| Presentation | Diagnosed urinary tract infection with fever and unresponsive to 72 hour course of outpatient antibiotic |
| Evidence of gross hematuria | |
| Altered mental status | |
| Comorbidities | Immunocompromised [AIDS, sickle cell, post splenectomy, transplant patient, cancer undergoing chemotherapy/ radiation or neutropenia with ANC <500] |
| Pregnancy | |
| Single kidney or known polycystic kidney disease | |
| Suprapubic catheter, ureteral stent or nephrostomy tube in place | |
| History of multi drug resistant bacterial UTI | |
| Examination | Hemodynamic instability |
| Severe pain requiring 3 or more analgesic doses | |
| Workup | Meet sepsis criteria |
| Reduced urinary output < 0.5ml/kg/hr. with BUN > 45 or creatinine >3.0 | |
| Positive urine culture and sensitivity noted unresponsive to outpatient therapy | |
| Positive blood culture | |
| Diabetic ketoacidosis or blood sugar > 350 | |
| Obstructive uropathy [not previously diagnosed] | |
| Pyelonephritis | |
| Emphysematous pyelonephritis | |
| Hydronephrosis | |
| Management | Persistent inadequate oral intake requiring IV fluids |
| Acute kidney injury or sodium <120 or > 160 or potassium > 6.0 mEq/L requiring fluids/ diuresis/ dialysis with close monitoring | |
| Obstructive uropathy requiring intervention | |
| Respiratory failure requiring respiratory support | |
| Vasoactive / inotrope support |
| Presentation | Persistent/worsening Dyspnea/ orthopnea/ fever |
| Failed/ non compliant outpatient antibiotic treatment | |
| Unable to tolerate oral regimen | |
| Comorbidities | Immunocompromised [AIDS, sickle cell, post splenectomy, transplant patient, cancer undergoing chemotherapy/ radiation or neutropenia with ANC <500] |
| Pregnant | |
| Examination | Persistent or worsening Respiratory symptoms |
| Evidence of systemic illness ( SIRS/ Sepsis, Altered mental status, Acute renal insufficiency etc.) | |
| Hemodynamic instability with or without arterial or venous pH > 7.50 | |
| pH <7.25 (Arterial or venous) with mental status changes | |
| PSI score >70 points | |
| Workup | Chest x-ray findings of Multilobar pneumonia, lung abscess, empyema or necrotizing pneumonia |
| Suspected drug-resistant organism | |
| Suspected tuberculosis | |
| Management | Persistent requirement of supplemental oxygen above baseline with documented hypoxia |
| Pleural effusion requiring tube thoracostomy or drainage | |
| Complications requiring IV antiarrhythmic / anti-hypertensive / beta-blocker/ calcium channel blocker / diuretic / insulin/ vasoactive/ inotrope with monitoring and / or titration |
| Presentation | DVT/PE with active bleeding |
| Bilateral DVT | |
| Comorbidities | History of coagulopathy |
| Liver disease with prolonged PTT or INR | |
| Major surgery or trauma within last month | |
| Malignancy with active cancer treatment | |
| Stroke in last 3 months/history of intracranial hemorrhage | |
| History of cancer with metastasis to brain | |
| Recent overt bleeding within 2 weeks | |
| Heparin induced thrombocytopenia | |
| Thrombocytopenia with platelet count of <75,000/cu.mm | |
| Pregnant | |
| Previous DVT [at least 2 episodes/episode within last 3 Months/recurrent despite adequate anti coagulant therapy] | |
| Subtherapeutic INR, Patient/ caregiver unable to administer anticoagulant and outpatient services unavailable | |
| Examination | Persistent Hemodynamic instability |
| Documented hypoxia requiring supplemental oxygen above baseline | |
| Hemodynamic instability | |
| Workup | Documented extensive thrombosis (clot in vena cava or above iliofemoral bifurcation) |
| Limb threatening thrombosis | |
| Management | Emergent IVC filter placement |
| Catheter directed thrombolysis | |
| Titrated vasoactive drips |
| Presentation | Abdominal pain unresponsive to 2 doses of parenteral analgesic over six hours |
| Altered mental status | |
