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lnLern Subslde nlghLfloaL Culde Lo SL. 8aphael's
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1able of ConLenLs

'()*+&*,-.+/0& 3


8lood 1ransufuslons 4
A8Cs 4
Clucose MonlLorlng 4
Llne verlflcaLlon 3
Add on Labs 3
non-formulary 8equesLs 3
Peparln urlp 3
lnsulln Slldlng Scale 3
Sallne nasal Spray 6
Lye urops 6
8ecLal 1ube 6


ShorLness of 8reaLh 7
ChesL aln 7
PyperLenslon 7
PypoLenslon 8
1achycardla 8
8radycardla 8
lever 8
Cl 8leed 9
Low urlne CuLpuL 9
vanco uoslng 9
lnsomnla 10
lalls ouL of bed 10
uellrlum/AglLaLlon 10
Pyperglycemla 11
nausea/vomlLlng 11
1ransfuslon 8eacLlon 12
aln Meds and CplaLe Converslon 12
CplaLe wlLhdrawal 12
LLCP wlLhdrawal 12
ConsLlpaLlon 13
Cl reps 13
LlecLrolyLe 8epleLlons 14-13
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& Pyperhos
o LlmlL phosphaLe dleL
o Call resldenL lf very hlgh Lo dlscuss phosphaLe blnders (alumlnum blnders,
calclum blnders, sevelamer, lanLhanum carbonaLe)

& PypoCalcemla
o CorrecL for albumln,
o CorrecLed Ca = (0.8 x (4 - albumln)) + Measured Ca
o Crder lonlzed Ca lf low
o Ca >8, can glve C Ca supplemenL 1g dally
lonlzed Ca Ca Chlorlde dose
4-4.3 1g
3.3-3.9 2g
3-3.4 3g
2.3-2.9 4g
<2.3 3g

& PyperCalcemla
o 10.3-12, revlew meds/dlagnoses, lv hydraLlon Lo lncrease urlne ouLpuL
o >12, Laslx, calclLonln, call resldenL

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& Pypokalemla (up Lo 20mLq/hr vla CenLral Llne, up Lo 10mLq/hr vla erlph lv)
o 8epleLe Lo 4
o kCl for lv, ackeL or lll for C
o 10 mLq lnc. 0.1
! 40mLq kCl C or 10mLq kCl lv qhr x3

& Pyperkalemla
o CeL an LkC, peaked 1, 8 prolong., C8S wldenlng, absenL p waves
3-3.4 Low k dleL, revlew meds, recheck ln 12 hrs
3.3-3.9 kayexalaLe 30cc C8 Laslx
6-6.4 1elemeLry, Calclum CluconaLe 1 amp, u30 1amp w/ lnsulln 10u lv, kayexalaLe
30ccC q 2hrs unLll 8M, recheck ln 2 hrs
>6.3 As above, sLarL conLlnuous albuLerol nebs, call resldenL, blcarb ls acldemlc

& PyponaLremla/PypernaLremla, lormula ln ockeL Medlclne 4-7 and 4-8,
[na] lnfusaLe
u3 0
x nS 38
x nS 77
LacLaLe 8lngers 130
nS 134
& lor PypernaLremla, calculaLe lree WaLer ueflclL (equaLlon ln ockeL Medlclne) and
glve LhaL amL of free waLer, 1L of 1/2nS 300mL free P2C and 1/4nS has 730mL

& PypoMag
o 8epleLe Lo 2 (2.4 ln cardlac pLs)
o 1g of MagSulfaLe lnc. 0.2
o Clve 2g lv aL a Llme and repeaL q8hrs

& Pypohos
o 8epleLe Lo 3.3
o >1.6 can glve neuLrahos C (up Lo 3g/day dlvlded q6hrs)
! 2 packeLs q 6hrs ls a good sLarLlng place
o lor lv, use khos (lf k<4) or nahos (lf k>4),
40-60kg 61-80kg 81-120kg
2.3-3 7.3 mmol 7.3 mmol 7.3 mmol
1.6-2.2 7.3 mmol 10 mmol 13 mmol
<1.6 13 mmol 20 mmol 20 mmol
o 8enal Ls w/ CreCl<30 should geL 30 normal dose
o uon'L repleLe lf pL ls hyperCa

