CCS Order Sets

Use these as starting templates. Modify based on vitals, age, pregnancy status, renal function, and contraindications.

Chest Pain / Possible ACS

ER location
ABCs, vital signs
Cardiac monitor, pulse oximetry
IV access x2
ECG stat
Aspirin
Nitroglycerin if no contraindication
Troponin serial
CBC, CMP, PT/INR, aPTT
Chest x-ray
Anticoagulation if ACS likely
Cardiology consult
Admit telemetry or cath lab for STEMI

Sepsis / Septic Shock

ER or ICU
ABCs, oxygen as needed
Cardiac monitor, pulse oximetry
IV access x2
CBC, CMP, lactate, blood cultures x2
Urinalysis and urine culture if urinary source possible
Chest x-ray if respiratory source possible
Broad-spectrum IV antibiotics
30 mL/kg crystalloid if hypotension or lactate >=4
Norepinephrine if persistent shock after fluids
Source control evaluation
Admit ICU if shock

DKA

ER or ICU depending severity
Vital signs, cardiac monitor
IV access
BMP/CMP, serum ketones or beta-hydroxybutyrate
Venous or arterial blood gas
Urinalysis
ECG
Isotonic IV fluids
Check potassium before insulin
IV insulin after K+ adequate
Potassium replacement as needed
Add dextrose when glucose approaches 200
Monitor anion gap

Acute Stroke

ER
ABCs, glucose fingerstick
Neurologic exam / NIHSS
Noncontrast head CT stat
ECG, CBC, CMP, PT/INR, aPTT, troponin
Neurology consult
Thrombolysis evaluation if eligible
CTA/head-neck imaging when large vessel occlusion suspected
Swallow evaluation before oral intake
Admit stroke unit or ICU

GI Bleed

ER
ABCs
Two large-bore IVs
CBC, CMP, PT/INR, type and crossmatch
IV fluids or blood products if unstable
Hold anticoagulants if appropriate
IV PPI if upper GI bleed suspected
GI consult
Endoscopy when stabilized
Admit monitored setting if significant bleed

COPD Exacerbation

Pulse oximetry
Oxygen target 88-92% if CO2 retention risk
Albuterol/ipratropium nebulizers
Systemic corticosteroids
Chest x-ray
CBC, BMP
ABG/VBG if severe distress or altered mental status
Antibiotics if purulent sputum plus increased dyspnea/volume or ventilatory support
Noninvasive ventilation if hypercapnic respiratory failure

Pneumonia

Vitals, pulse ox
Chest x-ray
CBC, CMP
Blood cultures if severe or admitted
Sputum culture if severe or risk factors
Empiric antibiotics based on outpatient/inpatient/severe setting
Oxygen if hypoxic
Assess CURB-65/PSI and admit if indicated

Pulmonary Embolism

Vitals, pulse ox
ECG, chest x-ray
CBC, CMP, PT/INR, aPTT, troponin, BNP
D-dimer if low/intermediate probability
CT pulmonary angiography if appropriate
V/Q scan if CTA contraindicated
Anticoagulation if high suspicion and low bleeding risk
Thrombolysis/embolectomy if massive PE with instability