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Antibiotics

  Bactrim 160 mg IV q6h
  Bactrim 160 mg PO/PT 3 times/week
  Bactrim 160 mg PO/PT q12h
  Bactrim 200 mg IV q8h
  Bactrim 320 mg IV q12h
  Bactrim 320 mg IV q6h
  Bactrim 400 mg IV q8h
  Bactrim 440 mg IV q8h
  Bactrim 80 mg PO/PT q12h
  Bactrim 80/400 IV
  Cefazolin 1 gm IV q8h
  Cefazolin 1 gm IV q8h x 2 more doses
  Cefazolin 1 gm IV q8h x24h
  Cefepime 1 gm IV q12h
  Cefepime 2 gm IV q12h
  Cefipime 1gm IV q12h
  Cefipime 2gm IV q12h
  Cefoxitin 1 gm IV q8h
  Cefoxitin 2 gm IV q8h
  Ceftriaxone 1 gm IV q12h
  Ceftriaxone 2 gm IV q24h
  Cephalexin 2 gm IV q8h until drains out
  Ciprofloxacin 400 mg IV q12h
  Clindamycin 300mg IV q8h
  Clindamycin 600 mg IV q6h
  Clindamycin 600mg IV q8h
  Clindamycin 900mg IV q8h
  Ertapenem 1 gm IV q24h
  Flagyl 250 mg IV q6h
  Flagyl 250 mg PO/PT q6h
  Flagyl 500 mg IV q6h
  Flagyl 500 mg IV q8h
  Flagyl 500 mg PO/PT q8h
  Flagyl 1000 mg IV x1 to finish 1 hr before surgery, then 500 mg IV q6h x2 doses
  Gentamicin 100 mg IV q8h
  Gentamicin 100 mg IV x1
  Gentamicin 120 mg IV q8h
  Imipenem/cilastatin 250 mg IV q6h
  Imipenem/cilastatin 250 mg IV q8h
  Imipenem/cilastatin 500 mg IV q12h
  Imipenem/cilastatin 500 mg IV q6h
  Imipenem/cilastatin 500 mg IV q8h
  Imipenem/cilastatin 750 mg IV q12h
  Imipenem/cilastatin 750 mg IV q6h
  Imipenem/cilastatin 750 mg IV q8h
  Imipenem/cilastatin 1000 mg IV q6h
  Imipenem/cilastatin 1000 mg IV q8h
  Linezolid 600 mg IV q12h
  Linezolid 600 mg PO q12h
  Meropenem 500 mg IV q8h
  Meropenem 750 mg IV q8h
  Meropenem 1000 mg IV q8h
  Meropenem 500 mg IV q12h
  Moxifloxacin 400 mg IV q24h
  Moxifloxacin 400 mg PO/PT q24h
  Nitrofurantoin 100 mg PO/PT q12h x7 days
  Polymixin 700000 units IV q12h
  Rifampin 600mg PO/PT qday
  Tigecycline 100 mg IV x1 now, then 50 mg IV q12h
  Unasyn 1.5 gm IV q6h
  Unasyn 3 gm IV q6h
  Vancomycin 250 mg PO/PT q6h
  Vancomycin 500 mg PO/PT q6h
  Vancomycin 1 gm IV q12h
  Vancomycin 1 gm IV x1
  Vancomycin 125 mg PO/PT q6h
  Vancomycin 750 mg IV q12h
  Vancomycin 750 mg IV x1
  Zosyn 2.25 gm IV q6h
  Zosyn 2.25 gm IV q8h
  Zosyn 3.375 gm IV q6h
  Zosyn 3.375 gm IV q8h
  Zosyn 4.5 gm IV q6h






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Antifungals

  Fluconazole 100 mg IV q24h
  Fluconazole 100 mg PO q24h
  Fluconazole 150 mg PO/PT x1
  Fluconazole 200 mg IV q24h
  Fluconazole 200 mg IV x1 now, then 100 mg IV q24h
  Fluconazole 200 mg PO q24h
  Fluconazole 200 mg PO/PT x1 now, then 100 mg PO/PT q24h
  Fluconazole 400 mg IV q24h
  Fluconazole 400 mg PO q24h
  Nystatin Powder 100,000 units/gm 1 application topical apply to affected area q8h
  Voriconazole 200 mg PO/PT q12
  Voriconazole PO/PT 400 mg q12h x2 doses then 200 mg q12h






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Antipyretic

  Acetaminophen 650 mg PO/PT qh4 ATC
  Acetaminophen 650 mg PO/PT qh4 prn fever/pain
  Acetaminophen 650 mg PO/PT/PR q4h ATC
  Acetaminophen 650 mg PO/PT/PR qh4 prn fever/pain
  Acetaminophen solution 650 mg PO/PT/PR q4h ATC
  Acetaminophen solution 650 mg PO/PT/PR q4h prn fever/pain
  Acetaminophen suppository 650 mg PR ATC
  Acetaminophen suppository 650 mg PR q4hr prn fever pain
  ASA 81 mg PO/PT/PR q24h
  Aspirin 325 mg PO/PR q24h
  Aspirin 81 mg PO q24h
  Celebrex 100 mg PO/PT q12h
  Celebrex 200 mg PO/PT q12h
  Celebrex 200 mg PO/PT q24h
  Ibuprofen 600 mg PO q6h ATC
  Ibuprofen 600 mg PO q6h prn fever/pain
  Ibuprofen 600 mg PO q6h prn fever/pain give with food or Maalox 30 cc PO/PT
  Ibuprofen 600 mg PO q6h prn fever/pain, if NPO, not taking PO, or tube feeds off, give with Maalox 30cc PO/PT
  Ibuprofen solution 600 mg PO q6h ATC
  Ibuprofen solution 600 mg PO q6h prn fever/pain






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Antivirals

  Acyclovir 200 mg IV q8h
  Acyclovir 200 mg PO/PT 5 times per day
  Acyclovir 200 mg PO/PT q8h
  Acyclovir 400 mg IV q8h
  Acyclovir 400 mg PO/PT 5 times per day
  Acyclovir 400 mg PO/PT q12h
  Acyclovir 400 mg PO/PT q8h
  Acyclovir 600 mg IV q8h
  Acyclovir 600 mg PO/PT q12h
  Acyclovir 600 mg PO/PT q8h
  Acyclovir 800 mg IV q8h
  Acyclovir 800 mg PO/PT 5 times per day
  Acyclovir 800 mg PO/PT q12h
  Acyclovir 800 mg PO/PT q6h
  Acyclovir 800 mg PO/PT q8h
  Epivir 100 mg PO/PT q24h
  Ganciclovir 1000 mg PO/PT q8h
  Ganciclovir 1000 mg q12h PO/PT
  Ganciclovir 300 mg q12h IV
  Ganciclovir 350 mg IV q12h
  Ganciclovir 350 mg IV q24h
  Ganciclovir 350 mg q12h IV
  Ganciclovir 400 mg q12h IV
  Ganciclovir 450 mg q12h IV
  Ganciclovir 500 mg q12h IV
  Ganciclovir 500 mg q12h PO/PT
  Lamivudine 150 mg PO/PT q12h
  Lamivudine 300 mg PO/PT q24h
  Lamivudine 50 mg PO/PT q24h
  Sustiva 600 mg PO/PT qhs
  Valgancyclovir 900 mg PO/PT q24h
  Ziagen 300 mg PO/PT q12h






