SHARP ESO FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔Ventricular Fibrillation/Pulseless Ventricular Tachycardia - ✔✔Provide continuous
CPR unless defibrillating. Give medications during CPR.
Immediate defibrillation if witnessed arrest and defibrillator is available.
i. CPR (2 min.) or until defibrillator arrives.
ii. O2 at minimum 15L/min. ambu bag.
iii. Defibrillate: Biphasic: joules per approved energy dose
iv. Epinephrine 1mg/IVP/ IO (use epinephrine 0.1mg/ml)
v. Defibrilate 200 joules
vi. Amiodarone 300mg IVP/IO
vii. Defibrillate 200 joules
viii. Amiodarone 150mg IVP/IO
xi. If rhythm persists, defibrillate, CPR, epinephrine 1mg IVP/IO (Use epinephrine
0.1mg/ml) every 3 to 5 minutes until ROSC is achieved.
✔✔Chest Pain - ✔✔i. O2 start at minimum 4L/min. NC and titrate to maintain SPO2
greater than or equal to 94%.
ii. Nitroglycerin 0.4mg sublingual if SBP greater than or equal to 90 mmHg and HR
greater than 50. May repeat every 3-5 minutes x2.
iii. Morphine sulfate 2mg IVP/IO, if SBP greater than or equal to 90 mmHg every 5
minutes up to a total of 10mg.
iv. Give aspirin 325 mg non-enteric coated, chewed or crushed. If not contraindicated
and no dose give on this date.
v. If hypotension develops and no evidence of pulmonary congestion, give 250ml NS
IV/IO (may be substituted with LR if currently infusing) and resume treatment for chest
pain if not relieved.
vi. 12 lead EKG
✔✔Hypotension: Symptomatic - ✔✔i. O2 at minimum 10L NRBM
ii. If hypovolemia is known or suspected, infuse 250ml NS (may be substituted with LR if
currently infusing). Repeat in 5 minutes if no clinical improvement.
iii. If SBP is less than 90mmHg, start dopamine 400mg/250ml D5W infuse at
5mcg/kg/minute. Titrate until SBP greater than or equal to 90mmHg and/or MAP greater
than 60mmHg or up to 20mcg/kg/min.
iv. In the presence of obvious blood loss, draw a stat H/H and Type and Cross 2 units
PRBCs.
v. If suspecting Sepsis, follow Suspected Sepsis Algorithm.
a. O2 at minimum 10L/min. NRBM.
b. Infuse 250ml NS may be substituted with LR if currently infusing. Repeat in 5 minutes
if no clinical improvement.
c. If fluid bolus ineffective, Ephedrine 5mg IVP/IO
d. If no improvement within 3 minutes, repeat Ephedrine at 10mg IVP/IO.
e. In the presence of obvious blood loss draw stat H/H and type and cross 2 units
PRBCs.
,✔✔Hypoglycemia - ✔✔Follow the Hypoglycemic Standardized procedure for any patient
with a serum glucose or fingerstick less than 70mg/dl (less than 60 mg/dl if pregnant).
✔✔Increased Cranial Pressure - ✔✔In the neurologically impaired patient with
examination that suggests elevated intracranial pressure: unilateral of bilateral fixed and
dilated pupils, decorticate or decerebrate posturing (Note: Implement only in the
absence of specific ICP orders.)
i. Raise HOB at least 30 degrees if patient is not hypotensive place patient's head in
midline position.
ii. Hyperventilate the intubated patient with FiO2 100% to maintain pCO2 26-30 mmHg.
iii. Draw serum K+, Na+, BUN, Cr, Glucose, serum osmolality and ABG.
✔✔Respiratory Depression - ✔✔Associated with prior narcotic or benzodiazepine
administration.
i. O2 at minimum 10L/min. NRBM
ii. Narcotic-associated respiratory depression:
Administer naloxone (Narcan) as follows (maximum dose of 0.4mg):
a. Apnea: 0.4mg IVP/IO once
b. RR less than 10: 0.1 mg IVP/IO Narcan every minute, may repeat x3.
iii. For benzodiazepine-associated respiratory depression (apnea to RR less than 10)
administer flumazenil (Romazicon) 0.2mg IVP/IO over 15 seconds. May repeat repeat in
45 seconds based on patient's response, not to exceed 0.6mg.
