ESO/EKG Sharp Exam Questions with correct
Answers
ESO for Asystole (aka Ventricular Standstill)
1. CPR 2min uninterrupted 2. 15L 02 ambu bag 3. Epinephrine 1 mg IVP/IO (use epinephrine 0.1
mg/ml), repeat q 3-5 minutes. Flat line or P wave w/ no QRS's.
ESO or bradycardia
1. 02 10L NRBM 2.if pacing wires present, initiate pacing 3.Atropine 0.5mg IVP/IO can repeat 3-5min
up to 3mg. 4. transcutaneous pacing asap 5. if ineffective, dopamine 400mg/250ml
D5W@5mcg/kg/min. Titrate response up to 20 mcg/kg/min 6. ineffective give epinephrine
2mg/250NS@2mcg/min, titrate response up to 10mcg/min. *Assess adequate intravascular
volume/volume status prior to vasoconstrictors.
ESO for PEA
1. CPR 2 min & look for causes H's (hypovolemia, hypoxia, hyper/o -kalemia, hypoglycemia,
hypothermia); T's (toxins, tamponade, thrombosis, trauma, tension pneumothorax). 2. O2 15L ambu
3. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/mL), repeat q 3-5 minutes 3. if hypovolemia
suspected bolus 250ml NS (LR if already infusing), repeat in 5min if no improvement. 4. Stat CXR
ESO for Ventricular Tachycardia (stable wide complex)
1) call physician for orders 2) O2 4L NC, titrate per status 3) 12 Lead EKG 4) Draw K+ & Mag++
ESO for Vtach (UNSTABLE, wide complex)
1) O2 10L NC 2) >150 biphasic: synchronized cardioversion for dose listed on defib. If responsive, give
Versed (midazolam) 0.5 IVP/IO prior to cardioversion. May repeat x1 to achieve sedation. *Romazicon
reversal for midazolam IVP 0.2mg over 15 sec. may repeat in 45sec up to 0.6mg. 3. Draw K+ and Mag+
+
ESO for VFibb/Pulseless Vtach
No stacked shocks. Cont CPR unless defibbing. Give meds during CPR. Immediate defib if witnessed
arrest. 1. CPR 2min or until defib arrives. 2.O2 15L ambu 3.Defib (joules per approved dose) 4.
Epinephrine 1mg (use 0.1mg/ml) 5. defib 6. Amiodarone 300mg IVP/IO 7. defib 8. Repeat Epinephrine
8. defib 9. Amiodarone 150mg IVP/IO 10. If rhythm persists: debib, CPR, repeat epi q3-5min.
ESO for chest pain
1) aspirin 325mg if not contraindicated. 2) O2 min 4LNC titrate so sat= or>94% 3)NTG is SBP>90
and/or MAP>60 & HR>50, May repeat 3-5minx2. 4)morphine 2mg if SBP>90 q5min up to 10mg. 5) if
hypotension develops & no pulm congestion suspected, bolus 250NS (or LR if running) & resume tx
for chest pain if unrelieved. 6) Stat EKG
ESO symptomatic hypotension
1) O2 10LNRBM 2) if hypovolemia suspected bolus 250NS (or LR if running). Repeat in 5min if needed.
3) if SBP<90 dopamine 400mg/250ml D5W at 5mcg/kg/min. Titrate until SBP= or >90 or MAP>60 or
up to 20mcg/kg/min 4) if blood loss get stat H&H, type and cross, and 2units RBC's. 5) if suspected
sepsis use algorithm.
ESO Sepsis Algorithm
, 1) if hypovolemic infuse 250ml NS (or LR), may repeat in 5min. 2) SIRS criteria 1: 4>WBC>12 or
bands>10% 2: HR>90 3: RR>20 4: temp less than 36 or >38.3. must meet 2 criteria 3) if meets 2
criteria assess for suspected/confirmed infection and organ disfunction. Must meet 1 of these
1:SBP<90, map<65, decrease SBP>40, lactate>2, creatinine>2, UOP<0.5ml/kg/hr, bili>2, platelets<100,
INR.1.5/aPTT>60sec, new onset resp failure w/ bipap. 3) if one met, obtain serum lactate (if none in
last 6hrs) and repeat in 4hrs )RRT can order POC lactate). 4) order blood cultures, consult RRT, call
physician.
