Chest Pain-Presumed cardiac in nature



Chest Pain-Presumed cardiac in nature |Extremity Injury |Suspected GI bleed |Abdominal pain and/or vomiting | |

|O2 @ 2L via N/C, Cardiac monitor, pulse |Determine mechanism of injury and exact |Draw and send rainbow to lab |Draw and send rainbow to lab |

|oximeter |location of pain. Evaluate joint above |U-preg on pre-menopausal females of |IV saline lock |

|Chest pain protocol on chart |and joint below the injury for |childbearing age |U-preg on pre-menopausal females of |

|EKG and show to ED MD |tenderness. Order appropriate x-ray |Urinalysis |childbearing age |

|IV saline lock | |Minicath on females |Urinalysis |

|Draw and send rainbow to lab |Right / Left(circle) ________________ |IV saline lock x2, bolus .9NS if SBP35 |

|ASA 325mg PO chewed (if no allergy to |Right / Left(circle)________________ |oximetry |Consult ED MD for analgesic medication |

|ASA) | |Orthostatic vitals as tolerated by pt | |

|NTG 0.4mg SubL every 5 min x 3 for CP if| |Anticipate nasogastric tube placement | |

|SBP > 90mm Hg |Immobilize / Elevate injured extremity |and gastric lavage | |

|Notify physician for persistent pain |Apply cold compress if injury is less |Anticipate administration of intravenous| |

|Pleuritic Chest Pain |than 48 hours old |crystalloid solutions and blood products| |

|CXR, EKG and show to ED MD, |Saline lock for obviously displaced | | |

|Pulse oximetry |fractures | | |

| |Consider U-preg for pre-menopausal | | |

| |females of childbearing age | | |

| |Consult ED MD for analgesic medication | | |

|Suspected UTI |Dyspnea in the absence of chest pain |Suspected overdose |Suspected renal colic |

|Without fever |Saline lock IV, cardiac monitor |IV .9NS, cardiac monitor, O2 2L N/C |IV Normal saline at 250cc/hr |

|Urinalysis |Draw and send rainbow to lab |Continuous pulse oximetry |Draw and send rainbow to lab |

|Minicath on females |EKG and show to ED MD |CBC, CMP, Urinalysis, UDS |Urinalysis |

|U-preg on pre-menopausal females of |O2 as appropriate |Acetaminophen level |Minicath on females |

|childbearing age |2L via N/C for COPD pts |Salicylate level |U-preg on pre-menopausal females of |

|With fever of 100.5F or > |Maintain pulse ox >92% for non-COPD pts |ETOH level |childbearing age |

|Same as above |CXR if no clear history of asthma |Fingerstick glucose |Consult ED MD for analgesic medication |

|Saline lock IV | |U-preg on pre-menopausal females of |Anticipate CT scan with kidney stone |

|Draw and send rainbow to lab | |childbearing age |protocol |

|Acetaminophen 1gm PO | |pCXR, EKG | |

|Sepsis pathway on chart if hypotensive | |Anticipate po charcoal | |

|or altered mental status | | | |

|Consult ED MD for analgesic medication | | | |

|Syncope in the absence of chest pain |Asthma |Suspected foreign body in the eye |Epistaxis (Nosebleed) |

|IV saline lock |O2 @ 2L via N/C |Obtain and document visual acuity in OD,|Apply direct pressure to control bleeding |

|Draw and send rainbow to lab |Continuous pulse oximetry |OS, and OU |ENT tray, Neo-Synephrine and silver Nitrate |

|Cardiac monitor, continuous pulse-ox |Stat Albuterol neb with peak flow before|Document tetanus immunization status |to bedside |

|EKG and show to ED MD |and after |If longer than 5 years administer 0.5cc |IV saline lock if SBP>180 or 100.5F | |

|Head injury | |Anticipate antibiotic administration | |

|CT head (only if loss of consciousness, | | | |

|or on Coumadin, or subsequent altered | | | |

|mental status) | | | |

|Patients on Coumadin with bleeding |Suspected ETOH intoxication |Lacerations |Signatures |

|IV saline lock |IV saline lock |Cleanse wound with normal saline | |

|PT / INR |Continuous cardiac monitor |X-ray injured area if indicated to rule | |

|CBC |Continuous pulse oximetry |out foreign body or a suspected fracture|RN Signature |

|Pulse oximetry |Draw and send rainbow to lab |Document tetanus immunization status | |

|Anticipate administration of intravenous|Anticipate administration of IV fluids |If longer than 5 years administer 0.5cc |Date:_______________Time:_______________ |

|crystalloid solutions and blood | |TD IM | |

|products, if SBP < 90 | |Suture set-up at bedside | |

| | |Anticipate post-suture clean up and | |

| | |dressing administration |MD Signature |

| | | | |

| | | | |

| | | |Date:_______________Time:_______________ |

***Circle the appropriate box to activate the order set within the chosen box. Printed1/23/2006 9:29 AM

|ER Dept Protocol Order Sheet |

|SMM |

|Adopted Date: |

|Revised Date: |

|Reviewed Date: |

|«LastName» , «FirstName» |

|«PatientNumber» / «AdmitDate» |

|«Gender» / «BirthDate» |

|«PatientAddress1» / *«PatientNumber»* |

|«SSN» / «Room» / «MedicalRecordNumber» |

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