✔✔Respiratory Distress - ✔✔Demonstrated by change in respiratory rate and/or use of
accessory muscles, altered level of consciousness of cyanotic nail beds.
i. O2 at minimum 10L/min. NRBM
ii. STAT portable x-ray
iii. In the presence of bronchospasm: Albuterol 0.5ml in 3ml NS aerosol inhalation
iv. The Rapid Response Team or ICU RN in the ICU may obtain an ABG of VBG if
unable to obtain ABG.
v. The Rapid Response Team or ICU RN in the ICU may initiate non-invasive ventilation
(NIV) for the following conditions in the absence of any contraindications
a. Exacerbation of: COPD; asthma; acute CHF
b. As a bridge to mechanical ventilation
c. Contraindications for NIV:
i. Respiratory Arrest
ii. Inability to maintain a patent airway or clear secretions
iii. Risk for aspiration of gastric contents (nausea, vomiting, or bowel obstruction)
iv. Pre-existing pneumothorax without chest tube or pneumomediastinum
v. Epistaxis
vi. Recent facial, oral, or skull surgery or trauma
vii. Encephalopathy/altered mental status
viii. Hypotension due to suspected intravascular volume depletion
ix. Unable to tolerate BIPAP
, ✔✔Status Epilepticus - ✔✔Generalized tonic-clonic movements lasting more than 3
minutes or recurrent seizures without return of consciousness
i. Protect airway, position patient in lateral decubitus position, protect patient from injury
ii. O2 at minimum 10L/min. NRBM
iii. Lorazepam (Ativan) 2mg IVP/IO over 1 minute
iv. Draw Na+; K+ Ca; glucose; BUN; Cr; and anticonvulsant levels if appropriate
✔✔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.
ANSWERS GUARANTEE A+
✔✔Ventricular Fibrillation/Pulseless Ventricular Tachycardia - ✔✔Provide continuous
CPR unless defibrillating. Give medications during CPR.
Immediate defibrillation if witnessed arrest and defibrillator is available.
i. CPR (2 min.) or until defibrillator arrives.
ii. O2 at minimum 15L/min. ambu bag.
iii. Defibrillate: Biphasic: joules per approved energy dose
iv. Epinephrine 1mg/IVP/ IO (use epinephrine 0.1mg/ml)
v. Defibrilate 200 joules
vi. Amiodarone 300mg IVP/IO
vii. Defibrillate 200 joules
viii. Amiodarone 150mg IVP/IO
xi. If rhythm persists, defibrillate, CPR, epinephrine 1mg IVP/IO (Use epinephrine
0.1mg/ml) every 3 to 5 minutes until ROSC is achieved.
✔✔Chest Pain - ✔✔i. O2 start at minimum 4L/min. NC and titrate to maintain SPO2
greater than or equal to 94%.
ii. Nitroglycerin 0.4mg sublingual if SBP greater than or equal to 90 mmHg and HR
greater than 50. May repeat every 3-5 minutes x2.
iii. Morphine sulfate 2mg IVP/IO, if SBP greater than or equal to 90 mmHg every 5
minutes up to a total of 10mg.
iv. Give aspirin 325 mg non-enteric coated, chewed or crushed. If not contraindicated
and no dose give on this date.
v. If hypotension develops and no evidence of pulmonary congestion, give 250ml NS
IV/IO (may be substituted with LR if currently infusing) and resume treatment for chest
pain if not relieved.
vi. 12 lead EKG
✔✔Hypotension: Symptomatic - ✔✔i. O2 at minimum 10L NRBM
ii. If hypovolemia is known or suspected, infuse 250ml NS (may be substituted with LR if
currently infusing). Repeat in 5 minutes if no clinical improvement.