| Comorbidities | Pregnancy> 20 weeks gestation with renal colic/pyelonephritis (refer UTI algorithm) |
| Immunocompromised [AIDS, sickle cell, post splenectomy, transplant patient, cancer undergoing chemotherapy/ radiation or neutropenia with ANC <500] | |
| Examination | Rebound and/or guarding |
| Inability to tolerate oral intake | |
| Persistent hemodynamic instability | |
| Coma/ Stupor/Obtundation | |
| Hemodynamic instability | |
| Workup | Acute Liver or Renal failure/ Hepatorenal syndrome with Cr>1.5mg/dl and requiring albumin/midodrine/octreotide |
| Complicated : Perforated/ Abscess | |
| Acute Pancreatitis with enzymes 3 X normal | |
| Acute diverticulitis | |
| Ileus | |
| Pyelonephritis with obstructive uropathy | |
| Acute renal failure with renal colic | |
| Renal colic with bilateral obstruction or single kidney with obstruction | |
| Ascites initial episode requiring paracentesis or albumin or diuretic or salt and fluid restriction | |
| Jaundice with Bilirubin >2.5mg/dl ± Albumin <2.0g/dl or BUN > 45 mg/dl or Cr > 3.0 mg/dl or increasing hepatomegaly or coagulopathy or fever or persistent vomiting or persistent IV fluids requiring anti infective/ anti emetic/ Serotonin agonist/ ERCP/ MRCP/ FFP/ Percutaneous transhepatic biliary drainage | |
| Disseminated intravascular coagulation and blood product transfusion | |
| Tubo ovarian abscess | |
| Management | NPO with IV fluids for 2 days |
| Uncontrolled pain requiring increasing pain medication, dose or frequency | |
| Open surgical procedure | |
| Nephrostomy tube placement for renal colic | |
| IV medications [antiarrhythmic/ anticonvulsant/ antihypertensive/ calcium channel blocker/ beta-blocker/ diuretic/ insulin/ vasoactive medication/ inotrope] along with continuous monitoring or monitoring with titration |
| Presentation | Persistent or worsening Neurological deficit or Unstable deficit (waxing/waning) |
| Persistent vomiting | |
| Recurrent neurologic deficit in preceding days and especially if increasing | |
| Non focal symptoms- confusion/ weakness/ seizures/ transient global amnesia | |
| Severe Headache or concern for cranial arteritis | |
| Disabling Stroke (new gait disturbance, unable to perform ADLs, NIHSS >3, fails dysphagia screen) | |
| Comorbidities | Known possible embolic source: Atrial fibrillation (esp. if not on anticoagulation), Cardiomyopathy, Artificial cardiac valve, Endocarditis, Known mural thrombus, Patent Foramen ovale or Recent myocardial infarction |
| Prior large stroke making serial neurological examination problematic | |
| Pregnancy | |
| Examination | Hypertensive or metabolic encephalopathy |
| Hemodynamic instability | |
| Coma/Stupor/ Obtundation | |
| Continuous/ intractable seizure | |
| GCS≤8 or decrease ≥2 | |
| Increased intracranial pressure | |
| Workup | Definitive imaging finding of CVA |
| Imaging results requiring further evaluation/management (carotid stenosis or abnormal echocardiogram) | |
| Management | Titrated vasoactive drip |
| Treatment of Embolic source (heparin/coumadin) e.g. mural thrombus, atrial fibrillation | |
| Treatment for Encephalitis (e.g. IV Acyclovir) | |
| Persistent hypertension requiring medication adjustment or addition |
| Presentation | Intractable or incapacitating |
| Focal neurologic signs | |
| Hypertensive emergency with symptoms | |
| Comorbidities | Prior large stroke making serial neurological examination problematic |
| Pregnancy | |
| Examination | Hemodynamic instability |
| Meningismus | |
| Suspected giant cell arteritis (also called temporal arteritis) | |
| Workup | Abnormal brain imaging (e.g. cerebral bleeding, hydrocephalus or vasospasm) |
| Central nervous system infection | |
| Increased intracranial pressure, or cerebral edema or papilledema | |
| Blocked VP shunt | |
| Antepartum/postpartum spinal headache requiring epidural blood patch or IV caffeine and fluid | |