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Bowel

  Bisacodyl 10mg PO/PT every day prn constipation
  Bisacodyl 10mg PO/PT every other day
  Bisacodyl 10mg PR every day prn constipation
  Bisacodyl 10mg PR/PO/PT every day prn constipation
  Bisacodyl 10mg PR/PO/PT every other day
  Docusate 100 mg PO q12h
  Docusate liquid 100 mg PT or Docusate 100 mg PO q12h
  Docusate liquid 100 mg PT q12h
  Fleet enema 1 PR q24h
  Fleet enema 1 PR x1
  Glycerin suppository 1 PR retain in rectum 15 minutes
  Glycerin suppository 1 PR retain in rectum 15 minutes, please repeat in 1 hour if no BM
  Magnesium citrate 300 cc PO/PT x1
  Magnesium citrate 300 cc PO/PT x1, please repeat in 12 hours if no BM
  Milk of Magma Trip Conc oral susp 10 cc PO/PT q6h prn constipation
  Senna liquid 8.8 mg PT or Senna tablet 8.6 mg PO q12h
  Senna liquid 8.8 mg PT q12h
  Senna tablet 8.6 mg PO q12h






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Cardiac

  Amiodarone 150 mg IV over 10 minutes
  Amiodarone 200mg PO/PT q24h
  Amiodarone gtt IV 1 mg/min x6 hours then 0.5 mg/min x18 hrs
  ASA 325mg PT/PR x1 now, then start ASA 81 mg PO/PT/PR q24h starting tomorrow
  Digoxin 0.125 mg PO q24h
  Digoxin 0.25 mg PO q24h
  Digoxin 0.5 mg IV x1
  Digoxin 0.5 mg PO q24h
  Digoxin 1 mg IV x1
  Diltiazem 20 mg IVP
  Diltiazem 25 mg IVP
  Diltiazem SR 200 mg PO/PT q12h






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Cholesterol

  ASA 325 mg PO/PT/PR 30 min before Niacine
  Atorvastatin (Lipitor) 10 mg PO/PT qhs
  Atorvastatin (Lipitor) 20 mg PO/PT qhs
  Atorvastatin (Lipitor) 30 mg PO/PT qhs
  Atorvastatin (Lipitor) 40 mg PO/PT qhs
  Atorvastatin (Lipitor) 50 mg PO/PT qhs
  Atorvastatin (Lipitor) 60 mg PO/PT qhs
  Atorvastatin (Lipitor) 70 mg PO/PT qhs
  Atorvastatin (Lipitor) 80 mg PO/PT qhs
  Ezetimibe 10 mg PO/PT q8h
  Niacin 1000 mg PO/PT q12h
  Niacin 1000 mg PO/PT q24h
  Niacin 1000 mg PO/PT q6h
  Niacin 1000 mg PO/PT q8h
  Niacin 1500 mg PO/PT q12h
  Niacin 1500 mg PO/PT q24h
  Niacin 1500 mg PO/PT q8h
  Niacin 250 mg PO/PT q24h
  Niacin 500 mg PO/PT q24h
  Vytorin 10/10 1 tab PO/PT qPM
  Vytorin 10/20 1 tab PO/PT qPM
  Vytorin 10/40 1 tab PO/PT qPM
  Vytorin 10/80 1 tab PO/PT qPM






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Dermatology

  Aquaphor ointment 1 application topical q12h to affected areas
  Bacitracin ointment 500 units/gm apply topically to affected area q12h
  Bacitracin topical 500 units per gram to all burned areas on the head and neck (except for eyes) q8h
  Biafine cream 1 application topical q24h
  Papain-Urea-Chlorophyllin Copper Na ointment 1 application topical q12h to affected areas
  Silvadene 1% cream apply to affected area q12h
  Silvadene 1% cream apply to affected area q24h
  Silvadene topical 1% to all burned areas below the neck q12h






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Diabetes

  Avandia 8 mg PO/PT q 12pm
  Metformin 850 mg PO/PT BID






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Electrolyte

  Calcium carbonate 500 mg PO/PT q8h
  Calcium carbonate 500 mg PO/PT q8h with each meal
  Kayexalate 15 gm PO/PT
  Kayexalate 15 gm PR
  Kayexalate 30 gm PO/PT
  Kayexalate 30 gm PR
  KCl 40 mEq IV x1
  Magnesium Oxide 800 mg PO/PT q24h
  Magnesium sulfate 2 gm IV x1
  NaCl 4 mg PO/PT q4h






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Electrolyte Sliding Scale

  Calcium Chloride IV sliding scale: Hold sliding scale if Creatinine is > 1.9 mg/dL
Ca > 1.19 mmol/L, no action required
Ca = 1.13-1.19 mmol/L, administer Calcium Chloride 1 gram IV once, infuse over 30-60 minutes
Ca = 1.06-1.12 mmol/L, administer Calcium Chloride 2 gram IV once, infuse over 30-60 minutes
Ca = 1-1.05 mmol/L, administer Calcium Chloride 3 gram IV once, infuse over 30-60 minutes
Ca < 1 mmol/L , administer Calcium Chloride 1 gram IV once, infuse over 30-60 minutes AND NOTIFY HOUSE OFFICER
  Keep Mg > 2.4, call MD for order if level drops below
  Magnesium Sulfate IV sliding scale: Hold sliding scale if creatinine > 1.9 mg/dL. Hold for hypermagnesemia if Mg > 2 mg/dL, contact physician for new order
Mg > 2.1 mg/dL, do nothing
Mg 1.8-2.1 mg/dL, give Magnesium Sulfate 2 gm IV once, infuse over 2 hours
Mg 1.5-1.7 mg/dL, give Magnesium Sulfate 4 gm IV once, infuse over 4 hours
Mg 1.2-1.4 mg/dL, give Magnesium Sulfate 6 gm IV once, infuse over 6 hours
Mg < 1.2 mg/dL, give Magnesium Sulfate 6 gm IV once, infuse over 6 hours AND NOTIFY HOUSE OFFICER
  Phosphorous IV sliding scale for Sodium Phosphate OR Potassium Phosphate:
Sodium Phosphate: Administer for patients with K > 3.9 mEq/dL OR if serum Creatinine > 1.9 mg/dL
Potassium Phosphate: Administer for patients with K < 4 mEq/dL
Phosphate > 2.9 mg/dL, no action required
Phosphate = 2-2.9 mg/dL, administer Phosphate 15 mmol IV once, infuse over 2 hours
Phosphate = 1-1.9 mg/dL, administer Phosphate 30 mmol IV once, infuse over 4 hours
Phosphate = 0.5-0.9 mg/dL, administer Phosphate 45 mmol IV once, infuse over 6 hours
Phosphate < 0.5 mg/dL, administer Phosphate 45 mmol IV once, infuse over 6 hours AND NOTIFY HOUSE OFFICER
  Potassium Chloride IV sliding scale. Hold sliding scale if creatinine > 1.9
K > 5.1 call MD
K 4-5.1 do nothing
K 3.7-3.9 give KCl 20 mEq IV over 1 hr
K 3.4-3.6 give KCl 40 mEq IV over 2 hr
K 3-3.3 give KCl 60 mEq IV over 3 hr
K < 3 give KCl 60 mEq IV over 3 hr AND NOTIFY HOUSE OFFICER






