus Conditional If/Then

X

If creatinine clearance is less than 60 mL/min, kidneys have not been ruled out for transplant and IV contrast is planned, Then give IV normal saline bolus 3 mL/kg/hr, for 3 hours pre contrast and then 1 mL/kg/hr, for 6 hours post contrast

sodium chloride 0.9% (normal saline) bolus

X

9 mL/kg, injection, IV, as directed, infuse over 3 hr Comments - 3 hours pre contrast

sodium chloride 0.9% (normal saline) bolus

X

(5)

Comments - 6 hours post contrast

Medications CRIT CARE - Electrolyte Replacement (Module) CRIT CARE - Insulin Infusion (Module)

CRIT CARE - Electrolyte Replacement (Module) [STEGH] CRIT CARE - Insulin Infusion (Non DKA) (Module) [STEGH] methylPREDNISolone sodium succinate

15 mg/kg, injection, IV, q24 hours

Comments - Maximum 1 gram per dose. Pharmacy round dose to nearest 250 mg dose

levothyroxine

100 mcg, injection, IV direct, ONCE (Def) Comments - bolus dose

2 mcg/kg, tab, NG TUBE, ONCE

Comments - bolus dose, pharmacy may round to nearest 25 mcg dose

levothyroxine

50 mcg, injection, IV direct, q12 hours, Start: T;N+720 (Def)

50 mcg, tab, NG TUBE, q12 hours, Start: T;N+720

hydrALAZINE

20 mg, injection, IV direct, q4 hours, PRN for Other: See Comments

Comments - for SBP greater than 160 mmHg and/or MAP greater than or equal to 90mmHg. (range 10-20 mg)

desmopressin

20 mcg, injection, IV, ONCE

Comments - for diabetes insipidus treatment

(6)

Timed, T;N, Blood, Frequency: q6 hours.

INR

X

PTT

X

Electrolytes,Serum,Plasma (LYTE)

X

Glucose,Random (GLUR)

X

Creatinine (CRE)

X

Urea (U)

X

Calcium,Serum,Plasma (CA)

X

Magnesium,Serum,Plasma (MG)

X

Phosphate (PHO)

X

Protein,Total (PR)

X

Bilirubin,Direct (BILD)

X

Bilirubin,Total (BILT)

X

Amylase,Total (AMY)

Aspartate Aminotransferase (AST)

(7)

Alkaline Phosphatase (ALP)

Gamma Glutamyl Transferase (GGT)

Lipase,Serum (LIP)

Creatine Kinase (CK)

Troponin-I,Plasma (TNI)

Troponin-T,Plasma (TNT)

Lactate Dehydrogenase (LD)

Lactate,Plasma (LACP)

Timed, T;N, Blood, Frequency: q6 hours. Comments - Regional sites only.

Glycated Hemoglobin (GLYHB)

Timed, T;N, Blood

Urinanalysis (DIPU)

Timed, T;N, Urine, Frequency: daily.

Microalbumin,Urine,Screen (MALBUS) X Timed, T;N, Urine Blood Gases (BG) Timed, T;N Blood Culture (BLC) Timed T;N

(8)

Blood Culture (BLC)

Timed T;N+2

Blood Culture (BLC)

Timed T;N+3

Sputum C&S (RESP)

Timed T;N

Urine Culture (URNC)

Timed, T;N Fluid Culture (FLDS) Timed T;N Diagnostic Imaging Chest AP Portable Communication Order

order chest xray stat and every 12 hours and prn.

Other Diagnostic Testing/Treatment ECG r

T;N

ECHO 2D r