I work in vancouver BC Canada at St pauls hospital. We see about 60,000 patients per year and run aa acute, treatment and substance abuse/psych areas. we have standard orders for initiation of IV's, ie it is deemed nessesary or prudent by the nursing staff. We also have a standard set of guidelines for ordering blood work. Our chest pain protocol includes nurse initiated IV,O2,12lead ECG as well as CBC,CK,Glucose,Sodium,Potassium,chloride,bicarb,BU N,creatinine,and troponin, if the patinet is on ASA or coumadin at home we also order coags.
We have simlar protocols for:
Drug OD - Lytes, BUN,Creatinine, Glucose, osmolality,ethonol,asa level, acetominophen level
suspected CVA- pt with new onset one-sided weakness - CBC,BUN,Creatinine,lytes, bicarb,glucose,CK,troponin,coags.
Seizure - any patient with a recurent seizure - glucose, sodium, calcium,magnesium and the anticonvulsent level they are on pluse or minus the coma protocol
Coma - a patient with a gcs = or < 10 without a fever - lytes,bun,Creatinine,asa level,acetominophen level,ethonol,osmolality and anticonvolsent level.
Sepsis - any patinet wiht a temp >38.5 or less than 35.0 combined with hemodynamic instability(hr >130, BP <90systolic or RR >30) - CBC and DIFF, Lytes, BUN, creatinine, Urine dip & C&S, blood C&S x 2.