ER Standing orders

KDSRN24 · May 3, 2000

Originally posted by CEN35:
Anybody out there that has standing orders in their ER, for ordering labs, IV's, EKG's, NTG/SL, X-ray, etc. I would like to hear from you, and what or how your department goes about it.

CEN

CEN35....Our deptartment has an extablished orthopedic protocol. It has been approved by several different commitees in the hospital and approved by the orthopedic Doc's. On all isolated injuries (below the knee and below the shoulder) the nurses may triage an xray prior to MD eval. We also triage EKG's for pt's with complaints of CP. We don't really order much lab work without MD eval first.

Hope this helps you. I'll try to find out more info. on establishing the algorhythms we use if you would like.

Trauma Columnist · May 4, 2000

I work in a level 1 trauma center and we have established protocols for CP that include; EKG, CXR, labs, O2, IV, monitor, NTG x3, baby ASA. We also have asthma protocols: peak flow, albuterol nebs, IV if necessary. We also have orthopedic protocols, peds fever protocols. The new thing we do is put EMLA (topical anesthetic) on peds pts that we think might require a stick. We do this at triage since it takes about 30-45 minutes to be effective. We see 70,000 visits a years and these protocols really help a lot. Hope this helps. judi

keaston · May 7, 2000

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,BUN,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

Sepsis - any patinet wiht a temp >38.5 or less than 35.0 combined with hemodynamic instability(hr >130, BP 30) - CBC and DIFF, Lytes, BUN, creatinine, Urine dip & C&S, blood C&S x 2.

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Kevin