| Management | Titrated vasoactive drip |
| Treatment of Embolic source (heparin/coumadin) e.g. mural thrombus, atrial fibrillation | |
| Treatment for Encephalitis | |
| Persistent hypertension requiring medication adjustment or addition |
| Presentation | Persistent/Worsening Dyspnea, wheezing or facial swelling despite therapy |
| Intolerance/ inability to take oral intake | |
| Comorbidities | Severe COPD |
| Examination | Altered mental status |
| Stridor or evidence of impending airway compromise | |
| Hemodynamic instability | |
| Workup | |
| Management | Anaphylaxis requiring repeat dosing of Epinephrine |
| Transfusion reaction | |
| Persistent requirement of supplemental oxygen |
| Presentation | Failure of 48 hrs. outpatient antibiotic treatment |
| Animal or Human bite to face or hand | |
| Inability to tolerate or worsening despite oral antibiotics | |
| Comorbidities | Immunocompromised [AIDS, sickle cell, post splenectomy, transplant patient, cancer undergoing chemotherapy/radiation or neutropenia with ANC <500] |
| Cancer currently undergoing chemotherapy/radiation therapy or neutropenia | |
| Poorly controlled Diabetes | |
| Examination | No improvement or worsening cellulitis-increase in girth of involved extremity or development of lymphangitis, purpura or petechiae |
| Weeping wound with increased exudates or foul smelling discharge | |
| Site: Orbital or peri orbital cellulitis or located over prosthesis or implanted device or of upper lip/nose/neck, involving >9% total BSA | |
| Extensive tissue sloughing | |
| Hemodynamic instability | |
| Workup | Meets Sepsis criteria |
| Infected implanted hardware | |
| Osteomyelitis | |
| Joint effusion requiring drainage | |
| Positive Blood cultures with suspected organism | |
| Management | Wound requiring debridement/ re-exploration |
| Need for operative intervention: necrotizing infection or osteomyelitis | |
| Frequent Complex wound care |
| Presentation | Persistent chest pain/ unstable angina, |
| AICD [automated implantable cardioverter defibrillator] with repetitive shocks ( > 2-3 shocks in 24 hrs.) | |
| Comorbidities | |
| Examination | Hemodynamic instability |
| Continued episodes of SVT or uncontrolled atrial fibrillation or atrial flutter on vasoactive drip | |
| Workup | Wide-complex tachycardia/ Atrial fibrillation/flutter, SVT, Non sustained ventricular tachycardia or symptomatic bradycardia requiring intervention and/or monitoring |
| Evidence of lethal ventricular arrhythmia | |
| EKG findings of ischemia/infarction | |
| Positive cardiac biomarkers | |
| Management | Titrated vasoactive drips requiring monitoring |
| Urgent electrical cardioversion | |
| Temporary pacemaker | |
| Defibrillation |
| Presentation | Chest pain consistent with Acute coronary syndrome, unstable angina or NSTEMI |
| Shortness of breath | |
| Comorbidities | Acute exacerbation of COPD requiring Intervention |
| Uncontrolled Diabetes (BS >350mg/dl) requiring intervention | |
| Acute renal failure requiring intervention | |
| Bleeding requiring transfusion | |
| Examination | Pulmonary edema/ rales |
| Hemodynamic instability (Hypotension, Uncontrolled hypertension, Arrhythmia, Tachycardia, tachypnea etc.) | |
| Workup | Elevated / positive Troponin |
| EKG changes suggestive of Ischemia or Acute myocardial infarction | |
| New onset or uncontrolled arrhythmia (requiring IV treatment/ pacemaker/defibrillation | |
| Pericarditis requiring drainage or pain management | |
| Management | Acute coronary syndrome/ Unstable Angina/ Non STEMI/ STEMI requiring intervention ( IV Nitro drip, IV Heparin etc.) |
| Heart failure requiring intervention | |
| Arrhythmia requiring intervention |
| Presentation | Suicidal ingestion |
| History of delirium tremens or seizures | |
| Comorbidities | Head trauma |
| Examination | Hemodynamic instability |
| Altered mental status | |
