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Standardized Procedure- Emergency Standing Orders at Sharp Healthcare Exam 2023
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Standardized Procedure- Emergency Standing Orders at Sharp Healthcare Exam 2023
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Standardized Procedure- EmergencyStanding Orders at Sharp Healthcare Exam
2023
General Procedure for all Life-Threatening Patient Conditions- what kind of
access should a nurse obtain? - -a. Obtain IV/intraosseous (IO) access (large
bore cannula in the antecubital vein should be the first target for IV access if
a central line is not present)
-General Procedure for all Life-Threatening Patient Conditions- what kind of
fluid should be started to KVO? - -b. Begin IV infusion of Normal Saline (NS)
to keep vein open (KVO)
-General Procedure for all Life-Threatening Patient Conditions- If IV access is
not available what medications can be given and how is it administered? - -
c. If IV access is not available: Narcan, Atropine, and Epinephrine may be
administered via endotracheal route at doses of 2 times the IV dose diluted
in 10ml NS flush
-General Procedure for all Life-Threatening Patient Conditions- what's the
process after giving each medication? - -d. Flush IV line with 20ml of NS
after each IV medication given and elevate extremity if applicable.
-General Procedure for all Life-Threatening Patient Conditions- In applicable
situations, what should be readily available? - -e. Oxygen
-What's the proper techniques using circulation, airway, and breathing? - -1.
Compressions should be performed at a rate of 100/min for two minutes
"push hard,push fast" allowing full chest recoil, and minimize interruptions in
chest compressions after each intervention.
2. All external electrical therapy will be cardioverted/defibrillated with
biphasic monitors using appropriate energy dose as designated by condition.
-True/False
In most cases, treatment (e.g. O2 administration) is administered
concurrently. - -TRUE
-True/False
Stickers with appropriate energy levels of cardioversion/defibrillation should
be placed on all defibrillators for quick reference. - -TRUE
-ASYSTOLE - -1. CPR (2 min)
2. O2 at 15ml/min ambu bag (8-10 breaths/min)
, 3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole
persists.
-BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - -1. O2 at minimum
10ml/mim NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse
generator and initiate pacing control.
3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg)
4. Transcutaneous pacing as soon as available
5. If above algorithm is ineffective, start dopamine 400mg/250ml D5W
infusion at 5mcg/kg/minute. Titrate until SBP =/> 90mmHg and/or MAP
>60mmHg up to 20mcg/kg/min.
6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min
IV/IO)
-PULSELESS ELECTRICAL ACTIVITY (PEA) - -1. CPR (2min) and assess for
possible causes.
2. O2 at 15ml/min ambubag (8-10breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5mim
4. If hypovolemia known or suspected, infuse 250ml LR or NS. Repeat in 5
minutes if no clinical improvement.
5. Stat CXR
-What are the 7 H's possible causes of PEA? - -1. Hypovolemia
2. Hypoxia
3. Hydrogen Ion (acidosis)
4. Hypokalemia
5. Hyperkalemia
6. Hypoglycemia
7. Hypothermia
-What are the 5 T'# possible causes of PEA? - -1. Toxins
2. Tamponade
3. Thrombosis
4. Trauma
5. Tension pneumothorax
-VENTRICULAR TACHYCARDIA (Wide Complex) STABLE - -1. Call the
physician for orders
IN ADDITION TO CALLING THE MD PERFORM THE FF:
a. O2 at minimum 4L/min NC and adjust per patient status
b. Obtain 12 Lead EKG
c. Draw serum K, Mg
-VENTRICULAR TACHYCARDIA (Wide Complex) UNSTABLE - -1. O2 at
minimum 10ml NRBM
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