SHARP ESO COMPREHENSIVE EXAM UPDATED
QUESTIONS AND ANSWERS GUARANTEE A+
✔✔Severe Anaphylaxis - ✔✔Stridor; wheezing; respiratory distress; pallor; cyanosis or
clinical signs of shock
i. O2 at minimum of 10L/min. NRBM
ii. Epinephrine 0.3mg IM (Use epinephrine 1mg/ml), preferably in thigh. Repeat in 5
minutes if no clinical improvement.
iii. Place patient supine and elevate lower extremities
iv. Infuse 250ml NS (may be substituted with LR if currently infusing). Repeat in 5
minutes if no clinical improvement.
v. In the presence of bronchospasm: Albuterol 0.5ml in 3ml NS aerosol inhalation
vi. Hydrocortisone (Solucortef) 100mg IVP/IO
vii. Diphenhydramine (Benadryl) 25mg IVP/IO
viii. Famotidine 20mg IVP
ix. If no response and patient still showing signs of shock, give epinephrine 0.1mg/IV/IO
(use epinephrine 0.1mg/ml) slowly over 5 minutes
x. If no response, RRT/ICU RN may start epinephrine infusion 2mg/250ml NS at
1mcg/min., titrate to patient response up to 10mcg/min.
✔✔Suspected Sepsis Algorithm - ✔✔i. If hypovolemia known or suspected, infuse
250ml NS (may be substituted with LR if currently infusing). Repeat in 5 minutes after
infusion is complete if no improvement
ii. Evaluate if patient meets at least 2 SIRS criteria:
a. WBC count greater than 12,000 or less than 4,000 or greater than 10% bands
b. Heart rate greater than 90bpm
c. Respiratory rate greater than 20 per minute
d. Temperature greater than 38.3 C or less than 36 C
iii. If patient meets two SIRS criteria, assess for infection (confirmed of suspected) and
organ dysfunction (any one of the below criteria):
a. SBP less than 90, MAP less than 65 or decrease in SBP greater than 40mmHg
b. Lactate greater than 2
c. Creatinine greater than 2 or UOP less than 0.5ml/kg/hr
d. Bili greater than 2
e. Platelets less than 100,000
f. INR greater than 1.5, aPTT greater than 60 seconds
g. New onset respiratory failure requiring BIPAP or intubation
h. New mental status changes
iv. If criteria in #3 met:
a. Obtain serum lactate if not done within 6 hours: repeat in 4 house if initial level
greater than 2). Rapid Response Team may order a POC lactate
b. Obtain blood cultures x2.
c. ICU/RRT RN Only if SBP less than 90mmHg after 250ml fluid bolus times two
i. Start norephinephrine 4mg/250ml NS @ 2mcg/min. Titrate until SBP greater than or
equal to 90 mmHg and/or MAP greater than 65mmHg up to 32 mcg/min.
ii. LR or NS fluid bolus order of 30ml/kg @ 126ml/hr
, d. Consocumult RRT and call physician
✔✔Documentation for nurse instituting ESO - ✔✔a. Life threatening condition
b. Precipitating factors
c. Specific ESO implemented (medication and/or treatment)
d. Patient's response
e. When and which physician was notified
✔✔ESO Documentation - ✔✔a. Interdisciplinary note
b. Provider communication note
c. Code Blue record and critique form-- for respiratory and cardiopulmonary arrest
d. Rapid Response Team record will be completed for all RRT events that utilize ESOs
✔✔One cycle of CPR - ✔✔-2 minutes of 100-120 compressions/min.
-O2 delivered by 15L by bag mask (10 breaths/min.)
-Use 30 compressions/2 ventilation ratio without an advanced airway
✔✔Time event recognized to first chest compression - ✔✔Less than one minute
✔✔Time event recognized to first defibrillation (initial rhythm is VF or pulseless VT) -
✔✔Less than 3 minutes
✔✔Subsequent shock delivered - ✔✔2 minutes from previous shock- allow full 2
minutes of chest compressions
✔✔Time pulselessness recognized to first IV/IO Epinephrine - ✔✔Less than 5 minutes
✔✔Time event recognized to first assisted ventilation - ✔✔Less than a minute
✔✔Targeted Temperature Management-TTM (Therapeutic hypothermia) - ✔✔Should
be considered for all patients not following commands or not showing purposeful
movement within 120 minutes after return of spontaneous circulation
✔✔Asystole treatment - ✔✔Asystole represents total absence of ventricular
activity/contraction. There is no pulse associated with this rhythm. Initiate CPR
immedicately.