| Combativeness | |
| Hallucinations | |
| CIWA score >15 or 8-14 with tachycardia | |
| Workup | Evidence of organ dysfunction due to ingestion |
| Management | Frequent IV Medications requirement (e.g. IV Ativan) |
| Presentation | New onset seizures and ≥2 within 24hrs |
| Known seizure disorder with ≥2 seizures within 24 hours and a change from baseline or change or progression of seizure type or increase in seizure duration | |
| Ongoing seizures or postictal state | |
| Seizures due to toxic exposure (e.g. theophylline or carbon monoxide toxicity) or hypoxemia | |
| Recurrent seizures or status epilepticus | |
| Comorbidities | Pregnancy beyond first trimester / eclampsia |
| Examination | Persistent focal neurological findings (e.g. Todd’s paralysis) |
| Clinical suspicion of meningitis or new CVA | |
| Delirium of any etiology, including alcohol withdrawal syndrome / DTs | |
| Hemodynamic instability | |
| Workup | New findings on head CT |
| New EKG changes or significant arrhythmias | |
| Known seizure disorder with therapeutic drug level or patient compliant but drug level not measurable | |
| Management | Initiation of anti convulsant or titration : continuous with monitoring every 1-2 hrs. or Bolus every 1-2 hrs. with monitoring or titration every 1-2 hrs. with monitoring or titration >2hrs with monitoring <24hrs |
| Respiratory compromise requiring oxygen support |
| Presentation | Decreased urination |
| Volume overload | |
| Comorbidities | Acute infection |
| Renal transplant | |
| Immunocompromised status | |
| Examination | Hemodynamic instability |
| Workup | Sodium < 120 mEq/L (120 mmol/L) and volume overload |
| Sodium > 160 mEq/L (160 mmol/L) | |
| Potassium> 6.0 mEq/L (6.0 mmol/L) with Neuromuscular deficit or Widening QRS or peaked T waves requiring Calcium chloride/ calcium gluconate/ 50% glucose with insulin/kayexalate | |
| Potassium<3.0mEq/L with PVCs requiring potassium administration | |
| Urine output < 0.5 ML/KG/h or creatinine≥ 2 X ULN or baseline or GFR > 50% decrease from baseline | |
| Management | Diuretic continuous or bolus with frequent monitoring or titration |
| Dialysis initiation or Continuous renal replacement therapy |
| Presentation | Persistent or worsening Neurological deficit |
| Persistent vomiting/ inability to take oral intake | |
| Comorbidities | Known possible infectious source |
| Pregnancy | |
| Jaundice with bilirubin >2.5mg/dl | |
| Hepatic Encephalopathy ≥ Grade II | |
| Examination | Neurologic assessment every 4 hours |
| Hemodynamic instability | |
| Workup | Hypertensive or metabolic encephalopathy |
| Definitive imaging finding e.g. CVA or Brain metastasis or cerebral edema | |
| Severe electrolyte abnormalities as possible etiology requiring frequent monitoring and intervention | |
| Acute heart failure with hypoxia and tachycardia | |
| Management | Anticonvulsant initiation |
| Presentation | Persistent vomiting/diarrhea/inability to tolerate oral intake> 48hrs |
| Altered mental status | |
| Comorbidities | History of CHF preventing aggressive hydration |
| Neutropenic cancer patient | |
| History of organ transplant | |
| Pregnant patient | |
| Examination | Hemodynamic instability |
| Workup | Meets criteria for sepsis |
| Evidence of ileus or bowel obstruction | |
| Acute renal failure | |
| Severe electrolyte abnormalities with EKG finding or requiring close monitoring | |
| Diabetic ketoacidosis | |
| Management | NPO with IV fluids for 2 days |
| Nasogastric tube | |
| TPN nutrition | |
| Initiation of Corticosteroid/ immunosuppressant/Anti tumor necrosis factor / monoclonal antibody for Inflammatory Bowel Disease |
| Presentation | Left heart failure with worsened symptoms |
| Right heart failure with worsened symptoms, > 3lbs weight gain and extremities’ edema | |
| Comorbidities | Chronic Obstructive Pulmonary Disease |
