Order

Ward order

General

ER

• CBC, DC
• GPT, Cre
• Na, K
• Glucose
• On IV catheter

Ward

• Record TPR, BP, SpO2
• Record IO
• Diet (regular, soft, NPO)
• On IV catheter
• On Foley catheter
• On NG tube

Pre-OP

• CBC, DC
• PT, aPTT
• EKG
• Chest X-ray
• Cefazolin 1000g Q8H IV
• NPO
• Prepare RBC 2U

Fluid

• NS 1000mL QD IF (run 60ml/hr)
• D5W 1000ml QD IF (run 60ml/hr)
• Taita.5 800mL QD IF (run 60ml/hr)
• Bfluid 1000 mL QD IF (run 60ml/hr)

Cardiovascular

Chest pain

• Troponin-T (repeat Q3H)
• EKG
• Chest X-ray
• Chest CT (CTA)
• Nitroglycerin 0.6mg PRN SL

Heart Failure

• NT-proBNP
• EKG
• Chest X-ray
• Furosemide 20mg Q6H IV
• Bumetanide 1mg Q6H IV
• O2 cannula/mask

Arrhythmia

• Na, K, Ca, Mg
• TSH
• EKG
• Propranolol 10mg TID PO
• Diltiazem 12.5mg STAT IF (NS 100mL, run 100min)
• Amiodarone 150mg QD IF (D5W 100mL, run 30min)
• Amiodarone 900mg QD cIF (D5W 500mL, run 1440min)
• Adenosine 6mg STAT IV
• Adenosine 12mg STAT IV
• Atropine 1mg STAT IV
• Cardioversion

Hypertension

• Cre
• EKG
• Amlodipine 5mg QD PO
• Captopril 25mg TID PO
• Labetalol 20mg PRN IV (repeat Q10min)
• Nicardipine 20mg QD IF (NS 100mL, run 5ml/hr)

Shock

• CBC, DC
• PT, aPTT
• Lactate
• ABG/VBG
• Blood culture x2
• EKG
• Chest X-ray
• Ultrasound (FAST)
• NS 1000mL STAT IF (run 60min)
• Norepinephrine 8mg QD cIF (D5W 250 mL, run 5 mL/hr)
• Vasopressin 60U QD cIF (NS 100 mL, run 4 mL/hr)
• Piperacillin 4000mg Q6H IF (NS 100 mL, run 30min)
• Transfuse RBC 2U

Acute coronary syndrome

• Troponin-T (repeat Q3H)
• PT, aPTT
• T-CHO, HDL, LDL, TG
• EKG
• Nitroglycerin 0.6mg STAT SL
• Aspirin 300mg STAT PO
• Clopidogrel 300mg STAT PO
• Heparin 4000U STAT IV
• Heparin 25000U QD cIF (NS 250 mL, run 12U/kg/hr)
• Morphine 4mg PRN IV
• O2 cannula/mask
• Consult CV

Respiratory

Dyspnea

• ABG/VBG
• Troponin-T
• NT-proBNP
• D-dimer
• EKG
• Chest X-ray
• Chest CT (CTPA)
• Furosemide 20mg Q6H IV
• Ipratropium/salbutamol 0.5/2.5mg Q6H IH
• O2 cannula/mask

Cough

• CBC, DC
• Sputum culture
• Chest X-ray
• Dextromethorphan 15mg TID PO
• Acetylcysteine 600mg BID PO

Asthma AE

• ABG/VBG
• Chest X-ray
• Salbutamol 0.4mg STAT IH (q20min for 3 doses)
• Ipratropium 0.5mg STAT IH (q20min for 3 doses)
• Methylprednisolone 125 mg STAT IV
• O2 cannula/mask

Respiratory failure

• ABG/VBG
• X-ray chest (standing)
• O2 nasal cannula (1-5 L/min, titrate to SpO2 > 94%)
• O2 simple mask (6-10 L/min, titrate to SpO2 > 94%)
• O2 non-rebreathing mask (10-15 L/min, titrate to SpO2 > 94%)
• High flow O2 cannula
• BiPAP
• Mechanical ventilator