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Endocrine

  Cosyntropin 250 mcg IV, please send cortisol levels before cosyntropin, then 30 min and 60 min after
  Decadron 10 mg IV x1
  Hydrocortisone 50 mg IV q6h
  Hydrocortisone 50 mg IV q8h
  Hydrocortisone 100 mg IV q8h
  Hydrocortisone 100 mg PO/PT q8h
  Levothyroxine 100 mcg IV q24h
  Levothyroxine 100 mcg PO/PT q24h
  Levothyroxine 12.5 mcg IV q24h
  Levothyroxine 150 mcg PO/PT q24h
  Levothyroxine 200 mcg PO/PT q24h
  Levothyroxine 25 mcg IV q24h
  Levothyroxine 25 mcg PO/PT q24h
  Levothyroxine 50 mcg IV q24h
  Levothyroxine 50 mcg PO/PT q24h
  Levothyroxine 75 mcg IV q24h
  Prednisone 20mg PO/PT q24h
  Prednisone 40mg PO/PT q24h
  Prednisone 60mg PO/PT q24h
  Solu-Medrol 125 mg IV q12h






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ENT

  Ofloxaxin otic 0.3% solution 3 drops to both ears q8h x3 days






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GI

  Anzemet (dolasetron) 12.5 mg IV q6h prn nausea/vomiting
  Anzemet (dolasetron) 12.5 mg IV x1
  Bisacodyl 10mg PR q12h
  Creon-10 2 tablets crushed with Sodium bicarbonate 650 mg crushed in 30 cc sterile water, inject into jejunal port of MICC tube, let sit for 30 minutes, aspirate remainder, flush with normal saline or free water
  Erythromycin 200 mg PT x1
  Loperamide 2 mg PO/PT after each loose stool
  Loperamide 2 mg PO/PT q6h
  Loperamide 2 mg PO/PT x1 now then 2 mg PO/PT after each loose stool
  Loperamide 4 mg PO/PT x1 now then 2 mg PO/PT after each loose stool
  Magnesia Magma Triple Conc oral susp 10 cc po/pt q6h
  Magnesia Magma Triple Conc oral susp 10 cc PO/PT q6h until BM
  Octreotide 100 mcg subcut q8h
  Octreotide 200 mcg subcut q8h
  Octreotide 25-50mcg/hr IV
  Ondansetron 8mg IV q6h prn nausea/vomiting
  Pantoprazole 40 mg PO/PT q24h
  Protonix 40 mg IV x1 now then 8 mg/hr IV x72 hours then 40mg IV q12h
  Reglan 10 mg IV q6h
  Reglan 10 mg IV q6h prn N/V
  Reglan 10 mg PO/PT q6h
  Reglan 10 mg PO/PT q6h prn N/V
  Reglan 10 mg PO/PT/IV q6h prn N/V
  Reglan 10 mg PO/PT/IV q6h prn N/V or high gastric residuals
  Zofran (ondansetron) 4mg IV q4h prn nausea/vomiting
  Zofran (ondansetron) 4mg IV q6h prn nausea/vomiting
  Zofran (ondansetron) 4mg IV x1
  Zofran (ondansetron) 4mg PO/PT/IV q4h prn nausea/vomiting
  Zofran (ondansetron) 4mg PO/PT/IV q6h prn nausea/vomiting
  Zofran (ondansetron) 6mg PO/PT q4h prn nausea/vomiting
  Zofran (ondansetron) 8mg IV/IM q4h prn nausea/vomiting






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Gout

  Allopurinol 100 mg PO/PT q12h
  Allopurinol 100 mg PO/PT q24h
  Allopurinol 100 mg PO/PT q6h
  Allopurinol 100 mg PO/PT q8h
  Allopurinol 200 mg PO/PT q12h
  Allopurinol 200 mg PO/PT q24h
  Allopurinol 200 mg PO/PT q6h
  Allopurinol 200 mg PO/PT q8h
  Allopurinol 300 mg PO/PT q12h
  Allopurinol 300 mg PO/PT q24h
  Allopurinol 300 mg PO/PT q6h
  Allopurinol 300 mg PO/PT q8h
  Allopurinol 400 mg PO/PT q12h
  Allopurinol 400 mg PO/PT q24h
  Allopurinol 400 mg PO/PT q6h
  Allopurinol 400 mg PO/PT q8h
  Allopurinol 500 mg PO/PT q12h
  Allopurinol 500 mg PO/PT q24h
  Allopurinol 500 mg PO/PT q6h
  Allopurinol 500 mg PO/PT q8h
  Allopurinol 600 mg PO/PT q12h
  Allopurinol 600 mg PO/PT q24h
  Allopurinol 600 mg PO/PT q6h
  Allopurinol 600 mg PO/PT q8h
  Colchicine 0.6 mg PO/PT q12h
  Colchicine 0.6 mg PO/PT q24h
  Colchicine 0.6 mg PO/PT q48h






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GU

  Ditropan 2.5 mg PO/PT q12h
  Ditropan 2.5 mg PO/PT q8h
  Ditropan 5 mg PO/PT q12h
  Ditropan 5 mg PO/PT q6h
  Ditropan 5 mg PO/PT q8h
  Ditropan XL 10 mg PO/PT q24h
  Ditropan XL 15 mg PO/PT q24h
  Ditropan XL 20 mg PO/PT q24h
  Ditropan XL 25 mg PO/PT q24h
  Ditropan XL 30 mg PO/PT q24h
  Ditropan XL 5 mg PO/PT q24h
  Doxazosin 10 mg PO/PT q12h
  Flomax 0.4 mg PO/PT q24h
  Flomax 0.8 mg PO/PT q24h
  Terazosin 10 mg PO/PT qhs hold sbp < 100






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Hematologic

  Aminocaproic acid 0.5 gm PO/PT q12h
  Aminocaproic acid 1 gm PO/PT q12h
  Aminocaproic acid 1.5 gm PO/PT q12h
  Aminocaproic acid 6 gm PO/PT q6h
  DDAVP 30 mcg IV x1 now
  Erythropoietin 10000 units subcut 2 times per week starting today
  Erythropoietin 10000 units subcut 3 times/week starting today
  Erythropoietin 20000 units subcut 2 times per week starting today
  Erythropoietin 20000 units subcut 3 times per week starting today
  Erythropoietin 20000 units subcut q week starting today
  Erythropoietin 40000 units subcut 2 times per week starting today
  Erythropoietin 40000 units subcut 3 times per week starting today
  Erythropoietin 40000 units subcut q week starting today
  Factor VII 1.2 mg IV
  Factor VII 4.8 mg IV
  FFP gtt IV 100 cc/hr
  FFP gtt IV 150 cc/hr
  FFP gtt IV 40 cc/hr
  Iron Sulfate 300 mg PO/PT q12h
  Iron sulfate 300 mg PO/PT q8h
  Iron sulfate 325 mg PO/PT q8h
  Plavix 300 mg PO/PT x1
  Plavix 600 mg PO/PT x1
  Plavix 75 mg PO/PT q24h
  Vitamin K 10 mg IV q24h x3 days