| Diabetes mellitus with uncontrolled blood sugar(>300) | |
| Pneumonia | |
| Mental Sickness or Substance Abuse | |
| Examination | Persistent tachycardia and /or Hypotension |
| Persistent Hypoxia or increased oxygen requirement from baseline | |
| Altered mental status | |
| Class III or IV Angina | |
| Hemodynamic instability | |
| Workup | Worsening renal failure or ESRD requiring >1 dialysis run or poor diuresis |
| Unstable cardiac rhythm or new onset dysrhythmia (A.fib/flutter, SVT with rate >120, V. fib/ tach, wide complex tachycardia) | |
| New onset Heart Failure | |
| Cardiac ischemia | |
| Management | Continuous diuretic drip or increasing requirement of diuretic due to poor response |
| Titrated vasoactive/ inotropic drips | |
| Pacemaker placement |
| Presentation | New onset or newly diagnosed Diabetes Mellitus |
| Altered mental status | |
| Comorbidities | Infection / myocardial infarction/ surgery/ trauma |
| Hemodialysis patient | |
| Examination | Hemodynamic instability |
| Workup | DKA as confirmed by Blood glucose > 250, pH < 7.30, HCO3≤18 mEq/L, positive serum or urine ketones |
| Hyperosmolar hyperglycemic state as noted with serum osmolarity >320 and Blood sugar >600 | |
| Acute renal failure or extreme oliguria | |
| Cerebral edema | |
| Management | Blood glucose and electrolyte monitoring at least every 4 hours |
| IV Insulin | |
| IV fluids requirement due to poor oral intake or hydration |
| Presentation | Syncope during exertion or while supine |
| Associated symptoms [palpitations, shortness of breath] | |
| Comorbidities | Family history of sudden cardiac death |
| Known diastolic dysfunction or ejection fraction <35% or previous myocardial infarction | |
| Examination | Hemodynamic instability |
| New neurological deficit | |
| Workup | Abnormal EKG finding: Wolff Parkinson White syndrome, bradycardia without suspected drug toxicity, QRS duration more than or equal to 120ms, QT interval either prolonged [men > 440ms; women > 460ms] or short <340ms, right bundle branch block with ST elevation in leads V1, V2 and V3, |
| Pacemaker malfunction requiring temporary pacemaker | |
| Arrhythmia as possible etiology | |
| Severe electrolyte abnormalities requiring close monitoring | |
| Aortic stenosis as possible etiology requiring further management | |
| Management | Continuous cardiac monitoring excluding Holter monitor |
| Initiation of antiarrhythmic medication | |
| Pacemaker placement |
| Presentation | Hematemesis or melena: significant amount or multiple episodes |
| Syncope/ dizziness / lethargy/ chest pain/ dyspnea | |
| Altered mental status | |
| Comorbidities | End stage liver disease |
| Coagulopathy (PT ≥ 1.5X ULN or INR ≥ 2.0 or PTT ≥ 1.5 X ULN or on anti coagulants) | |
| Portal hypertension | |
| Esophageal varices | |
| Pregnancy or postpartum | |
| Examination | Hemodynamic instability (Tachycardia and/or Tachypnea) |
| Orthostatic hypotension | |
| Workup | EKG changes concerning for ischemia or rhythm abnormalities |
| Management | Blood transfusion |
| IV fluid resuscitation | |
| IV Anti arrhythmic / anticonvulsant/ vasoactive/ inotrope/ octreotide or somatostatin | |
| Endoscopy with procedure to control bleeding | |
| Postpartum requiring return to OR to stop bleeding |
| Presentation | Wheezing with persistent/worsening symptoms after outpatient treatment for at least 1 day |
| Comorbidities | Past history of sudden exacerbation, respiratory failure, and/or intubation |
| Examination | Persistent tachypnea |
| Persistent documented hypoxia (O2 Sat< 90% or pO2 < 60mmHg or pCO2 >45 mmHg) requiring supplemental oxygen above baseline | |
| Impending respiratory fatigue/ accessory muscle use/ stridor or worsening dyspnea after treatment | |
| Decreased level of consciousness/ altered mental status | |
| Hemodynamic instability | |
| Workup | PEF 26-39% predicted after bronchodilator (for asthma)( PEF <25% → ICU) |