Gastrointestinal

Abdominal Pain

• CBC, DC
• Lactic acid
• Bilirubin-T
• Lipase
• Urinalysis
• Pregnancy test
• NPO
• Echo abdomen (hepatobiliary)
• X-ray abdomen (standing)
• CT abdomen/pelvis (with contrast)
• Ketorolac 30 mg Q6HPRN IF (in NS 100 mL, run 15 min)
• Tramadol 100 mg Q6HPRN IF (in NS 100 mL, run 60 min)
• Dimethicone 40mg TID PO
• Buscopan 20 mg Q6HPRN IV

Vomiting

• Na, K, Ca, Mg
• Metoclopramide 10mg STAT IV
• Metoclopramide 3.84mg TID PO
• Prochlorperazine 5mg TID PO
• NS 500mL STAT IF (120min)

Diarrhea

• Na, K, Ca, Mg
• Stool WBC, stool culture
• Loperamide 2mg PRN PO
• Smecta 3g TID PO
• NS 500mL STAT IF (120min)

Constipation

• Abdominal X-ray (KUB)
• MgO 250mg TID PO
• Sennoside 25mg HS PO
• Bisacodyl 10mg PRN R
• Fleet Enema

Upper GI Bleeding

• CBC
• PT, aPTT
• X-ray chest (standing)
• Normal saline 500 mL QD IF (run 120 min)
• RBC 2U transfusion (if Hb < 7)
• Pantoprazole 40 mg Q12H IV
• Hold anticoagulants/antiplatelets
• NPO
• Consult GI

Lower GI Bleeding

• CBC
• PT, aPTT
• CT angiography abdomen/pelvis
• Normal saline 500 mL QD IF (run 120 min)
• RBC 2U transfusion (if Hb < 7)
• Hold anticoagulants/antiplatelets
• NPO
• Consult GI

Jaundice

• CBC
• AST, ALT
• ALP, GGT
• Bilirubin-T, Bilirubin-D
• PT, aPTT
• Lipase
• Echo abdomen (hepatobiliary)
• CT abdomen/pelvis (with contrast)
• Flumarin 1000 mg Q12H IV

Renal

Hyperkalemia

• 12-lead EKG
• Calcium gluconate 9.3 mEq STAT IF (in NS 100 mL, run 120 min)
• Insulin regular 8 U STAT IV
• Dextrose 50% 40 mL STAT IV
• Sodium bicarbonate 49.8 mEq STAT IV
• Kalimate 3 pack TID PO
• Furosemide 20 mg STAT IV

Hypokalemia

• 12-lead EKG
• Potassium gluconate 40 mEq STAT PO
• Potassium chloride 20 mEq STAT IF (in NS 500 mL, run 120 min)
• Magnesium sulfate 16 mEq STAT IF (in NS 100 mL, run 60 min)

Hypernatremia

• D5W 1000 mL STAT IF (run 240 min)
• Furosemide 20 mg STAT IV

Hyponatremia

• Sodium chloride 0.9% 1000 mL STAT IF (run 240 min)
• Sodium chloride 3% 100 mL STAT IF (run 10 min)

Hypercalcemia

• Normal saline 1000 mL STAT IF (run 120 min)
• Furosemide 20 mg STAT IV

Acute Kidney Injury

• Cr, BUN
• Na, K, Ca, P, Mg
• ABG/VBG
• Urinalysis
• Echo (kidney, bladder)
• Normal saline 500 mL STAT IF (run 120 min)
• On Foley catheter
• Consult nephro

Metabolic

Hyperglycemia

• Insulin regular 6~10 U STAT SC

Hypoglycemia

• Dextrose 50% 40mL STAT IV

Hypothyroidism

• Levothyroxine 100mcg QD PO

Hematologic

Anemia

• PT / aPTT
• Stool OB
• RBC 2U transfusion (if Hb < 7)
• Diphenhydramine 30 mg STAT IF (in NS 100 mL, run 15 min, before transfusion)
• Fe(III) 100mg QD PO

Thrombocytopenia

• PT / aPTT
• Fibrinogen / D-dimer
• Platelet 12U transfusion (if Plt < 10,000)