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Hepatic

  Lactulose 10g/15cc 15 cc q12h
  Lactulose 10g/15cc 15 cc q24h
  Lactulose 10g/15cc 30 cc q12h
  Lactulose 10g/15cc 30 cc q24h
  Lactulose 10g/15cc 45 cc q12h
  Lactulose 10g/15cc 45 cc q24h
  Mitodrine 15 mg PO/PT q8h
  Mitodrine 7.5 mg PO/PT q8h
  Rifaximin 400 mg PO/PT q8h






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HTN

  Amlodipine 10 mg PO/PT qAM
  Avapro 300 mg PO/PT q12h
  Benicar 20 mg PO/PT q24h
  Benicar 40 mg PO/PT q24h
  Candesartan 16 mg PO/PT q24h
  Clonidine 0.1 mg PO/PT q12h
  Clonidine 0.1 mg PO/PT q6h
  Clonidine 0.1 mg PO/PT q8h
  Clonidine 0.2 mg PO/PT q12h
  Clonidine 0.2 mg PO/PT q6h
  Clonidine 0.2 mg PO/PT q8h
  Clonidine 0.3 mg PO/PT q12h
  Clonidine 0.3 mg PO/PT q24h
  Clonidine 0.3 mg PO/PT q6h
  Clonidine 0.3 mg PO/PT q8h
  Clonidine transdermal 0.1mg/24 patch per week
  Clonidine transdermal 0.2mg/24 patch per week
  Clonidine transdermal 0.3mg/24 patch per week
  Coreg 12.5 mg PO/PT q12h
  Coreg 25 mg PO/PT q12h
  Coreg 6.25 mg PO/PT q12h
  For sbp > 170 or dbp > 85, if pulse > 80 give metoprolol 5 mg IV, otherwise give hydralazine 10mg
  Hydralazine 10-20 mg IV q1h prn sbp > 140
  Hydralazine 10-20 mg IV q1h prn sbp > 160
  Hydralazine 20 mg IV x1
  Labetalol 10-20 mg IV q1h prn sbp > 140
  Labetalol 10-20 mg IV q1h prn sbp > 160
  Labetalol 10mg IV q20 min prn sbp > 160
  Lisinopril 10 mg PO q24h
  Lisinopril 20 mg PO q24h
  Lisinopril 40 mg PO q24h
  Lisinopril 5 mg PO q24h
  Metoprolol 10 mg IV q6h
  Metoprolol 10 mg IVP x1 now
  Metoprolol 100 mg PO/PT q12h
  Metoprolol 12.5mg PO/PT q6h RTC -Hold for HR <60 or SBP< 110
  Metoprolol 25 mg PO/PT q12h
  Metoprolol 25 mg PO/PT q6h
  Metoprolol 37.5 mg PO/PT q12h
  Metoprolol 5 mg IV q 1h prn sbp >170, hold for pulse <65
  Metoprolol 5 mg IV q 1h prn sbp >180, hold for pulse <65
  Metoprolol 5 mg IV q6h
  Metoprolol 5 mg IVP x1 now
  Metoprolol 50 mg PO/PT q12h
  Metoprolol 50 mg PO/PT q6h
  Metoprolol XL 25 mg PO daily
  Nitroglycerin 0.4 mg sublingual
  Nitroglycerin 0.5 inch paste to anterior chest wall
  Nitroglycerin 1 inch paste to anterior chest wall
  Nitroglycerin 1.5 inch paste to anterior chest wall
  Nitroglycerin 2 inch paste to anterior chest wall
  Propranolol 100 mg PO/PT q12h
  Propranolol 120 mg PO/PT q12h
  Propranolol 140 mg PO/PT q12h
  Propranolol 160 mg PO/PT q12h
  Propranolol 180 mg PO/PT q12h
  Propranolol 20 mg PO/PT q12h
  Propranolol 200 mg PO/PT q12h
  Propranolol 220 mg PO/PT q12h
  Propranolol 240 mg PO/PT q12h
  Propranolol 40 mg PO/PT q12h
  Propranolol 60 mg PO/PT q12h
  Propranolol 80 mg PO/PT q12h






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Immunologic

  CellCept 500 mg PO/PT q12h
  Tacrolimus 0.5 mg PO/PT q24h






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Ingestion

  Fomepizole 15 mg/kg IV run over 15 min, first dose STAT then q12h
  Hydroxycobalamin (Cyanokit) 5 gm IV x1 STAT
  Please send aspirin and acetaminophen levels now
  Please send methanol and ethylene glycol levels now
  Pyridoxine (vitamin B6) 50 mg PO/PT/IM/IV first dose STAT then q24h






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IV Fluid

  0.45% NaCl 50 cc/hr IV
  0.45% NaCl 75 cc/hr IV
  0.45% NaCl 100 cc/hr IV
  0.45% NaCl 125 cc/hr IV
  0.45% NaCl 150 cc/hr IV
  0.45% NaCl 200 cc/hr IV
  0.45% NaCl 250 cc/hr IV
  0.9% NaCl 50 cc/hr IV
  0.9% NaCl 75 cc/hr IV
  0.9% NaCl 100 cc/hr IV
  0.9% NaCl 125 cc/hr IV
  0.9% NaCl 150 cc/hr IV
  0.9% NaCl 200 cc/hr IV
  0.9% NaCl 250 cc/hr IV
  D5 0.45% NaCl 50 cc/hr IV
  D5 0.45% NaCl 75 cc/hr IV
  D5 0.45% NaCl 100 cc/hr IV
  D5 0.45% NaCl 110 cc/hr IV
  D5 0.45% NaCl 125 cc/hr IV
  D5 0.45% NaCl 150 cc/hr IV
  D5 0.45% NaCl 200 cc/hr IV
  D5 0.45% NaCl 250 cc/hr IV
  D5 0.9% NaCl 50 cc/hr IV
  D5 0.9% NaCl 75 cc/hr IV
  D5 0.9% NaCl 100 cc/hr IV
  D5 0.9% NaCl 125 cc/hr IV
  D5 0.9% NaCl 150 cc/hr IV
  D5 0.9% NaCl 200 cc/hr IV
  D5 0.9% NaCl 250 cc/hr IV
  Free water 150 cc PO/PT q6h
  Free water 200 cc PO/PT q6h
  Free water 250 cc PO/PT q12h
  Free water 250 cc PO/PT q6h
  Free water 500 cc PO/PT q12h
  Free water 500 cc PO/PT q6h
  Plasmalyte 100 cc/hr IV
  Plasmalyte 125 cc/hr IV
  Plasmalyte 150 cc/hr IV
  Plasmalyte 200 cc/hr IV
  Plasmalyte 250 cc/hr IV
  Plasmalyte 50 cc/hr IV
  Plasmalyte 75 cc/hr IV






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IV Fluid- Special

  23.4% NaCl 30 cc IV x1
  3% NaCl 125 cc IV x1
  3% NaCl 250 cc IV x1
  3% NaCl 500 cc IV x1
  3% NaCl gtt IV 30 cc/hr, please send serum sodium levels q2h
  3% NaCl gtt IV 30 cc/hr, please send serum sodium levels q4h
  3% NaCl gtt IV 60 cc/hr, please send serum sodium levels q2h
  3% NaCl gtt IV 60 cc/hr, please send serum sodium levels q4h
  7% Sodium acetate 125 cc IV x1
  7% Sodium acetate 250 cc IV x1
  Albumin 25% 100cc IV q6h x24h
  Albumin 25% 100cc IV x1 now
  Albumin 25% 50cc IV q6h x24h
  Albumin 25% 50cc IV x1 now
  Mannitol 50 gm IV wide open
  Mannitol 100 gm IV wide open