iii. If SBP is less than 90mmHg, start dopamine 400mg/250ml D5W infuse at
5mcg/kg/minute. Titrate until SBP greater than or equal to 90mmHg and/or MAP greater
than 60mmHg or up to 20mcg/kg/min.
iv. In the presence of obvious blood loss, draw a stat H/H and Type and Cross 2 units
PRBCs.
v. If suspecting Sepsis, follow Suspected Sepsis Algorithm.
a. O2 at minimum 10L/min. NRBM.
b. Infuse 250ml NS may be substituted with LR if currently infusing. Repeat in 5 minutes
if no clinical improvement.
c. If fluid bolus ineffective, Ephedrine 5mg IVP/IO
d. If no improvement within 3 minutes, repeat Ephedrine at 10mg IVP/IO.
e. In the presence of obvious blood loss draw stat H/H and type and cross 2 units
PRBCs.
,✔✔Hypoglycemia - ✔✔Follow the Hypoglycemic Standardized procedure for any patient
with a serum glucose or fingerstick less than 70mg/dl (less than 60 mg/dl if pregnant).
✔✔Increased Cranial Pressure - ✔✔In the neurologically impaired patient with
examination that suggests elevated intracranial pressure: unilateral of bilateral fixed and
dilated pupils, decorticate or decerebrate posturing (Note: Implement only in the
absence of specific ICP orders.)
i. Raise HOB at least 30 degrees if patient is not hypotensive place patient's head in
midline position.
ii. Hyperventilate the intubated patient with FiO2 100% to maintain pCO2 26-30 mmHg.
iii. Draw serum K+, Na+, BUN, Cr, Glucose, serum osmolality and ABG.
✔✔Respiratory Depression - ✔✔Associated with prior narcotic or benzodiazepine
administration.
i. O2 at minimum 10L/min. NRBM
ii. Narcotic-associated respiratory depression:
Administer naloxone (Narcan) as follows (maximum dose of 0.4mg):
a. Apnea: 0.4mg IVP/IO once
b. RR less than 10: 0.1 mg IVP/IO Narcan every minute, may repeat x3.
iii. For benzodiazepine-associated respiratory depression (apnea to RR less than 10)
administer flumazenil (Romazicon) 0.2mg IVP/IO over 15 seconds. May repeat repeat in
45 seconds based on patient's response, not to exceed 0.6mg.
✔✔Respiratory Distress - ✔✔Demonstrated by change in respiratory rate and/or use of
accessory muscles, altered level of consciousness of cyanotic nail beds.
i. O2 at minimum 10L/min. NRBM
ii. STAT portable x-ray
iii. In the presence of bronchospasm: Albuterol 0.5ml in 3ml NS aerosol inhalation
iv. The Rapid Response Team or ICU RN in the ICU may obtain an ABG of VBG if
unable to obtain ABG.
v. The Rapid Response Team or ICU RN in the ICU may initiate non-invasive ventilation
(NIV) for the following conditions in the absence of any contraindications
a. Exacerbation of: COPD; asthma; acute CHF
b. As a bridge to mechanical ventilation
c. Contraindications for NIV:
i. Respiratory Arrest
ii. Inability to maintain a patent airway or clear secretions
iii. Risk for aspiration of gastric contents (nausea, vomiting, or bowel obstruction)
iv. Pre-existing pneumothorax without chest tube or pneumomediastinum
v. Epistaxis
vi. Recent facial, oral, or skull surgery or trauma
vii. Encephalopathy/altered mental status
viii. Hypotension due to suspected intravascular volume depletion
ix. Unable to tolerate BIPAP
, ✔✔Status Epilepticus - ✔✔Generalized tonic-clonic movements lasting more than 3
minutes or recurrent seizures without return of consciousness
i. Protect airway, position patient in lateral decubitus position, protect patient from injury
ii. O2 at minimum 10L/min. NRBM
iii. Lorazepam (Ativan) 2mg IVP/IO over 1 minute
iv. Draw Na+; K+ Ca; glucose; BUN; Cr; and anticonvulsant levels if appropriate
✔✔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.