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?our resldenLs, llsLed on as 1ower 8esldenL nl" and verdl 8esldenL nl"

harmacy- 3493
Lab- 3090
ulLrasound- 3804
8adlology- 3124
lf you need a number, dlal 0" and ask Lhe operaLor

1o page,
- ulal 187, walL for Lhe prompLs and follow Lhem !"
- Cpen lnLerneL explorer
o Cllck x1end ulrecLory" ln Lhe green bar aL Lhe Lop of Lhe screen
o 1ype Lhe name of Lhe person you would llke Lo page
o 1ype a numerlcal message and cllck Send

1o flnd any aLLendlng's phone number
- Cpen lnLerneL explorer
o Cllck on hyslclans" on Lhe LefL hand slde of Lhe screen
o names are llsLed alphabeLlcally

1o conLacL Lhe resldenL/fellow on-call from a glven servlce
- Cpen lnLerneL explorer
o Cllck x1end ulrecLory" ln Lhe green bar aL Lhe Lop of Lhe screen
o AL Lhe boLLom of Lhe page ls a box conLalnlng Lhe names of Lhe varlous servlces
o SelecL Lhe servlce you would llke Lo conLacL and Cllck Lhe Cn Call now" 8uLLon

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8lood 1ransfuslons
- Crder LnLry
- Cllck Crder SeL" Lab
- urop down Medlcal Mus- Cenerlc" folder
- urop down LaboraLory" folder
- Cllck 8lood 8ank"
- ?ou musL now boLh requesL and order blood producLs
o under 8lood roducL 8equesL CpLlons" check Lhe approprlaLe box
o 1hen check Lhe correspondlng box under 1ransfuse opLlons"
o Check S1A1 under CollecLlon CpLlons"
o lollow prompLs. MosL pLs should geL 8ed 8lood Cells Leuko", choose 8ed
8lood Cells Leuko lrrad" for lmmunocompromlsed pLs
o 1ype per proLocol" for 1ransfuse Admln lnsLrucL"
- Lach unlL should lncrease PcL by 3 polnLs. Crder an P/P or C8C 2 hrs afLer Lhe
Lransfuslon compleLes

- Crder LnLry
- Cllck rocedure Search" 1ab
- uouble Cllck A8C- 8lood Cas Analysls- ArLerlal"
- Cn Lhe flrsL screen check u-prlnL S1A1"
- lollow prompLs. 8lA ="non-lnvaslve venLllaLlon"
- AfLer orderlng, ask Lhe nurse Lo geL you 2 A8C klLs and ask where Lhe Label rlnLer ls
locaLed. 1wo sLlckers wlll prlnL ouL. AfLer prlnLlng, press Lhe leed" buLLon Lo geL your
- lf pL ls obese, edemaceous, vu, weak pulse, or oLherwlse a dlfflculL sLlck, ask for Lhe
uoppler machlne. use small amounL of surgllube beLween probe and skln ln order Lo
ausculLaLe locaLlon of Lhe arLery.
- AfLer geLLlng Lhe A8C, place Lhe bar code on Lhe sample lLself. lace Lhe oLher sLlcker
on Lhe 8lohazard bag.
- uL Lhe sample ln Lhe bag and Lube lL Lo Lhe Lab.
- Someone wlll show you how Lo use Lhe Lube sysLem.

Clucose MonlLorlng
- Ls nC should have glucose checks q6hrs. Ls who are eaLlng should have glucose
checks aL each meal and ln Lhe evenlngs.
- nurses call checks aL meals and bedLlme AC and PS"
- Crder LnLry
- Cllck rocedure Search" 1ab
- 1ype Clucose MeLer -
- SelecL approprlaLe frequency.

