Exam (elaborations)
Sharp ESO Exam|94 Questions with complete Solutions
Sharp ESO Exam|94 Questions with complete Solutions
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Sharp ESO Exam|94 Questions withcomplete Solutions
End Tidal CO2 - -the maximum CO2 concentration at the end of each tidal
breath, which can be used to assess disease severity and response to
treatment. Reflects cardiac output during CPR. Can be used to measure the
effectiveness of cardiac compressions and assessment of return of
spontaneous circulation (ROSC) after cardiac event
-ROSC - -Return of spontaneous circulation is established with the presence
of palpable pulse, blood pressure, abrupt sustained increase in end tidal CO2
(typically > 40mmHg) after cardiac arrest
-therapeutic hypothermia - -Core temperature 32-36 C (89.6-96.8 F)
-joules for defibrillation - -Defibrillation Joules: 200 joules
-joules for cardioversion - -Cardioversion joules: 200 joules
Physicians may order 75-120-150-200 for conditions not covered in ESO
policy
-For the patient not following commands after 120 minutes of ROSC - -
Consider initiation of therapeutic hypothermia
-Treatment of pulseless arrests - -Provide 2 minutes of CPR-avoiding
interruptions in compressions
-Asystole treatment - -i. CPR (2 min.)
ii. O2 at 15 L/min. ambu bag
iii. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/ml), repeat q 3-5
minutes
iv. Repeat CPR and Epinephrine administration if no signs of ROSC
-Unstable Bradycardia - -i. O2 at minimum 10 L/min. NRBM
ii. If transvenous leads or epicardial pacing wires present, connect to a pulse
generator and initiate pacing per protocol.
If no response, perform the following:
iii. Atropine 1 mg IVP/IO, repeat q 3-5 minutes max 3 mg
iv. Transcutaneous pacing as soon as possible
If above algorithm is ineffective:
v. Start dopamine 400 mg/250 ml D5W infusion at 5 mcg/kg/minute. Titrate
to patient response up to 20mcg/kg/minute
If above algorithm is ineffective, start epinephrine 2 mg/ 250 ml NS @ 2
mcg/min., titrate to patient response up to 10 mcg/minute
, -Pulseless Electrical Activity - -i. CPR 2 minutes and assess for possible
causes
The H's:
-Hypovolemia
-Hypoxia
-Hydrogen ion (acidosis)
-Hypokalemia
-Hyperkalemia
-Hypoglycemia
-Hypothermia
The T's:
-Toxins
-Cardiac Tamponade
-Thrombosis
-Trauma
-Tension pneumothorax
ii. O2 at 15 L/min ambu bag
iii. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/mL), repeat q 3-5
minutes
iv. Repeat CPR and Epinephrine administration if no signs of ROSC
v. If hypovolemia known or suspected, infuse 250 mL NS may be substituted
with LF if currently infusing). Repeat in 5 minutes if no clinical improvement.
vi. Stat CXR
-Ventricular Tachycardia (Wide Complex): Stable - -i. Call the physician for
orders
ii. O2 at minimum 4 L/min. NC and adjust per patient status
iii. Obtain 12 lead EKG
iv. Draw serum K and Mg
-Ventricular Tachycardia (Wide Complex): Unstable - -i. O2 at minimum 10
L/min. NRBM
ii. If ventricular rate greater than 150:
-Biphasic: synchronized cardioversion (200 joules)
iii. If patient is awake and responsive, give midazolam (Versed) 0.5 mg IVP/
IO prior to cardioversion. May repeat to a total of 1 mg to achieve sedation.
Note: Romazicon is the reversal agent for midazolam. If patient has signs
and symptoms of oversedation (ex: decreased level of consciousness,
respiratory rate less than 10/min.) Romazicon 0.2mg IVP/IO over 15 seconds.
May repeat in 45 seconds based on patient response, not to exceed 0.6mg.
iv. Draw serum K+ and Mg++.
-Romazicon - -Reversal agent for midazolam
, -Standard Procedure Functions - -Emergency Standing Orders (ESOs) will be
initiated by ESO competency-validated RNs for life threatening conditions of
adult patients in the absence of a physician. In patient care areas without
ESO competency validated RNs, the Rapid Response Team or Code Blue will
be called for assistance.
-Emergency Standing Orders (ESO) - -Pre-established medical orders,
approved by appropriate medical staff to be administered in the absence of a
physician. Orders specify emergent treatment interventions for life-
threatening conditions.
-ESO Competent Nurse - -RN who had successfully demonstrated the
knowledge and skills in identification and treatment of life-threatening
conditions
-Rapid Response Team - -A team PF health care professionals who bring
critical care expertise to the patient bedside
-CPR (cardiopulmonary resuscitation) - -Includes circulation with
compressions, airway assessment and breathing (C-A-B)
-Intraosseous (IO) Therapy - -Specialty Catheter inserted into the
intraosseous space by a trained physician or IO insertion validated RN. Safe
and alternative route to IV therapy is initiated when IV access is urgently
needed but is not available
-Comatose Adult - -No eye opening to pain and no purposeful motor
response
-Unstable - -Serious signs and symptoms related to the life-threatening
rhythm or conditions which may include:
Signs: tachypnea; apnea; respiratory depression; tachycardia; bradycardia;
arrhythmias; hypotension; decreased O2 saturation; dyspnea; change in
level of consciousness; increased intracranial pressure (ICP); status
epilepticus
Symptoms: Dizziness; lightheadedness; shortness of breath; chest pain;
weakness; cold; diaphoretic; heart palpitations; anxiousness
-Titrate to patient's response: - -For the purpose of this policy, "patient
response" means improvement in the patient's symptom for which the
intervention was intended to relieve
-Circumstance under which an ESO Competent RN may perform ESO
standarized procedures: - -Emergency standing orders will be initiated by
ESO competency-validated RNs in the absense of a physician.
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