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ESO/EKG Sharp Exam Questions with correct Answers
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ESO/EKG Sharp Exam Questions withcorrect Answers
ESO for Asystole (aka Ventricular Standstill) - -1. CPR 2min uninterrupted 2.
15L 02 ambu bag 3. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/ml),
repeat q 3-5 minutes. Flat line or P wave w/ no QRS's.
-ESO or bradycardia - -1. 02 10L NRBM 2.if pacing wires present, initiate
pacing 3.Atropine 0.5mg IVP/IO can repeat 3-5min up to 3mg. 4.
transcutaneous pacing asap 5. if ineffective, dopamine 400mg/250ml
D5W@5mcg/kg/min. Titrate response up to 20 mcg/kg/min 6. ineffective give
epinephrine 2mg/250NS@2mcg/min, titrate response up to 10mcg/min.
*Assess adequate intravascular volume/volume status prior to
vasoconstrictors.
-ESO for PEA - -1. CPR 2 min & look for causes H's (hypovolemia, hypoxia,
hyper/o -kalemia, hypoglycemia, hypothermia); T's (toxins, tamponade,
thrombosis, trauma, tension pneumothorax). 2. O2 15L ambu 3. Epinephrine
1 mg IVP/IO (use epinephrine 0.1 mg/mL), repeat q 3-5 minutes 3. if
hypovolemia suspected bolus 250ml NS (LR if already infusing), repeat in
5min if no improvement. 4. Stat CXR
-ESO for Ventricular Tachycardia (stable wide complex) - -1) call physician
for orders 2) O2 4L NC, titrate per status 3) 12 Lead EKG 4) Draw K+ & Mag+
+
-ESO for Vtach (UNSTABLE, wide complex) - -1) O2 10L NC 2) >150
biphasic: synchronized cardioversion for dose listed on defib. If responsive,
give Versed (midazolam) 0.5 IVP/IO prior to cardioversion. May repeat x1 to
achieve sedation. *Romazicon reversal for midazolam IVP 0.2mg over 15 sec.
may repeat in 45sec up to 0.6mg. 3. Draw K+ and Mag++
-ESO for VFibb/Pulseless Vtach - -No stacked shocks. Cont CPR unless
defibbing. Give meds during CPR. Immediate defib if witnessed arrest. 1. CPR
2min or until defib arrives. 2.O2 15L ambu 3.Defib (joules per approved
dose) 4. Epinephrine 1mg (use 0.1mg/ml) 5. defib 6. Amiodarone 300mg
IVP/IO 7. defib 8. Repeat Epinephrine 8. defib 9. Amiodarone 150mg IVP/IO
10. If rhythm persists: debib, CPR, repeat epi q3-5min.
-ESO for chest pain - -1) aspirin 325mg if not contraindicated. 2) O2 min
4LNC titrate so sat= or>94% 3)NTG is SBP>90 and/or MAP>60 & HR>50,
May repeat 3-5minx2. 4)morphine 2mg if SBP>90 q5min up to 10mg. 5) if
hypotension develops & no pulm congestion suspected, bolus 250NS (or LR if
running) & resume tx for chest pain if unrelieved. 6) Stat EKG
, -ESO symptomatic hypotension - -1) O2 10LNRBM 2) if hypovolemia
suspected bolus 250NS (or LR if running). Repeat in 5min if needed. 3) if
SBP<90 dopamine 400mg/250ml D5W at 5mcg/kg/min. Titrate until SBP= or
>90 or MAP>60 or up to 20mcg/kg/min 4) if blood loss get stat H&H, type
and cross, and 2units RBC's. 5) if suspected sepsis use algorithm.
-ESO Sepsis Algorithm - -1) if hypovolemic infuse 250ml NS (or LR), may
repeat in 5min. 2) SIRS criteria 1: 4>WBC>12 or bands>10% 2: HR>90 3:
RR>20 4: temp less than 36 or >38.3. must meet 2 criteria 3) if meets 2
criteria assess for suspected/confirmed infection and organ disfunction. Must
meet 1 of these 1:SBP<90, map<65, decrease SBP>40, lactate>2,
creatinine>2, UOP<0.5ml/kg/hr, bili>2, platelets<100, INR.1.5/aPTT>60sec,
new onset resp failure w/ bipap. 3) if one met, obtain serum lactate (if none
in last 6hrs) and repeat in 4hrs )RRT can order POC lactate). 4) order blood
cultures, consult RRT, call physician.
-ESO for Hypoglycemia - -P&P #30094.99 for serum or fingerstick less than
70
-ESO for increased ITP - -(neuro impaired w/ dilated pupils in absence of ICP
orders) 1) if not hypotensive, put HOB>30degrees and midline. 2) if
intubated hyperventilate FiO2 at 100% to have to maintain PCO2 at 30-
35mmHg.3) Mannitol 20% (100gn/500ml) rapid infusion IVP/IO w/ filter (if
filter avail). 3) draw baseline serum K+, Na+, Cr, BUN, glucose, and ABG. 4)
insert urinary catheter.
-ESO Respiratory Depression (d/t narcs or benzos) - -1) O2 10LNRBM. 2) for
narcs give naloxalone max 0.4mg. for Apnea give 0.4mg IVP/IO once. For
RR<10 give 0.1mg q1min up to 3x's. 3) for benzos give Romazicon
(flumazenil) 0.2mg over 15 sec. May repeat in 45sec if needed up to 0.6mg
-ESO respiratory distress - -(noted by RR/accessory muscles/ALC/cyanotic
nailbeds) 1) O2 10LNRBM. 2) stat portable CXR. 3) if bronchospasm albuterol
0.5 in 3ml NS aerosol inhalation. 4) RRT can obtain ABG's 5) RRT may initiate
non-invasive ventilation for COPD/asthma/CHF if not contraindicated.
-ESO status epilepticus - -(seizure 3min+, or recurrent w/out return to of
conscious). 1) protect airway, put in lateral decubitus position, protect from
injury. 2) 02 10LNRBM 3) Ativan IVP/IO 2mg over 1min 4) draw K+, Na+, Cr,
BUN, glucose, and anticonvulsant levels
-ESO severe anaphylaxis - -(stridor/wheezing/resp
distress/pallor/cyanosis/signs of shock) 1) O2 min 10LNRBM 2) epi 0.3 IM
(use 1mg/ml) repeat in 5min if no improvement. 3) no improvement give
0.1mg IVP/IO (use 0.1mg/ml) push over 5 min. Solucortef (hydrocortisone)
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