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- All pL's on narcoLlcs should be on a bowel reglmen
- ln order of lnLenslLy, common laxaLlves are,
o SLool sofLeners, uocusaLe
o SLlmulanLs, Senna
o CsmoLlc agenLs, Mlralax
o Sallne laxaLlve, Magneslum clLraLe
o lf refracLory consLlpaLlon, call resldenL. ?ou can conslder LacLulose 13cc dally,
CoLyLely 1gallon, lleeLs enema

Cl reps
- Colonoscopy
o nC afLer mldnlghL Lhe nlghL before
o 1 gallon of Co-LyLely Lhe nlghL before
o lf sLools noL clear by 4 AM, glve one full boLLle of Mag ClLraLe
- LCu
o nC afLer mldnlghL Lhe nlghL before
o Cenerall, can glve mornlng meds
- llex Slg
o nC from Lhe nlghL before
o no Co-LyLely necessary
o 2 Lap waLer enemas Lhe mornlng of procedure,
! 1ype Lnema" lnLo rocedure Search and double cllck Lnema"
! Cllck Lhe Lxpand" buLLon ln Lhe lower rlghL corner of Lhe screen
! 1he defaulL wlll be Cn call x1". 1hls ls ok. uL ln Lhls order and Lell Lhe
nurse verbally LhaL you wanL one flrsL Lhlng ln Lhe mornlng and a second
enema when Lhe Cl lab calls for Lhe paLlenL.

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1ransfuslon 8eacLlon
- SLop Lransfuslon, keep lv open w/ nS (37cc/hr), verlfy correcL unlL glven Lo pL, alerL
blood bank, order 1ransfuslon 8eacLlon Screen" ln Cuadramed
o Clve 8enadryl 23mg C/lv, 1ylenol 630mg C/pr
o lf rxn ls mlld and sympLoms resolve w/ meds, Lransfuslon can be resumed
- lf hypoLenslon, resplraLory compromlse, 1>101, rlgors, any paln, or bleedlng, you musL
alerL resldenL lMMLulA1LL?

aln Meds- Cplold converslon (uoses llsLed are equlvalenL)
- Converslons are rough and ad[usLmenLs elLher up or down may be necessary when
converLlng from one drug Lo anoLher
- 1he doses llsLed ln Lhe Lable below are all equlvalenL ln Lerms of analgeslc effecL

urug lv
C uose uuraLlon
Morphlne 10 30 4
MS ConLln nA 30 12
Cxycodone nA 20 4
CxyConLln nA 20 8-12
ullaudld 1-1.3 7.3 4
lenLanyl 0.1 nA lv=1hr
nA 30 4
Codelne 120 200 4

CplaLe w/d
- uncomforLable buL noL llfe LhreaLenlng. aLlenLs aL PS8 are LreaLed sympLomaLlcally.
- Clonldlne 0.1mg-0.3mg C q8hrs prn P1n. Pold lf S8<100.
- 1ylenol prn muscle aches, Maalox prn dyspepsla, lvl lf dlarrhea/vomlLlng.

LLCP w/d
- aLlenLs wlLh suspecL LLCP w/d should be placed on ClWA proLocol
- 1he proLocol ls nurslng drlven, meanlng LhaL Lhe scores are deLermlned by nurses on a
regular basls.
- er PS8 proLocol, pLs w/ score >10 geL 2mg ALlvan C q1hr x 3.
- ClWA ls sub[ecLlve and does noL accounL for vlLals. lf pL wlLh suspecLed w/d has
Lachycardla or hyperLenslon and you Lhlnk Lhls ls due Lo LLCP w/d, you can order
addlLlonal aLlvan.
- Look aL Lhe pL's prevlous benzo requlremenL Lo deLermlne how much you Lhlnk Lhe
paLlenL wlll requlre.
o Cllck Lhe CharL 8evlew Lab on Lhe lefL slde "Cllck Lhe rocedure buLLon on Lhe
boLLom of Lhe screen" 1ype aLlvan" and hlL enLer. 1he hlsLory of aLlvan doses
wlll appear. uouble cllcklng each dose wlll glve # of mg.
- Crderlng addlLlonal aLlvan wlll vold Lhe proLocol and lL wlll be reseL. nurslng generally
doesn'L llke when you do Lhls buL you can do lL lf you feel Lhe pL's slgns and sympLoms
warranL lL.
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Llne verlflcaLlon- conflrmaLlon LhaL caLheLers are ln place and ready Lo use
- 8efore sLarLlng, ask Lhe nurse whaL Lype of llne ls ln place and revlew Lhe Cx8. A
resldenL or radlology can help you lf you are uncerLaln wheLher Lhe llne ls ln place.
- Crder LnLry
- Cllck rocedure Search"
- 1ype CvAu"
- lollow prompLs