a. CPR for 2 minutes
b. O2 at 15ml/min. ambu bag (10 breaths per minute)
c. Epinephrine 1mg IVP/IO (Use Epinephrine 0.1mg/ml) repeat every 3-5 minutes
d. Repeat CPR and Epinephrine administrations if not signs of ROSC
-NO defibrillation
-Transcutaneous pacing for asystole is not recommended as it is ineffective
QUESTIONS AND ANSWERS GUARANTEE A+
✔✔Severe Anaphylaxis - ✔✔Stridor; wheezing; respiratory distress; pallor; cyanosis or
clinical signs of shock
i. O2 at minimum of 10L/min. NRBM
ii. Epinephrine 0.3mg IM (Use epinephrine 1mg/ml), preferably in thigh. Repeat in 5
minutes if no clinical improvement.
iii. Place patient supine and elevate lower extremities
iv. Infuse 250ml NS (may be substituted with LR if currently infusing). Repeat in 5
minutes if no clinical improvement.
v. In the presence of bronchospasm: Albuterol 0.5ml in 3ml NS aerosol inhalation
vi. Hydrocortisone (Solucortef) 100mg IVP/IO
vii. Diphenhydramine (Benadryl) 25mg IVP/IO
viii. Famotidine 20mg IVP
ix. If no response and patient still showing signs of shock, give epinephrine 0.1mg/IV/IO
(use epinephrine 0.1mg/ml) slowly over 5 minutes
x. If no response, RRT/ICU RN may start epinephrine infusion 2mg/250ml NS at
1mcg/min., titrate to patient response up to 10mcg/min.
✔✔Suspected Sepsis Algorithm - ✔✔i. If hypovolemia known or suspected, infuse
250ml NS (may be substituted with LR if currently infusing). Repeat in 5 minutes after
infusion is complete if no improvement
ii. Evaluate if patient meets at least 2 SIRS criteria:
a. WBC count greater than 12,000 or less than 4,000 or greater than 10% bands
b. Heart rate greater than 90bpm
c. Respiratory rate greater than 20 per minute
d. Temperature greater than 38.3 C or less than 36 C
iii. If patient meets two SIRS criteria, assess for infection (confirmed of suspected) and
organ dysfunction (any one of the below criteria):
a. SBP less than 90, MAP less than 65 or decrease in SBP greater than 40mmHg
b. Lactate greater than 2
c. Creatinine greater than 2 or UOP less than 0.5ml/kg/hr
d. Bili greater than 2
e. Platelets less than 100,000
f. INR greater than 1.5, aPTT greater than 60 seconds
g. New onset respiratory failure requiring BIPAP or intubation
h. New mental status changes
iv. If criteria in #3 met:
a. Obtain serum lactate if not done within 6 hours: repeat in 4 house if initial level
greater than 2). Rapid Response Team may order a POC lactate
b. Obtain blood cultures x2.
c. ICU/RRT RN Only if SBP less than 90mmHg after 250ml fluid bolus times two
i. Start norephinephrine 4mg/250ml NS @ 2mcg/min. Titrate until SBP greater than or
equal to 90 mmHg and/or MAP greater than 65mmHg up to 32 mcg/min.
ii. LR or NS fluid bolus order of 30ml/kg @ 126ml/hr
, d. Consocumult RRT and call physician
✔✔Documentation for nurse instituting ESO - ✔✔a. Life threatening condition
b. Precipitating factors
c. Specific ESO implemented (medication and/or treatment)
d. Patient's response
e. When and which physician was notified
✔✔ESO Documentation - ✔✔a. Interdisciplinary note
b. Provider communication note
c. Code Blue record and critique form-- for respiratory and cardiopulmonary arrest
d. Rapid Response Team record will be completed for all RRT events that utilize ESOs
✔✔One cycle of CPR - ✔✔-2 minutes of 100-120 compressions/min.
-O2 delivered by 15L by bag mask (10 breaths/min.)
-Use 30 compressions/2 ventilation ratio without an advanced airway
✔✔Time event recognized to first chest compression - ✔✔Less than one minute
✔✔Time event recognized to first defibrillation (initial rhythm is VF or pulseless VT) -
✔✔Less than 3 minutes
✔✔Subsequent shock delivered - ✔✔2 minutes from previous shock- allow full 2
minutes of chest compressions
✔✔Time pulselessness recognized to first IV/IO Epinephrine - ✔✔Less than 5 minutes
✔✔Time event recognized to first assisted ventilation - ✔✔Less than a minute
✔✔Targeted Temperature Management-TTM (Therapeutic hypothermia) - ✔✔Should
be considered for all patients not following commands or not showing purposeful
movement within 120 minutes after return of spontaneous circulation
✔✔Asystole treatment - ✔✔Asystole represents total absence of ventricular
activity/contraction. There is no pulse associated with this rhythm. Initiate CPR
immedicately.
a. CPR for 2 minutes
b. O2 at 15ml/min. ambu bag (10 breaths per minute)
c. Epinephrine 1mg IVP/IO (Use Epinephrine 0.1mg/ml) repeat every 3-5 minutes
d. Repeat CPR and Epinephrine administrations if not signs of ROSC
-NO defibrillation
-Transcutaneous pacing for asystole is not recommended as it is ineffective