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MRI

  For MRI ONLY: Fentanyl 25 - 250 mcg IVP
  For MRI ONLY: If hx of asthma of IVDA use Benadryl 25 - 50 mg as first sedation drug, may repeate up to additional 25 mg IV
  For MRI ONLY: If nausea - Phenergan 12.5 - 25 mg IV or Zofran 4 mg IV, if vomiting abort and page MD
  For MRI ONLY: Narcan 0.1 - 0.2 mg IVP to max 1 mg
  For MRI ONLY: Romazicon 0.1 - 0.2 mg IVP to max 1 mg
  For MRI ONLY: Versed 0.5 - 4 mg IVP






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Musculoskeletal

  Baclofen 10 mg PO/PT q6h
  Baclofen 10 mg PO/PT q8h
  Baclofen 20 mg PO/PT q8h
  Baclofen 40 mg PO/PT q24h
  Baclofen 5 mg PO/PT q8h






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Nursing

  APMS (pain service) consult
  Cognitive language evaluation
  Fever pack, please (Blood cx, Urine cx, Sputum cx)
  Lights out at 10pm, minimize interruptions 10pm-5am q daily
  No Lovenox and no heparin
  Out of bed as tolerated
  Patient must lay flat until Neurosurgery clearance
  Patient must lay flat until Ortho-spine clearance
  PT/OT consult
  Regular diet
  Regular diet
  SCD left lower extremity only
  SCD right lower extremity only
  SCD's bilateral lower extremities






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Nutrition

  Calcitriol 0.25 mcg PO/PT q24h
  Calcitriol 0.5 mcg PO/PT q24h
  Calcitriol 1 mcg PO/PT q24h
  Folic acid 1 mg IV q24h x3 days
  Folic acid 1 mg PO/PT/IV q24h x3 days
  MVI 1 tab IV q24h
  MVI 1 tab IV q24h x3 days
  MVI 1 tab PO/PT q24h
  MVI 1 tab PO/PT q24h x3 days
  MVI 1 tab PO/PT/IV q24h
  MVI 1 tab PO/PT/IV q24h x3 days
  Thiamine 100 mg IV q24h x3 days
  Thiamine 100 mg PO/PT/IV q24h x3 days






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Ophthalmic

  Bacitracin ophthalmic 0.5 inch ribbon to both eyes q4h x7 days
  Latanoprost ophthalmic 0.005% 1drop OD qPM
  Latanoprost ophthalmic 0.005% 1drop OS qPM
  Latanoprost ophthalmic 0.005% 1drop OU qPM
  Ophthalmic lubricant 1/3-1/2 inch ribbon to both eyes PRN lubrication






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Other

  Chloraseptic spray 2-4 sprays q30 min prn throat pain
  Chlorhexidine Gluconate mouthwash 0.12% 15cc swish and spit q6h
  Corpack in stomach, ok to start feeds
  Hep lock IVF when taking PO
  Nimodipine 30 mg PO/PT q2h
  Nimodipine 60 mg PO/PT q4h
  Oxymetazoline (Afrin) nasal 0.05% 3 sprays q12h x3 days






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Pain

  Baclofen 5 mg PO/PT q8h prn Pain
  Continue APMS orders as per APMS
  d/c APMS
  Fentanyl 100 mcg IV q1hr prn pain
  Fentanyl 100 mcg IV q1hr with dressing changes or other procedures
  Fentanyl 25 mcg IV x1
  Fentanyl 50 mcg IV q1hr prn pain
  Fentanyl 50 mcg IV q1hr with dressing changes or other procedures
  Fentanyl 50 mcg IV x1
  Fentanyl 50 mcg/hr IV titrate to effect
  Fentanyl gtt 100 mcg/hr IV titrate to effect
  Fentanyl gtt IV titrate to effect
  Flexeril 10 mg PO/PT q8h
  Flexeril 5 mg PO/PT q8h
  Gabapentin 100 mg PO/PT q8h
  Gabapentin 1000 mg PO/PT q 8h
  Gabapentin 1100 mg PO/PT q 8h
  Gabapentin 1200 mg PO/PT q 8h
  Gabapentin 300 mg PO/PT q 24h x 1 day then q 12h x 2 days, then q 8h
  Gabapentin 300 PO/PT q8h
  Gabapentin 400 mg PO/PT q 8h
  Gabapentin 500 mg PO/PT q 8h
  Gabapentin 600 mg PO/PT q 8h
  Gabapentin 700 mg PO/PT q 8h
  Gabapentin 800 mg PO/PT q 8h
  Gabapentin 900 mg PO/PT q 8h
  Hydromorphone 0.2 mg IV x1 now
  Hydromorphone 0.4 mg IV q2h prn pain
  Hydromorphone 0.4 mg IV x1 now
  Hydromorphone 0.4-0.8 mg IV q2h prn pn
  Hydromorphone 0.8 mg IV q2h prn pn
  Hydromorphone 0.8 mg IV x1 now
  Hydromorphone 1 mg IV q2h prn pain
  Hydromorphone 1 mg IV x1 now
  Hydromorphone 2 mg IV x1 now
  Hydromorphone 2 mg PO/PT q4h prn pn
  Lyrica (Pregabalin) 100 mg PO/PT q8h
  Lyrica (Pregabalin) 150 mg PO/PT q8h
  Lyrica (Pregabalin) 200 mg PO/PT q8h
  Lyrica (Pregabalin) 25 mg PO/PT q8h
  Lyrica (Pregabalin) 250 mg PO/PT q8h
  Lyrica (Pregabalin) 300 mg PO/PT q8h
  Lyrica (Pregabalin) 50 mg PO/PT q8h
  Lyrica (Pregabalin) 75 mg PO/PT q8h
  Lyrica 100 mg PO/PT q8h x2days, then 150 mg PO/PT q8h x2 days, then 200 mg PO/PT q8h x2 days, then 300 mg PO/PT
  Methadone 10 mg IV q8h
  Methadone 10 mg PO/PT q8h
  Methadone 35 mg PO/PT q8h
  Methocarbamol 1000 mg IM/IV q24h
  Methocarbamol 1000 mg PO/PT q6h
  Methocarbamol 1500 mg PO/PT q6h
  Methocarbamol 1500 mg PO/PT q8h
  Methocarbamol 2000 mg IM/IV q24h
  Methocarbamol 3000 mg IM/IV q24h
  Morphine 1-2 mg IV q2h prn pain
  Morphine 2 mg IV q2h prn pain
  Morphine 2 mg IV x1 now
  Morphine 2-4 mg IV q1h prn pain
  Morphine 4 mg IV q1h prn pain
  Morphine 4 mg IV q2h prn pain
  Morphine 4 mg IV q4h prn pain
  Morphine 4 mg IV x1 now
  Morphine 4-8 mg IV q1h prn pain
  Morphine 4mg IV q2h prn pain
  Morphine 8 mg IV x1 now
  Morphine gtt 4 mg/hr IV titrate to effect
  Morphine gtt 4 mg/hr IV titrate to effect
  MS Contin 15mg PO/PT q8h
  Oxycodone 10 mg PO/PT q3h
  Oxycodone 10 mg PO/PT q3h prn pain
  Oxycodone 15 mg PO/PT q3h
  Oxycodone 15 mg PO/PT q3h prn pn
  Oxycodone 5 mg PO/PT q3h
  Oxycodone 5 mg PO/PT q3h prn pain
  Oxycodone 5-10 mg PO/PT q3h prn pain
  OxyContin 10 mg PO/PT q12h
  OxyContin 20 mg PO/PT q12h
  OxyContin 40 mg PO/PT q12h
  OxyContin 60 mg PO/PT q12h
  OxyContin 80 mg PO/PT q12h
  Percocet 10/650 2 tabs PO/PT q4h prn pain
  Percocet 10/650 PO/PT q4h
  Percocet 5/325 PO/PT q4h
  Percocet 5/325 PO/PT q4h prn pain
  Pregabalin 100 mg PO/PT q8h
  Pregabalin 150 mg PO/PT q8h
  Pregabalin 200 mg PO/PT q8h
  Pregabalin 50 mg PO/PT q8h
  Pregabalin 50 mg PO/PT q8h x 2 days then 75 mg PO/PT q8h x 2 days then 100 mg q8h
  Pregabalin 75 mg PO/PT q8h
  Skelaxin 800 mg PO/PT q6h
  Skelaxin 800 mg PO/PT q8h
  Titrate fentanyl gtt to off as tolerated
  Toradol 30 mg IV q6h prn pain x5 days
  Toradol 30 mg IV q6h x5 days
  Toradol 30 mg IV x1
  Toradol 60 mg IM x1
  Ultram 100 mg PO/PT q4h
  Ultram 100 mg PO/PT q6h
  Ultram 25 mg PO/PT q4h
  Ultram 25 mg PO/PT q6h
  Ultram 50 mg PO/PT q4h
  Ultram 50 mg PO/PT q6h
  Wean Fentanyl as tolerated