Add-Cn Labs
- SomeLlmes labs cannoL be added on dependlng on Lhe collecLlon Lube Lype. Call Lhe lab
lf you aren'L sure.
- Crder LnLry
- Cllck rocedure Search" Lab
- 1ype Add on"
- 1ype ln Lhe labs you wanL Lo add ln Lhe rocedures Lo be added" box
- 1ype lasL lab draw" ln Lhe Speclmen ueparLmenL#" box

non-lormulary 8equesLs
- Crder LnLry
- Cllck rocedure Search" Lab
- 1ype nl" and follow prompLs
- CrlLlcald ls a common nonformulary used by nurslng for lrrlLaLed perlneal area. lor
uose and 8ouLe" selecL Apply cream Loplcally", choose prn" and Lype for skln
lrrlLaLlon" for frequency.

Peparln urlp (aka Peparln nomogram or Peparln gLL)
- Crder LnLry
- Cllck Crder SeL" Lab
- urop down Medlcal Mus- Cenerlc" folder
- urop down Cardlology Crder SeLs" folder
- urop down Cardlac CaLh osL" folder
- Cllck Peparln nomogram Cardlology"
- Cn Lhe rlghL slde, check Peparln nomogram Cardlology Crder" and cllck Lhe Add Crder
buLLon on Lhe boLLom rlghL
- SelecL obLaln a11 C am when a11 ls LherapeuLlc"
- LnLer Lhe pL's welghL and helghL. 1hls can be found by cllcklng Lhe house and person
lcon ln Lhe upper lefL corner of Lhe screen nexL Lo Lhe pL's name. 1helr helghL and
welghL ls dlsplayed ln Lhe lacesheeL" secLlon of Lhe screen
- 1he drlp raLe ls auLocalculaLed by Lhe compuLer and Lhe drlp wlll be ad[usLed by nurslng.

lnsulln Slldlng Scale
- Crder LnLry
- Cllck rocedure Search" 1ab
- 1ype 8lSS- and double cllck 8egular lnsulln Puman Slldlng Scale"
- Cllck on 8S less Lhan 70 LreaL per Pypogly. roLocol", and Lhe lndlvldually cllck on each
cholce under Lhe Mlddle" headlng, and cllck Ck
- LnLer Lhe followlng # of unlLs, 0 for 101-130, 0 for 131-200, 2 for 201-230, 4 for 231-300,
6 for 301-330, 8 for 331-400, 10 for >401
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Sallne nasal Spray, 1ype Ccean" lnLo rocedure search

Lye urops (arLlflclal Lears), 1ype uexLran 70" lnLo rocedure search

8ecLal 1ube for dlarrhea managemenL, 1ype lecal ManagemenL" lnLo rocedure Search

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- ln general, evenlng blood sugars are for monlLorlng and should noL be covered
(especlally noL Lo be covered by AsparL) b/c Lhe pL ls noL eaLlng
- Call resldenL for guldance lf Lhe blood sugar ls very hlgh (>300)
- ?ou can revlew prevlous glucose readlngs & lnsulln dosages,
o CharL 8evlew
o uouble cllck harmacy" under Lhe Anclllary headlng
o uouble cllck Clucose Levels vs lnsulln&u30 1reaLmenLs"
- lf pL has perslsLenLly very hlgh glucose, you can conslder lnsulln drlp (ask resldenL before
sLarLlng Lhls)
o 1ype lCu lnsulln urlp roLocol" lnLo rocedure Search. Clucose checks and
lnfuslon raLe ad[usLmenLs wlll be done auLomaLlcally by nurslng
o Make sure you make Lhe pL nC whlle Lhe drlp ls runnlng.
o ?ou can LranslLlon Lo subC lnsulln when glucose readlngs are below 130 x 3-4
! CalculaLe LoLal dally lnsulln requlremenL by mulLlplylng # of unlLs glven
for lasL 4 hrs x6 (for a LoLal of 24hrs).
! Palf of Lhls LoLal should be glven basal (nP 8lu) and Lhe oLher half
bolus (AsparL 1lu wlLh meals).
! lor example, lf Lhe pL's LoLal requlremenL ls 40 unlLs of lnsulln as
calculaLed from Lhe drlp, you should LranslLlon Lhem Lo 10 unlLs nP
8lu, 7 unlLs premeal asparL 1lu.