Coagulopathy

• PT / aPTT
• Fibrinogen / D-dimer
• FFP 2U transfusion (if active bleeding)

Infectious

Fever

• CBC, DC
• Blood culture, blood culture
• Urinalysis, urine culture
• Sputum stain + culture
• Influenza rapid test
• COVID rapid test
• X-ray chest (standing)
• Acetaminophen 500 mg Q6HPRN PO (if BT > 38)
• Cefuroxime 1500 mg Q8H IV
• Ceftriaxone 1000 mg Q12H IV
• Piperacillin/tazobactam 3000 mg Q6H IF (in NS 100 mL, run 30 min)
• Cefepime 2000 mg Q12H IF (in NS 100 mL, run 30 min)
• Meropenem 1000 mg Q8H IF (in NS 100 mL, run 30 min)

Pneumonia

• CBC, DC
• Sputum stain + culture
• X-ray chest (standing)
• Amoxicillin/clavulanate 1000 mg Q12H PO
• Doxycycline 100 mg Q12H PO
• Ceftriaxone 1000 mg Q12H IV
• Azithromycin 500 mg QD PO
• Levofloxacin 750 mg QD IF (run 90 min)
• Piperacillin/tazobactam 3000 mg Q6H IF (in NS 100 mL, run 30 min)

Urinary tract infection

• CBC, DC
• Urinalysis, Urine culture
• Cr, BUN
• TMP/SMX 160/800 mg Q12H PO
• Ciprofloxacin 400 mg Q12H IF (run 60 min)
• Ceftriaxone 1000 mg Q12H IV
• Piperacillin/tazobactam 3000 mg Q6H IF (in NS 100 mL, run 30 min)

Soft tissue infection

• CBC, DC
• Wound culture
• Cefalexin 500 mg QID PO
• Doxycycline 100 mg Q12H PO
• Cefazolin 1000 mg Q8H IV
• Teicoplanin 6 mg/kg QD IF (in NS 100 mL, run 30 min)
• Incision & drainage

Immune

Allergy

• Levoceterizine 5mg HS PO

Neurological

Headache

• Brain CT (without contrast)
• Acetaminophen 1000 mg STAT PO
• Ketorolac 30 mg STAT IM
• Sumatriptan 50 mg STAT PO

Dizziness

• Diphenhydramine 30 mg STAT IF (in 100 mL NS, run 15 min)
• Diphenidol 25 mg TID PO

Seizure

• One-touch sugar
• Na, K, Ca, Mg
• EEG
• Lorazepam 4 mg STAT IV
• Levetiracetam 500 mg Q12H IF (in NS 100 mL, run 15 min)
• Propofol 1 mg/kg STAT IV
• On IV catheter
• On endotracheal tube

Consciousness change

• One-touch sugar
• Na, K, Ca, Mg
• CBC, DC
• ABG/VBG
• CT brain (without contrast)
• Thiamine 100 mg STAT IV
• Dextrose 50% 40 mL STAT IV
• Naloxone 0.4 mg STAT IV
• Flumazenil 0.2 mg STAT IV
• Monitor GCS

Ischemic stroke

• PT, aPTT
• T-CHO, HDL, LDL, TG
• CT brain (without contrast)
• MRI brain (without contrast)
• Alteplase 0.9 mg/kg STAT IF (in NS 100 mL, 10% bolus + 90% run 60 min)
• Aspirin 100 mg STAT PO
• Clopidogrel 300 mg STAT PO
• Normal saline 500 mL STAT IF (run 300 min)
• Aspirin 100 mg QD PO
• Clopidogrel 75 mg QD PO
• Lansoprazole 30 mg QD LZ
• Consult neurology

OBGYN

Prepartum

• CBC, DC
• PT, aPTT
• AST, ALT
• BUN, Cre
• Urine analysis
• EKG
• Fetal heart monitor, tocometer
• Fetal ultrasound
• Ringer-solution 500ml QD IF
• Dinoprostone 1.5mg STAT V
• Oxytocin 5U QD IF (ringer 500ml, 8ml/hr titrate)
• Cefazolin 1000mg Q8H IV
• Prepare blood
• NPO

