Rapid Response Team Protocol and Order Set
Order Set: Rapid Response
Patient Information (two identifiers required)
Scope: This order set pertains to those orders initiated by
the Rapid Response Team and does not include orders
that pertain to the patient’s condition outside of the
interventions of the Rapid Response Team.
Last name: _______________________________
First name: _______________________________
Legend:
Open boxes are orders that a clinician will need to order
by checking the box.
Close boxes are those orders that automatically are done
for all patients and do not require a clinician to order by
checking.
Date of Birth: ____/____/____
Age: _________
Pt. ID #: __________________________________
Vital Signs (initially and as indicated)


Blood Pressure, Heart rate, Respiratory rate, Temperature
O2 Saturation
Nursing Orders


Blood Glucose (finger stick)
Cardiac Monitor
Respiratory



Clear and maintain airway
Nasal cannula, Mask
o Stabilize patient and maintain O2 saturation of 90%.
Ventilation assistance with positive pressure ventilation
IV

Patient IV access
IV fluid:

Normal Saline at TKO mL/hour
 Other ___________________ at ______ mL/hour
Medications
Albuterol _______ mg (2.5 –5 mg) nebulizer as needed for respiratory distress
Nitroglycerin 0.4mg sublingual for chest pain. May repeat every 5 minutes for total of 3 doses
 Hold for Systolic Blood Pressure less than 100 mm Hg.
 D50W IV / 50cc
 Lasix _________ mg IV
REVERSAL KIT
Romazicon (Flumazemil)
 Pediatric (reversal of benzodiazepine when used in conscious sedation or general anesthesia): Initial
dose: 0.01mg/kg (maximum dose: 0.2 mg) given over 15 seconds; may repeat 0.01 mg/kg (maximum
dose: 0.2mg) after 45 seconds, and then every minute to a maximum total cumulative dose of 0.05
mg/kg or 1 mg, whichever is lower; usual total dose: 0.08 -1 mg (mean: 0.65mg)
 Adult: 0.2 mg (2mL) IV over 15 seconds. Repeat doses if desired level of consciousness not obtained,
0.2 mg may be repeated at 1minute intervals. Maximum cumulative dose 1 mg.
Narcan (Naloxone)
Pediatric
 Post-anesthesia narcotic reversal: 0.01 mg/kg; may repeat every 2-3 minutes based on response
 Opiate Intoxication: <20kg: 0.1mg/kg; may repeat every 2-3 minutes based on response
>20kg: 2 mg/dose; may repeat every 2-3 minutes based on response
 Adult: 0.4mg IV at 2-3 minute intervals based on response
Atropine
 Adult only: 0.4mg (1ml) IV push


2092506
Page 1
(Rapid Response Team Protocol and Order Set)
ANAPHYLAXIS KIT (for severe reactions)
Benadryl (Diphenhydramine): Give IV dose over at least 2 minutes
 Pediatric (for anaphylaxis): IV or deep IM 1.25mg/kg every 6-8 hours; not to exceed 300mg/day
 Adult: IV or deep IM 25-50 mg every 4 hours; not to exceed 400 mg/day
Epinephrine (1:1000): NOT FOR IV USE
 Pediatric: Subcutaneous 0.01 mg/kg every 15 minutes for 2 doses, then every 4 hours as needed;
single dose not to exceed 0.5mg
 Adult: IM or Subcutaneous: 0.3mg every 10-15 minutes; single dose not to exceed 0.5mg
Solu-Medrol (Methylprednisolone): Do not administer doses over 125mg by IV push
 Pediatric (for asthma exacerbation): IV push 1 mg/kg over 3-5 minutes every 6 hours for 48 hours
For status asthmaticus – loading dose 2mg/kg over 15-30 minutes then 0.5-1 mg/kg IV push every
6 hours
 Adults (for asthma exacerbations): IV push 30-45 mg over 3-5 minutes every 6-8 hours for 48 hours
 Other: __________________________________________________________________________
Lab / Diagnostic Tests



Chest X-Ray (AP Portable)
Other imaging studies __________________________________
Arterial Blood Gases

EKG
 HEME Group
 Blood Cultures
 UA
CHEMISTRY
 Lyte Panel
 Lyte Panel (ER)
 Chem 8
CARDIAC PROFILE
 CK
 TROP
 Other: _______________________________________
Authorized prescriber signature: ___________________________________________________________
Printed name: _________________________________________________________________________
Date: __________________________
2092506
Time: ___________
Page 2