! Pave nurse glve Lhe long acLlng nP and u/C Lhe drlp afLer 2 hrs (Lakes
2 hrs for nP Lo sLarL worklng)
o lf Lhe pL ls nC, glve 30 mornlng basal lnsulln and hold shorL acLlng lnsulln

- uo Lhorough abdomlnal exam and conslder abd xray Lo evaluaLe
- lf bowel obsLrucLlon or lleus, make nC, sLarL lvl (nS [73cc/hr ls a good place Lo sLarL),
and place nC1 (resldenL can help you do Lhls).
- lf n/v ls noL severe, and you Lhlnk sympLoms mlghL be due Lo dyspepsla, you can sLarL
wlLh Maalox or blsmuLh subsallcylaLe.
- AnLl-emeLlc drugs
o Zofran 2mg-4mg lv
o 8eglan 3-10mg q6hrs C/lv, good for gasLroparesls
o Compazlne 3-10mg q6hrs C, good lf co-exlsLlng anxleLy

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- MelaLonln 3mg Lwo hrs before bed, llLLle slde effecLs. 8esL cholce ln old or medlcally
compllcaLed pLs.
- 8enadryl 23mg or ALarax 30mg wlLh opLlon Lo repeaL, good general sleep ald buL
cauLlon ln elderly as Lhls can preclplLaLe dellrlum. Also has anLl-chollnerglc effecLs so
may exacerbaLe consLlpaLlon, urlnary reLenLlon, dry mouLh eLc.
- 1razodone- 30 mg, also good general ald buL agaln has anLl-chollnerglc effecLs
- 8enzos, ALlvan (0.3-1mg) or xanax (0.23-0.3mg)- especlally useful lf co-exlsLlng anxleLy.
CauLlon ln elderly and subsLance abusers.
o CauLlon aLlvan ln renal lmpalrmenL and xanax ln llver lmpalrmenL
- Seroquel, zolpldem, SonaLa- sLronger meds w/ more slde effecLs. Cenerally don'L glve
Lhls overnlghL Lo paLlenLs you do noL know well. 1hese Lypes of meds should be sLarLed
by Lhe day Leam.

lalls ouL of bed
- See pL, geL a sLory of whaL happened, and do a full physlcal and Lhorough neurologlcal
- uocumenL flndlngs ln an evenL noLe
- nurslng wlll also flll ouL a form and ask you Lo co-slgn
- nurslng musL Lhen Lake frequenL vS per nurslng proLocol, f/u on Lhese vlLals and ensure
no lnsLablllLy
- lf !"# head Lrauma conslder S1A1 non-conLrasL head C1
- lf any slgnlflcanL ln[ury or unsLable, alerL resldenL.