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Pressors

  Dobutamine 10 mcg/kg/min IV
  Dobutamine 15 mcg/kg/min IV
  Dobutamine 20 mcg/kg/min IV
  Dobutamine 5 mcg/kg/min IV
  Dopamine 10 mcg/kg/min IV
  Dopamine 15 mcg/kg/min IV
  Dopamine 2.5 mcg/kg/min IV
  Dopamine 20 mcg/kg/min IV
  Dopamine 25 mcg/kg/min IV
  Dopamine 30 mcg/kg/min IV
  Dopamine 35 mcg/kg/min IV
  Dopamine 40 mcg/kg/min IV
  Dopamine 45 mcg/kg/min IV
  Dopamine 5 mcg/kg/min IV
  Dopamine 50 mcg/kg/min IV
  Epinephrine gtt IV start at 5 mcg/min
  Levophed 10 mcg/min IV
  Levophed 2.5 mcg/min IV
  Levophed 20 mcg/min IV
  Levophed 40 mcg/min IV
  Levophed 5 mcg/min IV
  Levophed 6 mcg/min IV, titrate to off as tolerated for MAP > 60
  Levophed gtt IV to be at bedside
  Neo-Synephrine 0.5 mg IV x1
  Neo-Synephrine 10 mcg/min IV
  Neo-Synephrine 100 mcg/min IV
  Neo-Synephrine 150 mcg/min IV
  Neo-Synephrine 180 mcg/min IV
  Neo-Synephrine 20 mcg/min IV
  Neo-Synephrine 40 mcg/min IV
  Neo-Synephrine 50 mcg/min IV
  Neo-Synephrine 60 mcg/min IV
  Vasopressin 0.04 units/min IV






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Psychiatric

  Amitriptyline 10 mg PO/PT qhs
  Amitriptyline 100 mg PO/PT qhs
  Amitriptyline 125 mg PO/PT qhs
  Amitriptyline 150 mg PO/PT qhs
  Amitriptyline 20 mg PO/PT qhs
  Amitriptyline 25 mg PO/PT qhs
  Amitriptyline 50 mg PO/PT qhs
  Amitriptyline 75 mg PO/PT qhs
  Bupropion 100 mg PO/PT q12h
  Bupropion 100 mg PO/PT q8h
  Bupropion 150 mg PO/PT q8h
  Daytrana patch 10mg/9hr q daily, place on pt at 6am, remove at 3pm
  Effexor XR 150 mg PO/PT q12h
  Emsam transdermal apply one 12 mg / 24 hr patch q 24h
  Emsam transdermal apply one 6 mg / 24 hr patch q 24h
  Emsam transdermal apply one 9 mg / 24 hr patch q 24h
  Fluoxetine 10 mg PO/PT qAM
  Fluoxetine 20 mg PO/PT q12h
  Fluoxetine 20 mg PO/PT qAM
  Fluoxetine 40 mg PO/PT q12h
  Fluoxetine 40 mg PO/PT qAM
  Fluoxetine 60 mg PO/PT qAM
  Fluoxetine 80 mg PO/PT qAM
  Haldol 0.5-2 mg IV q2h prn agitation
  Lexapro 10 mg PO/PT q24h
  Lexapro 15 mg PO/PT q24h
  Lexapro 20 mg PO/PT q24h
  Nicotine transdermal 14mg/24h patch apply one patch q24h
  Nicotine transdermal 21mg/24h patch apply one patch q24h
  Nicotine transdermal 7mg/24h patch apply one patch q24h
  Paroxetine 10 mg PO/PT q24h
  Paroxetine 20 mg PO/PT q24h
  Paroxetine 30 mg PO/PT q24h
  Paroxetine 40 mg PO/PT q24h
  Paroxetine 50 mg PO/PT q24h
  Quetiapine 100 mg PO/PT q8h
  Quetiapine 150 mg PO/PT q8h
  Quetiapine 200 mg PO/PT q8h
  Quetiapine 25 mg PO/PT q12h
  Quetiapine 250 mg PO/PT q8h
  Quetiapine 50 mg PO/PT q12h
  Quetiapine 50 mg PO/PT q8h
  Quetiapine 50 mg PO/PT qhs
  Sertraline 100 mg PO/PT q24h
  Sertraline 150 mg PO/PT q24h
  Sertraline 200 mg PO/PT q24h
  Sertraline 25 mg PO/PT q24h
  Sertraline 50 mg PO/PT q24h
  Wellbutrin SR 150 mg PO/PT q12h






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PUD

  Maalox 30 cc PO/PT x1
  Pepcid 20 mg IV q12h
  Pepcid 20 mg IV q24h
  Prevacid 30 mg PO/PT q12h
  Prevacid 30 mg PO/PT q24h
  Protonix 40 mg IV q12h
  Protonix 40 mg IV q12h
  Protonix 40 mg IV x1 now then gtt 8 mg/hr IV
  Protonix 40 mg IV x1 now then gtt 8 mg/hr IV x72 hours then Protonix 40 mg IV q12h
  Protonix 40 mg PO/PT q12h
  Protonix 40 mg PO/PT/IV q12h
  Protonix gtt 8 mg/hr IV
  Protonix gtt 8 mg/hr IV x72 hours then Protonix 40 mg IV q12h
  Ranitidine 150 mg PO q12h
  Ranitidine granules 150 mg PO/PT q12h
  Sucralfate 1 gm PO/PT q6h






