ORDERS (Medical-Surgical)

PATIENT LABEL HERE TELEMETRY ORDERS (Medical-Surgical)

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1.  Telemetry monitoring without pulse oximetry  Telemetry monitoring with pulse oximetry

2. Please choose appropriate indication below: Syncope with one of the following:  Congestive heart failure, ventricular tachycardia, systolic blood pressure < 90, second or third degree heart block, heart rate < 45 or heart rate > 120  Syncope with normal physician exam, normal EKG or previously normal echocardiogram  Asymptomatic second or third degree heart block New onset atrial fibrillation/flutter, uncontrolled chronic atrial fibrillation/flutter, sustained ventricular  tachycardia Post-operative patients with one of the following: angina, new EKG changes, positive pre-operative stress  test, systolic blood pressure < 90 or heart rate > 130  Initiation of antiarrythmic medications or other medications that may prolong QT interval  External pacemaker  Acute myocardial infarction, chest pain, rule out myocardial infarction, unstable angina  Decompensated congestive heart failure Post-operative patients with one of the following:  Previous history of coronary artery bypass graft, percutaneous coronary intervention, valve repair/ replacement  Symptomatic bradycardia (heart rate < 45) or symptomatic tachycardia (heart rate > 120)  Cardiac contusion  Ischemic or hemorrhagic strokes (with potential for arrhythmia)  Myocarditis or pericarditis  Step down from Intensive Care with recent cardiac or respiratory arrest  Post coronary angiography, post ablation/cardioversion, post defibrillator/pacemaker placement  Suspected or diagnosed sleep apnea  Drug toxicity with arrhythmia  Electrolyte abnormality: Potassium < 3.0 or > 6.0, Calcium < 7.0 or > 11.0, Magnesium < 1.3 or > 3.0 Other (list here): 

______Date Time Physician Signature PID Number

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