Intrapartum

• Cefazolin 1000mg ONCE IV
• Oxytocin 20U PRN IF (ringer 500ml, 120min)
• Carbetocin 100mcg PRN IV
• Misoprostol 200mcg PRN SL
• Methylergonovine 0.2mg PRN IM
• Tranexamic-acid 1000mg PRN IF (NS 100ml, 30min)

Postpartum

• CBC, DC
• Ringer-solution 500ml QD IF
• Normal-saline 1000ml QD IF
• Dextrose-5% 1000ml QD IF
• Ergonovine 0.2mg TID PO
• Cefalexin 250mg TID PO
• Acetominophen 500mg TID PO
• Naproxen 250mg BID PO
• Tenoxicam 20mg PRN IV
• MgO 500mg TID PO
• Bisacodyl 20mg Q4HPRN R
• Wound management
• Patient control analgesia

Tocolysis

• Nifedipine 10mg Q4H PO
• Ritodrine 50mg BID IF (NS 250ml, 20ml/hr)
• Atosiban 75mg BID IF (NS 100ml, 9ml/hr)
• Betamethasone 12mg QD IM
• Cefmetazole 1000mg Q8H IV

Preeclampsia

• Nifedipine 30mg QD PO
• Labetalol 200mg BID PO
• Hydralazine 10mg Q6H PO
• Nicardipine 20mg QD IF (NS 100ml, 5ml/hr titrate)
• Aspirin 150mg QD PO
• MgSO4 160meq QD cIF (200ml, 10ml/hr)

Ophthalmology

Conjuntivitis

• Sulfamethoxazole 1 gtt QID OU
• Tetracycline 1 XX HS OU
• Betamethasone 0.1% 1 gtt QID OU

Retinal detachment

• Tropicamide 1 gtt STAT OU
• Consult ophthalmology

Otolaryngology

Sudden sensorineural hearing loss

• Prednisolone 1 mg/kg QD PO

Otitis externa

• Ofloxacin 5 gtt Q12H E

Foreign body

• Neck X-ray
• Consult ENT

Dermatology

Contact Dermatitis

• Betamethasone 1XX BID D

Urticaria

• Diphenhydramine 30 mg STAT IM
• Hydrocortisone 100 mg STAT IM

Herpes zoster

• Acyclovir 800 mg 5X/DAY PO

Urologic

Low back pain

• Urinalysis / Urine culture
• Abdomen X-ray (KUB)
• Ketorolac 30 mg STAT IM
• Buscopan 20 mg STAT IM

Hematuria

• Urinalysis / Urine culture
• Abdomen X-ray (KUB)
• Tranexamic acid 1000 mg STAT IF (in D5W 100 mL, run 120 min)

Urinary retention

• Bethanechol 25mg TID PO
• On Foley catheter

Psychologic

Insomnia

• Zolpidem 10mg HS PO

Agitation

• Lorazepam 2mg STAT IM
• Haloperidol 5mg STAT IM
• Protective restraint

Suicide attempt

• Urine drug screen

Trauma

Laceration / Abrasion

• Wound management/suture, wound photo
• Tetanus toxoid 1 amp STAT IM
• Tetracycline ointment 1XX PRN D
• Cephalexin 250 mg Q6H PO
• Gauze + bosmin

Fracture

• X-ray (extremities, spine, pelvis)
• Tetanus toxoid 1 amp STAT IM
• NPO
• Consult orthopedist

Trauma

• CT brain/chest/abdomen/pelvis without contrast
• Tetanus toxoid 1 amp STAT IM
• Morphine 10 mg STAT IF (in NS 100 mL, run 60 min)
• Cefazolin 1000 mg Q8H+S IV
• Tranexamic acid 500 mg Q8H IF (in D5W 100 mL, run 20 min)
• NPO
• Consult orthopedist / plastic surgeon

Burn

• Burn management
• Tetanus toxoid 1 amp STAT IM
• Silver sulfadiazine 1XX PRN D

Insect bite

• Diphenhydramine 30 mg STAT IM
• C.B. ointment 1XX PRN D