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Pulmonary

  Advair 250/50 1 puff q12h
  Albuterol MDI 90 mcg/spray 10 puffs q4h
  Albuterol MDI 90 mcg/spray 2 puffs q4h
  Albuterol MDI 90 mcg/spray 2 puffs q4h prn wheezing
  Albuterol nebulizer 2.5mg in 3cc 1 neb q4h
  Albuterol/Atrovent 120/21 mcg MDI 10 puffs or Albuterol/Atrovent 2.5mg/500mcg nebulized 4h
  Albuterol/Atrovent 120/21 mcg MDI 10 puffs or Albuterol/Atrovent 2.5mg/500mcg nebulized 4h prn wheeze
  Albuterol/Atrovent 120/21 mcg MDI 10 puffs q4h
  Albuterol/Atrovent 120/21 mcg MDI 10 puffs q4h prn wheezing
  Albuterol/Atrovent 120/21 mcg MDI 10 puffs q4h while on vent, 3 cc nebulized q4h while on trach collar
  Albuterol/Atrovent 120/21 mcg MDI 2 puffs q6h and 10 puffs q4h prn wheezing
  Albuterol/Atrovent 120/21 mcg MDI 4 puffs or Albuterol/Atrovent 2.5mg/500mcg nebulized 4h prn wheeze
  Albuterol/Atrovent 2.5mg/500mcg nebulized q4h
  Atrovent MDI 18mcg/spray 10 puffs q4h
  Atrovent nebulized 1 neb q6h
  Budenoside nasal 32mcg/spray 2 sprays q24h
  Budenoside nasal 32mcg/spray 4 sprays q24h
  Fluticasone 4 puffs q12h
  N-acetylcysteine 1 neb q6h
  N-acetylcysteine 10% inh sol'n 400mg inh q4h prn thick secretions
  N-acetylcysteine 20% inh solution 600 mg inh q4h
  N-acetylcysteine 20% inh solution 600 mg inh q4h prn thick secretions
  Singulair 10 mg PO/PT q24h
  Singulair 10 mg PO/PT qhs
  Sodium bicarbonate 1 neb q6h
  Xopenex 1.25 mg nebulizer q6hr
  Xopenex HFA 45 mcg/spray 10 puffs q4h
  Xopenex HFA 45 mcg/spray 2 puffs q4h






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Radiocontrast Prophylaxis

  N-acetylcysteine 150 mg/kg IV 1 hr before CT then 50 mg/kg IV per hour for 4 hours after CT
  N-acetylcysteine 150 mg/kg IV x 1 hr then 50 mg/kg IV per hour for 4 hours
  Sodium bicarbonate 3 amps in 1 Liter D5W 3 cc/kg IV 1 hr before CT then 1 cc/kg per hour for 6 hours after CT
  Sodium bicarbonate 3 amps in 1 Liter D5W 3 cc/kg IV x1 hr then 1 cc/kg per hour for 6 hours






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Renal

  Acetazolamide 125 mg IV q12h
  Acetazolamide 125 mg IV q6h
  Acetazolamide 125 mg IV q8h
  Acetazolamide 250 mg IV q12h
  Acetazolamide 250 mg IV q6h
  Acetazolamide 250 mg IV q8h
  Calcium acetate 1336 mg PO/PT with meals
  Lasix 20mg IV q12h
  Lasix 20mg IV q6h
  Lasix 20mg IV x1
  Lasix 40mg IV q12h
  Lasix 40mg IV q6h
  Lasix 40mg IV q6h x24h
  Lasix 40mg IV q6h x24h
  Lasix 40mg IV x1
  Lasix 80mg IV x1
  Metolazone 10 mg PT q24h
  Nephrovite 1 tab PO/PT q24h
  PhosLo 2 caps PO/PT qAM
  PhosLo 3 caps PO/PT qAM
  PhosLo 4 caps PO/PT qAM
  Renagel (sevelamer) 1200 mg PO/PT q8h
  Renagel (sevelamer) 1600 mg PO/PT q8h
  Renagel (sevelamer) 800 mg PO/PT q8h






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Resuscitation

  Adenosine 12mg rapid IVP x1
  Adenosine 6mg rapid IVP x1
  Amiodarone 300mg IVP
  Atropine 0.5 amp IVP
  Atropine 0.5 amp IVP x1
  Atropine 1 amp IVP
  Atropine 1 amp IVP x1
  Calcium chloride 1 amp IVP x1
  D50 1 amp IVP x1
  Epinephrine 1 amp IVP
  Epinephrine 1 amp IVP x1
  Glucagon 1 mg IVP x1
  Lidocaine 100 mg IVP
  Milrinone 0.5 mcg/kg/min IV
  Narcan 0.4 mg IVP x1
  Narcan 2 mg IVP x1
  Vasopressin 40 Units IVP
  Vasopressin 40 units IVP x1






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RISS-Novolog

  Subcutaneous Sliding Scale Novolog insulin:
Glucose   0-60        1/2 Amp D50 IV, Notify Physician
               61-150    0 units
               151-200   2 units
               201-250   4 units
               >250        6 units






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RISS- STC

  STC Insulin Protocol #1:
Subcutaneous Sliding Scale regular human insulin:
Glucose   0-60        1/2 Amp D50 IV, Notify Physician
               61-150     0 units
               151-200   2 units
               201-250   4 units
               >250         6 units

  STC Insulin Protocol #2:
IV Sliding Scale regular human insulin:
Glucose   0-60       1/2 Amp D50 IV, Notify Physician
               61-150   0 units
               151-200 1 unit regular insulin subcutaneous
               201-250 2 units regular insulin subcutaneous
               >250      3 units

  STC Insulin Protocol #3:
IV regular human insulin drip: Initiate when criteria met and discontinue all other forms of insulin and antidiabetic agents.
Glucose 151-250 1 unit/hour
             251-350 2 units/hour
             >350      3 units/hour

  STC Insulin Protocol #4:
Titrate IV regular insulin drip to maintain blood glucose level between 100-150 mg/dL. (do not decrease glucse by > 100 ml/dL/hour)

  STC Insulin Protocol #5:
Refer to the Guidelines for Hyperglycemia Management in Adult Patients for suggested titration schedule and definition of monitored units.

  STC Insulin Protocol #6:
If Glucose < 60
       - hold insulin drip, give 25ml D50 IV
       - check glucose in 15, 30, and 60 minutes
       - repeat 25ml D50 IV for each glucose < 60
       - once Blood Glucose > 100, restart drip at 1/2 previous infusion rate






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RISS- UMMS

  UMMS Insulin protocol #1:
Discontinue all previous insulin orders. Check blood sugar (BS) every 4 hours. Administer sliding scale insulin:
Glucose   121-150 2 units regular insulin subcutaneous
               151-180 4 units regular insulin subcutaneous
               181-200 6 units regular insulin subcutaneous

  UMMS Insulin protocol #2:
If BS < 120 for 24 hours consider decreasing the frequency of BS checks.
If BS > 200, start insulin infusion.
If BS > 120 for 12 hours on SSI, begin insulin infusion.
Titrate insulin infusion to keep BS 80-120 mg/dL

  UMMS Insulin protocol #3:
During insulin infusion monitor BS every 1 hr until BS within range for at least 4 hours and patient is medically stable; then check BS every 2 hours.
If patient's condition or nutrition changes, or if BS is no longer in goal range, resume every 1 hr monitoring.