ESO for Hypoglycemia
P&P #30094.99 for serum or fingerstick less than 70
ESO for increased ITP
(neuro impaired w/ dilated pupils in absence of ICP orders) 1) if not hypotensive, put HOB>30degrees
and midline. 2) if intubated hyperventilate FiO2 at 100% to have to maintain PCO2 at 30-35mmHg.3)
Mannitol 20% (100gn/500ml) rapid infusion IVP/IO w/ filter (if filter avail). 3) draw baseline serum K+,
Na+, Cr, BUN, glucose, and ABG. 4) insert urinary catheter.
ESO Respiratory Depression (d/t narcs or benzos)
1) O2 10LNRBM. 2) for narcs give naloxalone max 0.4mg. for Apnea give 0.4mg IVP/IO once. For
RR<10 give 0.1mg q1min up to 3x's. 3) for benzos give Romazicon (flumazenil) 0.2mg over 15 sec. May
repeat in 45sec if needed up to 0.6mg
ESO respiratory distress
(noted by RR/accessory muscles/ALC/cyanotic nailbeds) 1) O2 10LNRBM. 2) stat portable CXR. 3) if
bronchospasm albuterol 0.5 in 3ml NS aerosol inhalation. 4) RRT can obtain ABG's 5) RRT may initiate
non-invasive ventilation for COPD/asthma/CHF if not contraindicated.
ESO status epilepticus
(seizure 3min+, or recurrent w/out return to of conscious). 1) protect airway, put in lateral decubitus
position, protect from injury. 2) 02 10LNRBM 3) Ativan IVP/IO 2mg over 1min 4) draw K+, Na+, Cr,
BUN, glucose, and anticonvulsant levels
ESO severe anaphylaxis
(stridor/wheezing/resp distress/pallor/cyanosis/signs of shock) 1) O2 min 10LNRBM 2) epi 0.3 IM (use
1mg/ml) repeat in 5min if no improvement. 3) no improvement give 0.1mg IVP/IO (use 0.1mg/ml)
push over 5 min. Solucortef (hydrocortisone) 100mg IVP/IO. 4) diphenhydramine (Benadryl) 25mg
IVP/IO 5) infuse 250 NS (LR if running) & may repeat in 5 min.
Asystole Rhythm
the absence of ventricular activity, "flat line". Confirmed in at least two different leads, check leads.
CPR immediately for 2 min (100-120). DO NOT DEFIB
Sinus Brady (unstable)
>60/pt's regular HR, and symptomatic. Ranges from SB to 3rd degree block.
1st degree block
PR interval is >.20 but consistent
Answers
ESO for Asystole (aka Ventricular Standstill)
1. CPR 2min uninterrupted 2. 15L 02 ambu bag 3. Epinephrine 1 mg IVP/IO (use epinephrine 0.1
mg/ml), repeat q 3-5 minutes. Flat line or P wave w/ no QRS's.
ESO or bradycardia
1. 02 10L NRBM 2.if pacing wires present, initiate pacing 3.Atropine 0.5mg IVP/IO can repeat 3-5min
up to 3mg. 4. transcutaneous pacing asap 5. if ineffective, dopamine 400mg/250ml
D5W@5mcg/kg/min. Titrate response up to 20 mcg/kg/min 6. ineffective give epinephrine
2mg/250NS@2mcg/min, titrate response up to 10mcg/min. *Assess adequate intravascular
volume/volume status prior to vasoconstrictors.
ESO for PEA
1. CPR 2 min & look for causes H's (hypovolemia, hypoxia, hyper/o -kalemia, hypoglycemia,
hypothermia); T's (toxins, tamponade, thrombosis, trauma, tension pneumothorax). 2. O2 15L ambu
3. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/mL), repeat q 3-5 minutes 3. if hypovolemia
suspected bolus 250ml NS (LR if already infusing), repeat in 5min if no improvement. 4. Stat CXR
ESO for Ventricular Tachycardia (stable wide complex)
1) call physician for orders 2) O2 4L NC, titrate per status 3) 12 Lead EKG 4) Draw K+ & Mag++
ESO for Vtach (UNSTABLE, wide complex)
1) O2 10L NC 2) >150 biphasic: synchronized cardioversion for dose listed on defib. If responsive, give
Versed (midazolam) 0.5 IVP/IO prior to cardioversion. May repeat x1 to achieve sedation. *Romazicon
reversal for midazolam IVP 0.2mg over 15 sec. may repeat in 45sec up to 0.6mg. 3. Draw K+ and Mag+
+
ESO for VFibb/Pulseless Vtach
No stacked shocks. Cont CPR unless defibbing. Give meds during CPR. Immediate defib if witnessed
arrest. 1. CPR 2min or until defib arrives. 2.O2 15L ambu 3.Defib (joules per approved dose) 4.