- osslble preclplLanLs Lo conslder, anLlchollnerglcs, narcoLlcs, benzos,
narcoLlc/benzo/LLCP wlLhdrawal, sLerolds, paln
- Check, vlLals, llngersLlck lf on anLl-hyperglycemlc, ls paln LreaLed adequaLely?, 8ecenL
med changes?, Can llnes or caLheLers be u/C'ed?
- llrsL llne,
o Paldol 1mg lv for elderly, 2mg lv for non-elderly. 8epeaL q30 mlns x3 unLll
! Check LkC before glvlng. uo noL glve lf C1c>300.
o ALlvan- 1mg C/lv ln non-elderly. 8epeaL q30mlns x3 unLll calm.
- Second llne, 2
generaLlon anLlpsychoLlcs. referred lf poor rxn Lo 1
generaLlon l.e.
dysLonlc rxn/orLhosLasls/nMS
o 8lsperldone 0.23mg for elderly, 0.3mg for non-elderly
! 8epeaL q4hrs
! C only
o Clanzaplne 2.3 mg for elderly, 3mg for non-elderly
! 8epeaL q4hrs
! C or lM
- lf pL has a dysLonlc rxn (acuLe spasm of faclal, neck, or exLraocular muscles), 30 mg
8enadryl lM S1A1. Can repeaL q13mlns lf no response up Lo 3 Llmes. lf sLlll no rellef,
aLlvan 2mg lM S1A1.

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Whenever posslble, see Lhe pL yourself. lf Lhe pL ls unsLable ln any way, call your resldenL or call
a code. 1he followlng general Llps Lo be consldered for sLable paLlenLs.

ShorLness of 8reaLh
- Lxamlne pL yourself
- MosL common eLlologles are CCu, CPl /ulm edema (has Lhe pL goLLen a loL of lv
flulds or blood producLs?)
- LlsLen for crackles (CPl/fluld overload) or wheezlng (CCu)
- lf Lhe pL has a poor C2 SaL, conslder lncreaslng C2.
o C2 opLlons ln order of lncreaslng lnLenslLy are, nasal canula, flow-by face mask,
non-rebreaLher facemask, 8lA, lnLubaLlon (only ln lCu)
- lf crackles, S1A1 porLable Cx8, Laslx, A8C lf Lhey need Lo go on 8lA
- lf wheezlng, conslder AlbuLerol/lpraLroplum nebullzer LreaLmenL, call resplraLory
- Avold 8lA ln nA or lf loLs of secreLlons
- CLher eLlologles Lo Lhlnk abouL, L (C1 Anglo & uoppler w/ heparln drlp lf poslLlve),
Mucous plug (LreaL w/ sucLlon), asplraLlon (sucLlon, Cx8, add unasyn lf you Lhlnk Lhey
- lf unconLrolled desaL, have nurse call rapld response and page resldenL, lncrease C2, geL
S1A1 A8C, Cx8, lyLes, C8C, lacLlc acld

ChesL aln
- Lxamlne pL yourself and look aL vlLals
- S1A1 LkC, porLable Cx8
- Compare LkC Lo prevlous, Cllck CharL 8evlew""uouble cllck LkC/LLC" under
Anclllary"uouble cllck 1racemasLer LkC Llnk""uouble cllck on Lhe mosL recenL LkC
Lo compare
o Call Lhe resldenL lf any acuLe changes
- lf you suspecL anglna,
o nlLro subllngual 0.4mg q3mlnsx3, asplrln 323mg chewed (lf no asplrln LhaL day),
oxygen, meLoprolol 3mg lv S1A1 q3mlns for goal P8=33-70, morphlne 4mg
lv, order 1roponln 1 and Ck S1A1 and Lhen q8hrs x3

- WhaL ls Lhe P8? Pave any home anLlhyperLenslves been held? lf so, conslder resLarLlng
or glvlng half Lhe dose.
- SLarL by glvlng scheduled meds early.
- lf Lhe P8 ls normal or hlgh, labeLalol 10mg lv or meLoprolol 3mg lv (can repeaL)
- lf P8 ls low, hydralazlne 10mg C or 3mg lv can be glven.
- lf any slgns of end organ damage, call resldenL, pL may need Lransfer Lo lCu

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- Look ln Lhe bedslde charL (green blnder) Lo deLermlne basellne
o ulalysls, clrrhosls, CPl, cardlomyopaLhy, young women ofLen have low 8
o Conslder checklng manual 8
o Check urlne ouLpuL
- Conslder lv nS bolus. ln healLhy pLs, 1L bolus should be flne. 8e genLle for pLs w/ low
Ll or dlalysls dependenL (300 or 230 mL)
o Crder LnLry"rocedure Search"Lype bolus""double cllck 8olus (enLeral
only)" and follow prompLs
- 8emember LhaL Lhls can also be a slgn of lnfxn (see lever below)

