[select name="Q1" value="Code Stroke Activated|Patient BIBA after cardiac arrest with ROSC|Pregnant vag bleed|Code Sepsis"] [conditional field="Q1" condition="(Q1).is('Code Stroke Activated')"] [textarea default="Patient's LKWT was "] [textarea default="NIHSS is "] [textarea default="Differential diagnosis includes ischemic stroke, hemorrhagic stroke, todd's paralysis, hypoglycemia, brain mass, metabolic encephalopathy, among others."] [checkbox name="variable_1" value="EKG, CXR and labs obtained and patient was brought emergently to CT."] [textarea default="Pt's presentation and findings discussed initially with neurologist on call, Dr. ** who recommended "] [textarea default="CT/CTA showed: ** Neurologist updated with results and now recommends ** "] [checkbox name="variable_1" value="ASA administered"] [textarea default="Patient is within the 4.5 hr window for tPA, meets all inclusion criteria and no exclusion criteria identified."] [checkbox name="variable_2" value="Risks and benefits of tPA were discussed with patient and/or family who have given informed consent for treatment|Risks and benefits of tPA were discussed with patient and/or family who at this time decline treatment.|tPA administered|The patient will be admitted to the hospital to ICU for further workup and treatment.|The patient will be transferred for higher level of care for possible interventional directed clot retrieval."] [textarea default="Discussed with "][comment memo="timestamp"] [/conditional] [conditional field="Q1" condition="(Q1).is('Patient BIBA after cardiac arrest with ROSC')"] [comment memo="Please note the following: Calculate the total downtime which may be from last known well to ROSC, or if witnessed - time of arrest to time of ROSC - note time EMS arrived, note time ACLS was started"] [textarea default="EMS was called for"] [textarea default="ON EMS arrival, patient found to be "][comment memo="pulseless, apneic, initial rhythm on the monitor was "] [textarea name="variable_4" default="LKWT/Witnessed arrest time was: "] [textarea name="variable_2" default="ACLS measures were started at: "] EMS performed the following interventions prior to arrival [checkbox name="variable_1" value="Patient was intubated|Patient was bagged with BVM en route|IO was placed|IV placed|Patient was shocked one or more times|ACLS per protocol"] Timestamps: [textarea name="variable_3" default="ROSC achieved at: Lost pulses again at, etc."] [textarea default="Total down time without CPR: **. Total downtime with CPR: **"] [textarea default="Other pertinent historical history"] Emergency Caveat: Further history and physical precluded by [checkbox name="variable_1" value="patient acuity|unresponsive|pt intubated|in cardiac arrest"] [textarea default="Discussed with "] [/conditional] [conditional field="Q1" condition="(Q1).is('Pregnant vag bleed')"] [textarea]This patient in the first trimester of pregnancy presented to the emergency department with complaints of vaginal bleeding and abdominal pain. VSS. Os is closed.[/textarea] A pelvic ultrasound demonstrated [select value="normal intrauterine gestation with normal FHT.|failure to identify a gestational sac.|blighted ovum.|subchorionic hemorrhage."] Rh was [checkbox value="positive.|negative and patient administered Microrogham."] UA was [checkbox value="positive|negative"] for infection. Clinical Impression: [select value="Threatened Miscarriage|UTI|Early Pregnancy vs. Ectopic|Missed Abortion"] [text] Anticipatory guidance, supportive measures and return indications discussed with patient. See DCI. DCI: Bed rest. Pelvic Rest. Drink plenty of fluids. [checkbox value="Take the antibiotics prescribed for urinary tract infection|Follow up with your OB/GYN in 1-2 days|Return here or with your OB in 48 hours for repeat BHCG level|Bring a copy of your results from today's visit"] Return to the ER for increased bleeding (more than 1 pad an hour for consecutive hours), increased abdominal cramping, fever, passage of products of conception, lightheadedness or any other concerns. [/conditional] [conditional field="Q1" condition="(Q1).is('Code Sepsis')"] [comment memo="SIRS Criteria: 2 or more (note which ones): T>100.9F or < 96.8F, HR>90 bpm, RR>20/min, WBC count > 12,000 or < 4000 or >10%bands"] [comment memo="End Organ Dysfunction: Lactate >2, SBP <90 or MAP <65, AMS, bili>2, PLatelet count < 100, creatinine >2, new Hypoxemia"] [textarea default="Patient has 2 or more SIRS criteria and potential source of infection, therefore initial screening labs were drawn and sent including cultures. The patient now shows evidence of end-organ dysfunction therefore Code Sepsis Activated."] [textarea default="CODE SEPSIS ACTIVATED at "][comment memo="timestamp"] [checkbox name="variable_12" value="Bundle was initiated. Lactate was drawn|Cultures obtained|Broad spectrum antibiotics ordered|30 cc/kg IVF bolus administered."] [textarea name="variable_9" default="Initial Lactate was "] [comment memo="By 6 hour mark - comment on repeat lactate level if initial was greater than 2 and if it was greater than 4 - perform sepsis reassessment exam. If patient is persistent hypotensive after tht 30 cc/kg bolus - document that patient requires pressors, choice of pressor and placement of central line."] [textarea default="6 hour goals"] [textarea name="variable_1" default="SEPSIS REASSESSMENT PERFORMED AT:"][comment memo="timestamp - delete if not performed"] [/conditional]
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