Epinephrine 1mg (use 0.1mg/ml) 5. defib 6. Amiodarone 300mg IVP/IO 7. defib 8. Repeat Epinephrine
8. defib 9. Amiodarone 150mg IVP/IO 10. If rhythm persists: debib, CPR, repeat epi q3-5min.
ESO for chest pain
1) aspirin 325mg if not contraindicated. 2) O2 min 4LNC titrate so sat= or>94% 3)NTG is SBP>90
and/or MAP>60 & HR>50, May repeat 3-5minx2. 4)morphine 2mg if SBP>90 q5min up to 10mg. 5) if
hypotension develops & no pulm congestion suspected, bolus 250NS (or LR if running) & resume tx
for chest pain if unrelieved. 6) Stat EKG
ESO symptomatic hypotension
1) O2 10LNRBM 2) if hypovolemia suspected bolus 250NS (or LR if running). Repeat in 5min if needed.
3) if SBP<90 dopamine 400mg/250ml D5W at 5mcg/kg/min. Titrate until SBP= or >90 or MAP>60 or
up to 20mcg/kg/min 4) if blood loss get stat H&H, type and cross, and 2units RBC's. 5) if suspected
sepsis use algorithm.
ESO Sepsis Algorithm
, 1) if hypovolemic infuse 250ml NS (or LR), may repeat in 5min. 2) SIRS criteria 1: 4>WBC>12 or
bands>10% 2: HR>90 3: RR>20 4: temp less than 36 or >38.3. must meet 2 criteria 3) if meets 2
criteria assess for suspected/confirmed infection and organ disfunction. Must meet 1 of these
1:SBP<90, map<65, decrease SBP>40, lactate>2, creatinine>2, UOP<0.5ml/kg/hr, bili>2, platelets<100,
INR.1.5/aPTT>60sec, new onset resp failure w/ bipap. 3) if one met, obtain serum lactate (if none in
last 6hrs) and repeat in 4hrs )RRT can order POC lactate). 4) order blood cultures, consult RRT, call
physician.
ESO for Hypoglycemia
P&P #30094.99 for serum or fingerstick less than 70
ESO for increased ITP
(neuro impaired w/ dilated pupils in absence of ICP orders) 1) if not hypotensive, put HOB>30degrees
and midline. 2) if intubated hyperventilate FiO2 at 100% to have to maintain PCO2 at 30-35mmHg.3)
Mannitol 20% (100gn/500ml) rapid infusion IVP/IO w/ filter (if filter avail). 3) draw baseline serum K+,
Na+, Cr, BUN, glucose, and ABG. 4) insert urinary catheter.
ESO Respiratory Depression (d/t narcs or benzos)
1) O2 10LNRBM. 2) for narcs give naloxalone max 0.4mg. for Apnea give 0.4mg IVP/IO once. For
RR<10 give 0.1mg q1min up to 3x's. 3) for benzos give Romazicon (flumazenil) 0.2mg over 15 sec. May
repeat in 45sec if needed up to 0.6mg
ESO respiratory distress
(noted by RR/accessory muscles/ALC/cyanotic nailbeds) 1) O2 10LNRBM. 2) stat portable CXR. 3) if
bronchospasm albuterol 0.5 in 3ml NS aerosol inhalation. 4) RRT can obtain ABG's 5) RRT may initiate
non-invasive ventilation for COPD/asthma/CHF if not contraindicated.
ESO status epilepticus
(seizure 3min+, or recurrent w/out return to of conscious). 1) protect airway, put in lateral decubitus
position, protect from injury. 2) 02 10LNRBM 3) Ativan IVP/IO 2mg over 1min 4) draw K+, Na+, Cr,
BUN, glucose, and anticonvulsant levels
ESO severe anaphylaxis
(stridor/wheezing/resp distress/pallor/cyanosis/signs of shock) 1) O2 min 10LNRBM 2) epi 0.3 IM (use
1mg/ml) repeat in 5min if no improvement. 3) no improvement give 0.1mg IVP/IO (use 0.1mg/ml)
push over 5 min. Solucortef (hydrocortisone) 100mg IVP/IO. 4) diphenhydramine (Benadryl) 25mg
IVP/IO 5) infuse 250 NS (LR if running) & may repeat in 5 min.
Asystole Rhythm
the absence of ventricular activity, "flat line". Confirmed in at least two different leads, check leads.
CPR immediately for 2 min (100-120). DO NOT DEFIB
Sinus Brady (unstable)
>60/pt's regular HR, and symptomatic. Ranges from SB to 3rd degree block.
1st degree block
PR interval is >.20 but consistent