- CeL LkC Lo deLermlne rhyLhm and conslder checklng lyLes S1A1
- SLarL by glvlng any scheduled meds early
- lor Aflb
o ullLlazem 10 mg lv, can repeaL x3 lf 8 LoleraLes, lf sLlll ln rapld Aflb, may need
dllL drlp (call resldenL)
o lf 8 ls low, conslder dlgoxln (call resldenL)
o lf new onseL Aflb, may need heparln drlp (call resldenL)
- Call resldenL for any new onseL wlde complex Lachycardla
- no beLa-blockers or calclum channel blockers for WW (call resldenL)

- CeL LkC and check lyLes
- 8evlew medlcaLlons, have Lhere been recenL changes?
- Some meds have anLldoLes (Ca for CC8, glucagon for beLa-blockers, anLl-dlg for dlg)
- Lnsure you have good lv access
- lf aLroplne/paclng/pressors are requlred, call Lhe resldenL

- an CulLure, blood, urlne, spuLum
- S1A1 Cx8
- urlnalysls
- Can glve 1ylenol 630mg q4hrs prn fever Lo lower Lemp
- Can glve uemerol 23mg lv lf pL has rlgors

! ,!
- lf new onseL large bleed, alerL resldenL and call Cl Leam
- SLandard orders are, roLonlx drlp 8mg/hr, nC, S1A1 C8C and coags, 2 large bore lv's,
draw P/P q4hrs
o Clve 1u 88Cs S1A1, don'L walL for Lhe C8C
o lf hypoLenslve, glve a nS bolus
o uL anLl-coagulanLs on hold
o lf hlgh ln8, conslder ll, sLandard ls 4 unlLs.
! Crder LnLry"rocedure Search"Lype plasma""double cllck lasma
(1ransfuse 1hawed lasma)" and follow prompLs
o lf acLlve bleed, conslder Lagged 88C scan Lo locallze bleed. ?ou musL call Lhe
radlology resldenL Lo geL Lhls done emergenLly overnlghL.
- 1here are no evldence based P/P goals. ln general, keep Pgb>9 and PcL>23. lor cardlac
pLs, keep PcL>28.
- lf pL ls requlrlng loLs of blood producLs and Lhey have CPl, conslder Laslx w/ each unlL of
blood Lo prevenL pulm edema

Low urlne CuLpuL
- Check l/Cs and vlLals ln Lhe green blnder
- Make sure Lhe loley ls flowlng well. Ask nurse Lo flush lL lf lL ls noL flowlng well,
especlally lf Lhere ls hemaLurla (cloLs can easlly clog Lhe loley).
- Check bladder scan for posL-vold resldual (v8) Lo see lf Lhe pL ls reLalnlng urlne. lf
v8>300cc, caLheLerlze.
- lf you Lhlnk Lhe loley ls clogged from cloLs, conslder ConLlnuous 8ladder lrrlgaLlon (C8l),
dlscuss wlLh resldenL
- Crder random urlne na (lena<1 means pre-renal) and random urlne urea
(leurea<33 means pre-renal)
o lena ls noL accuraLe lf pL ls on dlureLlcs
o lf prerenal, glve flulds lf CPl ls noL presenL, glve Laslx lf CPl ls presenL

vanco doslng Ad[usLmenLs
- vanco Lrophs should be drawn 30mlns before Lhe 4
- Ad[usL Lhe dose by Lhe doslng guldellnes
o Cpen lnLerneL Lxplorer Lo Lhe PS8 Pomepage
o Cllck ueparLmenLs" on Lhe LefL hand slde of Lhe page
o 1ype vanco" ln Lo Search bar aL Lhe Lop of Lhe page
o Scroll all Lhe way down and cllck vancomycln uoslng and MonlLorlng
o rlnL Lhls ouL and carry lL wlLh you.
o Ad[usL per Lhe guldellnes