  UMMS Insulin protocol #4:
If BS is ever < 60 give 25 ml D50 IV.
Re-check BS in 15, 30, and 45 mins., then every 1 hour until stable.
Give 25 ml D50 IV for any BS < 60.
If receiving an insulin infusion, stop insulin infusion.

  UMMS Insulin protocol #5:
Once insulin infusion is between 1-2 units per hour without active titration, consider sliding scale insulin.






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RSI

  Etomidate 20 mg IVP x1
  Ketamine 140 mg IVP x1
  Succinylcholine 100 mg IVP x1
  Vecuronium 10 mg IVP x1
  Versed 4 mg IVP x1






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Sedation

  Alprazolam 0.25 mg PT q12h
  Ativan 0.5 mg IV q4-6h prn agitation
  Ativan 0.5 mg IV q4h
  Ativan 0.5 mg IV q6h
  Ativan 0.5 mg IV q8h prn panic attack
  Ativan 0.5 mg PO/PT q2h
  Ativan 0.5 mg PO/PT q2h
  Ativan 1 mg IV q2h prn agitation
  Ativan 1 mg IV q4-6h prn agitation
  Ativan 1 mg IV q4h
  Ativan 1 mg IV q6h
  Ativan 1 mg IV x1
  Ativan 1 mg IV x1 now
  Ativan 1 mg PO/PT q2h
  Ativan 1 mg PO/PT q2h prn agitation
  Ativan 1 mg PO/PT q4h
  Ativan 1 mg PO/PT q4h prn agitation
  Ativan 1 mg PO/PT q6h
  Ativan 1 mg PO/PT q6h prn agitation
  Ativan 2 mg IV q4-6h prn agitation
  Ativan 2 mg IV q4h
  Ativan 2 mg IV q6h
  Ativan 2 mg IV x1
  Ativan 2 mg IV x1 now
  Ativan 2 mg PO/PT q2h
  Ativan 2 mg PO/PT q2h prn agitation
  Ativan 2 mg PO/PT q4h
  Ativan 2 mg PO/PT q4h prn agitation
  Ativan 2 mg PO/PT q6h
  Ativan 2 mg PO/PT q6h prn agitation
  Ativan 4 mg IV x1
  Clonazepam 1 mg PO/PT q12h
  Dexmedetomidine (Precedex) 1 mcg/kg IV load over 10 minutes, then 0.5 mcg/kg/hr IV titrate to RASS -1
  Diazepam 10 mg PO/PT/PR q12h
  Diazepam 10 mg PO/PT/PR q6h
  Diazepam 5 mg IV q4h
  Diazepam 5 mg PO/PT q12h
  Diazepam 5 mg PT q4h
  Diphenhydramine 25 mg IV q6h
  Diphenhydramine 25 mg IV x1
  Diphenhydramine 25 mg PO/PT q6h
  Diphenhydramine 25 mg PO/PT x1
  Diphenhydramine 25 mg PO/PT/IV q6h prn itching
  Diphenhydramine 50 mg IV q6h
  Diphenhydramine 50 mg IV x1
  Diphenhydramine 50 mg PO/PT q6h
  Diphenhydramine 50 mg PO/PT x1
  Geodon 20 mg PO/PT q12h
  Geodon 40 mg PO/PT q12h
  Geodon 60 mg PO/PT q12h
  Geodon 80 mg PO/PT q12h
  Haldol 10 mg IV
  Haldol 10 mg IVP x1
  Haldol 2.5 mg IV x1 now
  Haldol 5 mg IV q4h
  Haldol 5 mg IV q4h prn agitation
  Haldol 5 mg IV q6h
  Haldol 5 mg IV q6h prn agitation
  Haldol 5 mg IVP x1
  Haldol 5-10 mg q1h prn agitation, get EKG and call MD if requires more than 40mg in 1 hour
  Lorazepam gtt 2 mg/hr IV titrate to RASS -1
  Narcan 0.1 IV q5min prn
  Propofol 50 mcg/kg/min IV titrate to RASS -1
  Versed 0.5 mg IV q4-6h prn agitation
  Versed 0.5 mg IV q4h
  Versed 0.5 mg IV q6h
  Versed 0.5 mg PO/PT q2h
  Versed 0.5 mg PO/PT q2h
  Versed 1 mg IV q4-6h prn agitation
  Versed 1 mg IV q4h
  Versed 1 mg IV q6h
  Versed 1 mg IV x1 now
  Versed 1 mg PO/PT q2h
  Versed 1 mg PO/PT q2h prn agitation
  Versed 1 mg PO/PT q4h
  Versed 1 mg PO/PT q4h prn agitation
  Versed 1 mg PO/PT q6h
  Versed 1 mg PO/PT q6h prn agitation
  Versed 2 mg IV q4-6h prn agitation
  Versed 2 mg IV q4h
  Versed 2 mg IV q4h
  Versed 2 mg IV x1 now
  Versed 2 mg PO/PT q2h
  Versed 2 mg PO/PT q2h prn agitation
  Versed 2 mg PO/PT q4h
  Versed 2 mg PO/PT q4h prn agitation
  Versed 2 mg PO/PT q6h
  Versed 2 mg PO/PT q6h prn agitation
  Versed gtt 2 mg/hr IV titrate to RASS -1
  Wean Propofol as tolerated
  Wean Propofol to off as tolerated






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Seizure

  Keppra 1 gm IV x1 then 500 mg IV q12h
  Keppra 1000 mg PO/PT q12h
  Keppra 1gm PO/PT then 500 mg PO/PT q12h
  Keppra 500 mg PO/PT q12h
  Phenobarbital 60 mg PO/PT q12h
  Phenobarbital 60 mg PO/PT q8h
  Phenytoin 1 gm IV x1 now
  Phenytoin 100 mg IV q8h x7days, please send free dilantin level qAM
  Phenytoin 100 mg IV q8h, please send free dilantin level qAM
  Phenytoin 125 mg IV q8h
  Phenytoin 150 mg IV q8h






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Sleep

  Ambien 10 mg PO/PT qhs
  Ambien 10 mg PO/PT qhs prn sleep
  Ambien 5 mg PO/PT qhs
  Ambien 5 mg PO/PT qhs prn sleep
  Chloral hydrate 1 gm PO/PT qhs
  Chloral hydrate 1 gm PO/PT qhs prn sleep
  Haldol 5mg q4-6h prn sleep
  Haldol 5mg q4-6h prn sleep only from 10pm-6pm






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Thromboembolism

  Coumadin 5 mg PO/PT qhs
  Heparin 200 units/hr IV
  Heparin 300 units/hr IV
  Heparin 400 units/hr IV
  Heparin 500 units/hr IV
  Heparin 5000 units subcut q8h
  Lovenox 100 mg subcutaneous 24h
  Lovenox 30 mg subcut q12h
  Lovenox 40 mg subcut q24h
  Lovenox 40mg subcut q12h






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Vaccinations

  Haemophilus influenza vaccine 0.5 cc subcut
  Hepatitis B Ig 50 units/cc 30 cc in 170 cc NS IM
  Meningococcal vaccine 0.5 cc subcut
  Pneumovax vaccine 0.5 cc subcut






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