Sharp ESO
End Tidal CO2 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Core temperature 32-36 C (89.6-96.8
F)
joules for defibrillation - CORRECT ANSWERS Defibrillation Joules: 200 joules
joules for cardioversion - CORRECT ANSWERS 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 - CORRECT
ANSWERS Consider initiation of therapeutic hypothermia
Treatment of pulseless arrests - CORRECT ANSWERS Provide 2 minutes of
CPR-avoiding interruptions in compressions
Asystole treatment - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Reversal agent for midazolam
Standard Procedure Functions - CORRECT ANSWERS 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) - CORRECT ANSWERS 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 - CORRECT ANSWERS RN who had successfully
demonstrated the knowledge and skills in identification and treatment of life-threatening
conditions
Rapid Response Team - CORRECT ANSWERS A team PF health care professionals
who bring critical care expertise to the patient bedside
CPR (cardiopulmonary resuscitation) - CORRECT ANSWERS Includes circulation with
compressions, airway assessment and breathing (C-A-B)
Intraosseous (IO) Therapy - CORRECT ANSWERS 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 - CORRECT ANSWERS No eye opening to pain and no purposeful
motor response
Unstable - CORRECT ANSWERS Serious signs and symptoms related to the
life-threatening rhythm or conditions which may include:
End Tidal CO2 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Core temperature 32-36 C (89.6-96.8
F)
joules for defibrillation - CORRECT ANSWERS Defibrillation Joules: 200 joules
joules for cardioversion - CORRECT ANSWERS 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 - CORRECT
ANSWERS Consider initiation of therapeutic hypothermia
Treatment of pulseless arrests - CORRECT ANSWERS Provide 2 minutes of
CPR-avoiding interruptions in compressions
Asystole treatment - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Reversal agent for midazolam
Standard Procedure Functions - CORRECT ANSWERS 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) - CORRECT ANSWERS 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 - CORRECT ANSWERS RN who had successfully
demonstrated the knowledge and skills in identification and treatment of life-threatening
conditions
Rapid Response Team - CORRECT ANSWERS A team PF health care professionals
who bring critical care expertise to the patient bedside
CPR (cardiopulmonary resuscitation) - CORRECT ANSWERS Includes circulation with
compressions, airway assessment and breathing (C-A-B)
Intraosseous (IO) Therapy - CORRECT ANSWERS 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 - CORRECT ANSWERS No eye opening to pain and no purposeful
motor response
Unstable - CORRECT ANSWERS Serious signs and symptoms related to the
life-threatening rhythm or conditions which may include:
