STANDARDIZED PROCEDURE -EMERGENCY STANDING
ORDERS AT SHARP HEALTHCARE 2023 EXAM WITH
VERIFIED SOLUTIONS
General Procedure for all Life-Threatening Patient Conditions- what kind of access
should a nurse obtain? - ANSWER-a. Obtain IV/intraosseous (IO) access (large bore
cannula in the antecubital vein should be the first target for IV access if a central line
is not present)
General Procedure for all Life-Threatening Patient Conditions- what kind of fluid
should be started to KVO? - ANSWER-b. Begin IV infusion of Normal Saline (NS) to
keep vein open (KVO)
General Procedure for all Life-Threatening Patient Conditions- If IV access is not
available what medications can be given and how is it administered? - ANSWER-c. If
IV access is not available: Narcan, Atropine, and Epinephrine may be administered
via endotracheal route at doses of 2 times the IV dose diluted in 10ml NS flush
General Procedure for all Life-Threatening Patient Conditions- what's the process
after giving each medication? - ANSWER-d. Flush IV line with 20ml of NS after each
IV medication given and elevate extremity if applicable.
General Procedure for all Life-Threatening Patient Conditions- In applicable
situations, what should be readily available? - ANSWER-e. Oxygen
What's the proper techniques using circulation, airway, and breathing? - ANSWER-1.
Compressions should be performed at a rate of 100/min for two minutes "push
hard,push fast" allowing full chest recoil, and minimize interruptions in chest
compressions after each intervention.
2. All external electrical therapy will be cardioverted/defibrillated with biphasic
monitors using appropriate energy dose as designated by condition.
True/False
In most cases, treatment (e.g. O2 administration) is administered concurrently. -
ANSWER-TRUE
True/False
Stickers with appropriate energy levels of cardioversion/defibrillation should be
placed on all defibrillators for quick reference. - ANSWER-TRUE
ASYSTOLE - ANSWER-1. CPR (2 min)
2. O2 at 15ml/min ambu bag (8-10 breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.
, BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - ANSWER-1. O2 at minimum
10ml/mim NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse
generator and initiate pacing control.
3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg)
4. Transcutaneous pacing as soon as available
5. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate until SBP =/> 90mmHg and/or MAP >60mmHg up to
20mcg/kg/min.
6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min IV/IO)
PULSELESS ELECTRICAL ACTIVITY (PEA) - ANSWER-1. CPR (2min) and assess
for possible causes.
2. O2 at 15ml/min ambubag (8-10breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5mim
4. If hypovolemia known or suspected, infuse 250ml LR or NS. Repeat in 5 minutes if
no clinical improvement.
5. Stat CXR
What are the 7 H's possible causes of PEA? - ANSWER-1. Hypovolemia
2. Hypoxia
3. Hydrogen Ion (acidosis)
4. Hypokalemia
5. Hyperkalemia
6. Hypoglycemia
7. Hypothermia
What are the 5 T'# possible causes of PEA? - ANSWER-1. Toxins
2. Tamponade
3. Thrombosis
4. Trauma
5. Tension pneumothorax
VENTRICULAR TACHYCARDIA (Wide Complex) STABLE - ANSWER-1. Call the
physician for orders
IN ADDITION TO CALLING THE MD PERFORM THE FF:
a. O2 at minimum 4L/min NC and adjust per patient status
b. Obtain 12 Lead EKG
c. Draw serum K, Mg
VENTRICULAR TACHYCARDIA (Wide Complex) UNSTABLE - ANSWER-1. O2 at
minimum 10ml NRBM
2. If ventricular rate is >150: BIPHASIC- Synchronized cardioversion per approved
energy dose listed on defibrillator
3. If patient is awake and responsive, give Midazolam (versed) 0.5mg IVP/IO prior to
cardioversion. May repeat to a total of 1mg to achieve sedation.
4. Draw serum K, Mg
What's the reversal agent for midazolam (Versed) and when can you give it? -
ANSWER-Romazicon 0.1mg IVP/IO over 15sec. May repeat in 45sec based on
ORDERS AT SHARP HEALTHCARE 2023 EXAM WITH
VERIFIED SOLUTIONS
General Procedure for all Life-Threatening Patient Conditions- what kind of access
should a nurse obtain? - ANSWER-a. Obtain IV/intraosseous (IO) access (large bore
cannula in the antecubital vein should be the first target for IV access if a central line
is not present)
General Procedure for all Life-Threatening Patient Conditions- what kind of fluid
should be started to KVO? - ANSWER-b. Begin IV infusion of Normal Saline (NS) to
keep vein open (KVO)
General Procedure for all Life-Threatening Patient Conditions- If IV access is not
available what medications can be given and how is it administered? - ANSWER-c. If
IV access is not available: Narcan, Atropine, and Epinephrine may be administered
via endotracheal route at doses of 2 times the IV dose diluted in 10ml NS flush
General Procedure for all Life-Threatening Patient Conditions- what's the process
after giving each medication? - ANSWER-d. Flush IV line with 20ml of NS after each
IV medication given and elevate extremity if applicable.
General Procedure for all Life-Threatening Patient Conditions- In applicable
situations, what should be readily available? - ANSWER-e. Oxygen
What's the proper techniques using circulation, airway, and breathing? - ANSWER-1.
Compressions should be performed at a rate of 100/min for two minutes "push
hard,push fast" allowing full chest recoil, and minimize interruptions in chest
compressions after each intervention.
2. All external electrical therapy will be cardioverted/defibrillated with biphasic
monitors using appropriate energy dose as designated by condition.
True/False
In most cases, treatment (e.g. O2 administration) is administered concurrently. -
ANSWER-TRUE
True/False
Stickers with appropriate energy levels of cardioversion/defibrillation should be
placed on all defibrillators for quick reference. - ANSWER-TRUE
ASYSTOLE - ANSWER-1. CPR (2 min)
2. O2 at 15ml/min ambu bag (8-10 breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.
, BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - ANSWER-1. O2 at minimum
10ml/mim NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse
generator and initiate pacing control.
3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg)
4. Transcutaneous pacing as soon as available
5. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate until SBP =/> 90mmHg and/or MAP >60mmHg up to
20mcg/kg/min.
6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min IV/IO)
PULSELESS ELECTRICAL ACTIVITY (PEA) - ANSWER-1. CPR (2min) and assess
for possible causes.
2. O2 at 15ml/min ambubag (8-10breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5mim
4. If hypovolemia known or suspected, infuse 250ml LR or NS. Repeat in 5 minutes if
no clinical improvement.
5. Stat CXR
What are the 7 H's possible causes of PEA? - ANSWER-1. Hypovolemia
2. Hypoxia
3. Hydrogen Ion (acidosis)
4. Hypokalemia
5. Hyperkalemia
6. Hypoglycemia
7. Hypothermia
What are the 5 T'# possible causes of PEA? - ANSWER-1. Toxins
2. Tamponade
3. Thrombosis
4. Trauma
5. Tension pneumothorax
VENTRICULAR TACHYCARDIA (Wide Complex) STABLE - ANSWER-1. Call the
physician for orders
IN ADDITION TO CALLING THE MD PERFORM THE FF:
a. O2 at minimum 4L/min NC and adjust per patient status
b. Obtain 12 Lead EKG
c. Draw serum K, Mg
VENTRICULAR TACHYCARDIA (Wide Complex) UNSTABLE - ANSWER-1. O2 at
minimum 10ml NRBM
2. If ventricular rate is >150: BIPHASIC- Synchronized cardioversion per approved
energy dose listed on defibrillator
3. If patient is awake and responsive, give Midazolam (versed) 0.5mg IVP/IO prior to
cardioversion. May repeat to a total of 1mg to achieve sedation.
4. Draw serum K, Mg
What's the reversal agent for midazolam (Versed) and when can you give it? -
ANSWER-Romazicon 0.1mg IVP/IO over 15sec. May repeat in 45sec based on