| Imaging finding of Pulmonary edema/ pulmonary embolism/ pulmonary infiltrates/ pneumothorax / pleural effusion | |
| Management | Bronchodilator >6X/24h |
| Persistent supplemental oxygen requirement above baseline | |
| Mechanical ventilation or NIPPV |
| Presentation | Finding of acute end organ damage [acute renal failure, hypertensive encephalopathy, intracranial hemorrhage, papilledema, focal neurologic abnormalities, cerebrovascular accident, congestive heart failure, acute coronary syndromes, aortic dissection] |
| Comorbidities | Pregnancy |
| Pheochromocytoma induced hypertension | |
| Examination | Altered mental status |
| Papilledema | |
| Focal neurological abnormality | |
| Unstable vital signs/ Hemodynamic instability | |
| Acute EKG findings | |
| Persistent or worsening symptoms | |
| Workup | |
| Management | Initiation of antihypertensive requiring titration and/or monitoring beyond observation time |
| Initiation of antiarrhythmic requiring titration and/or monitoring |
| Presentation | High risk for thromboembolism requiring anticoagulation therapy [check DVTs/PE algorithm] |
| Bleeding and blood product transfusion with chest pain or dyspnea or tachycardia and postural hypotension and/or INR > 2.0 | |
| Acute onset or worsening neurological impairment | |
| Cardiac arrest and post resuscitation care | |
| Intolerance to oral intake NPO with IV fluids | |
| Post operative fever | |
| Comorbidities | Worsening of previous arrhythmia |
| COPD requiring bronchodilator(≥6/day) or steroid | |
| NYHA Class III or IV | |
| Sleep apnea | |
| Requiring continuous cardiac monitoring due to known ventricular assist device | |
| Examination | Hypoxia with pulse oximetry <89% requiring supplemental oxygen above baseline |
| Compartment syndrome/ limb ischemia | |
| Malignant hyperthermia | |
| Hemodynamic instability | |
| Workup | Elevated cardiac biomarkers [see chest pain algorithm] |
| Hyperkalemia (potassium > 6.0) with EKG changes or neuromuscular deficit requiring management with calcium chloride/ calcium gluconate/ glucose with insulin/ Kayexalate | |
| Hypokalemia with potassium <3.0, PVCs >6 / min/ Bigeminal rhythm / Multifocal PVCs/ Torsades de pointes / Ventricular fibrillation / ventricular tachycardia and potassium chloride ≥ 10 mEq/h or ≥ 120 mEq/24h | |
| Hypercalcemia (calcium of 11.1-≥15.0 mg/ dl) requiring management with IV fluids / calcium lowering agent | |
| Hypocalcemia (calcium level of <5.0 -7.4mg/ dl) requiring calcium administration | |
| Hypermagnesemia (magnesium > 2.5) requiring calcium gluconate or diuretic | |
| Hypomagnesemia (magnesium <1.0-1.4) with Torsade de pointes/ ventricular fibrillation/ ventricular tachycardia requiring magnesium administration | |
| Hypernatremia with sodium > 150 mEq/ L requiring IV fluid and electrolyte monitoring | |
| Hyponatremia with sodium of 120-129 requiring fluid restriction/ IV fluid and oral sodium supplement / medication administration (Conivaptan / Demeclocycline/ diuretic / lithium / tolvaptan) | |
| Hypophosphatemia with serum phosphorus of < 1.0 requiring phosphate administration | |
| Acute kidney injury criteria (check under AKI ) | |
| Disseminated intravascular coagulation | |
| Management | IV medications [antiarrhythmic/ anticonvulsant/ antihypertensive/ calcium channel blocker/ beta-blocker/ diuretic/ insulin/ vasoactive medication/ inotrope] along with continuous monitoring or monitoring with titration |
| Pain management requiring parenteral medication [3 times over 24 hours or change in medication, dose or frequency] | |
| Cerebral edema requiring intracranial pressure monitoring / corticosteroid / osmotic diuresis | |
| Chest tube with continuous suction or drainage >100ml / d or requiring repositioning < 24 hrs. | |
| Temporary or permanent pacemaker |
| Presentation | Pre-term premature rupture of membranes (PPROM) with 24-<32 weeks requiring corticosteroid administration or ≥ 32 weeks |
| Abdominal pain or trauma | |
| Nausea/ vomiting | |
| Spinal headache | |
| Comorbidities | Hypertension |
| Diabetes/ Pregestational Diabetes/ Gestational Diabetes | |
| Thyroid Disorder | |
| Substance Abuse | |
| Mental Health Disorder | |
| Examination | Hemodynamic instability |
| Inadequate oral intake | |
| Workup | Persistent amniotic fluid leakage |
| Concern of chorioamnionitis | |
| Preterm premature rupture of membranes with Amniotic fluid index < 5cm | |
| Preterm premature rupture of membranes with oligohydramnios (Single deep amniotic fluid pocket ≤2cm) | |
| Management | IV medications [antiarrhythmic/anticonvulsant/ antihypertensive/calcium channel blocker/ beta-blocker/diuretic/insulin/ vasoactive medication/ inotrope] along with continuous monitoring or monitoring with titration |
| Presentation | Graft dysfunction (Graft vs Host Disease/ rejection/failure) and on immunosuppressant requiring medication adjustment or with signs of toxicity |
| Bone Marrow or Stem Cell Transplant requiring fluids or awaiting engraftment | |
| Liver Transplant complication | |
| Acute vascular rejection | |
| Comorbidities | Post Transplant infection with ANC < 1000/cu.mm or WBC >12,0000 or Bands > 10% |
| Acute Leukemia or Lymphoma and induction chemotherapy | |
| Radioactive implant ≤ 7d since insertion and isolation | |
| Examination | Hemodynamic instability |
| Hypoxia requiring supplemental oxygen | |
| Persistent tachycardia/ development of rhythm abnormalities | |
| Workup | Acute kidney injury/ urinoma/ worsening proteinuria |
| Aplasia secondary to treatment (myeloablative therapy) | |
| Tumor Lysis syndrome with Calcium <7.5mg/dl or K >5.5 mEq/L or PO4 ≥4.1mg/dl or Uric acid ≥ 7.5 mg/dl | |
| Echocardiogram showing new findings of decreased ejection fraction or other abnormalities | |
| AST/ALT/ Alkaline phosphatase > 4X upper limit of normal | |
| Bilirubin >2X Upper limit of normal | |
| Biloma/ Hematoma of Liver | |
| Hepatic abscess | |
| Hepatic artery thrombosis | |
| Lymphocele causing compression of urinary bladder/ iliac vein or obstruction of ureter | |
| Seroma requiring drainage | |
| Management | New immunosuppressant initiation or adjustment |
| Multiple transfusion dependency | |
| Thrombolysis/ thrombectomy or anticoagulant initiation for hepatic/portal vein thrombosis |
| Presentation | Altered mental status |
| Seizure | |
| Impending respiratory failure | |
| Comorbidities | Acute Kidney injury |
| SIADH | |
| Examination | Hemodynamic instability |
| Workup | Lumbar puncture findings indicative of infection |
| Cerebral edema | |
| Sepsis | |
| Brain Abscess | |
| Lactic acidosis | |
| Management | Neurological assessment every 1-2 hours |
| Anti-infective (antibiotic/anti-fungal/ anti-viral) | |
| IV Medication (Vasoactive/Inotrope/ antiarrhythmic/anti convulsant/ anti hypertensive/ beta blocker/ calcium channel blocker/ diuretic/ insulin/ neuromuscular blockade) administration with frequent monitoring | |
| Disseminated intravascular coagulation and blood product transfusion |
| Presentation | Altered mental status |
| Seizure | |
| Impending respiratory failure | |
| Comorbidities | Acute Kidney injury |
| SIADH | |
| Examination | Hemodynamic instability |
| Workup | Lumbar puncture findings indicative of infection |
| Cerebral edema | |
| Sepsis | |
| Brain Abscess | |
| Lactic acidosis | |
| Management | Neurological assessment every 1-2 hours |
| Anti-infective (antibiotic/anti-fungal/ anti-viral) | |
| IV Medication (Vasoactive/Inotrope/ antiarrhythmic/anti convulsant/ anti hypertensive/ beta blocker/ calcium channel blocker/ diuretic/ insulin/ neuromuscular blockade) administration with frequent monitoring | |
| Disseminated intravascular coagulation and blood product transfusion |