Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Seizures Contributing Diagnoses
text
Activity
Item
Bed rest with seizure precautions
boolean
Nursing
Item
Vital signs: every 2 hrs with neuro checks until stable X4, then every 4 hrs
boolean
Nursing
Item
Notify MD for: T > 100, BP < 90/60 or > 170/110, seizures, glasgow coma scale < 15
boolean
Item
Dilantin loading options
text
Code List
Dilantin loading options
CL Item
PO Dilantin____mg (15mg/kg) every 4 hrs X3 doses OR (1)
CL Item
IV Dilantin 50 mg/min; IVP to total of____mg (18mg/kg) then begin Dilantin 300mg PO QD OR (2)
CL Item
Fosphenytoin-load (10-20 PE/kg) (3)
Medications
Item
If PO Dilantin, please specify amount
integer
Medications
Item
If IV Dilantin 50 mg/min, please specify IVP to total of
integer
Medications
Item
Ativan 2-4 mg slow IVP over 10 min prn active seizures lasting more than 3 min
boolean
Medications
Item
Tylenol 650 mg PO every 4-6 hrs prn fever or pain
boolean
Medications
Item
MOM 30 mL PO every 12 hrs prn constipation
boolean
Medications
Item
Other
boolean
Medications
Item
If Other, please specify
text
Lab
Item
Hemogram
boolean
Lab
Item
Comp met profile
boolean
Lab
Item
Urine Toxicology screen for "drugs of abuse"
boolean
Other
Item
MRI of head with and without contrast for "new onset seizures, R/O mass, lesion"
boolean
Other
Item
EEG for " new onset seizures"; to be read by neurologist
boolean