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Describe it
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This is a handwritten ICU Admission Order Sheet for an acutely ill patient. Here is a full breakdown:
Header
ADMIT in ICU
Left Column - Monitoring, Nursing & Investigations
Vitals & Nursing:
- RBS (Random Blood Sugar) - hourly
- BP (Blood Pressure) - 1-2 hourly
- I/O (Intake/Output) - hourly
- Foley's catheter - insert
- NPO (Nothing by Mouth)
Investigations:
- CXR (Chest X-ray)
- ECG
- CBC (Complete Blood Count)
- LFT (Liver Function Tests)
- RFT (Renal Function Tests)
- Coagulation Profile
- ABG (Arterial Blood Gas)
- NCCT Head (Non-Contrast CT scan of brain)
Right Column - Medications
| Drug | Dose/Route | Frequency |
|---|---|---|
| Inj. Ceftriaxone | 1g IV | BD (twice daily) |
| Inj. Pantoprazole | 40mg IV | OD (once daily) |
| Inj. Ondansetron (Emset) | 8mg → 4mg IV | TDS (three times daily) |
| Inj. Tramadol | 1 amp IV | SOS (as needed) |
| Inj. Paracetamol (PCM) | 1g IV | BD |
| Tab. Zerodol SP | 1 tab | BD |
| Inj. Citicoline | 1g IV | OD |
| Inj. Regular Insulin | 6 units IV | STAT, then recheck RBS at 30 min |
Insulin Sliding Scale (based on RBS):
- 150-200 mg/dL → 20 units
- 201-250 mg/dL → 40 units
- 251-300 mg/dL → 60 units
Clinical Interpretation
This order set points to a patient admitted urgently with likely:
- Neurological event - NCCT Head + Citicoline (neuroprotective) suggest possible stroke or head injury
- Hyperglycemia / Diabetic emergency - aggressive insulin sliding scale and hourly RBS monitoring
- Suspected infection - IV Ceftriaxone antibiotic
- Pain and nausea - Tramadol, Paracetamol, Zerodol SP, Ondansetron
- Stress ulcer prophylaxis - Pantoprazole
Important note: The insulin sliding scale doses listed (20-60 units per reading) are very high compared to standard protocols. Any clinician administering these orders should verbally confirm the doses with the prescribing physician before giving insulin to avoid hypoglycemia.
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