Sharp Memorial ESO Exam 2024
Asystole
1. CPR (2 mins)
2. O2 at 15 L/min ambu bag
3. Epinephrine 1 mg IVP/IO (Use Epinephrine 0.1 mg/1ml) Repeat 3-5 mins
Bradycardia - Unstable
1. O2 at minimum 10 L/min NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator and initiate
pacing per protocol.
3. Atropine 0.5 mg IVP/IO, repeat q3-5 minutes (max 3mg)
4. Transcutaneous pacing as soon as available.
5. If above algorithm is ineffective, start Dopamine 400 mg/250ml D5W infusion at 5 mcg/kg/min.
Titrate to patient response up to 20 mcg/kg/min.
6. If above algorithm is ineffective, start epinephrine 2 mg/250mL NS at 2 mcg/min, titrate to patient
response up to 10 mcg/min.
(Note: Assess patient for adequate intravascular volume and volume status when using
vasoconstrictors)
Pulseless Electrical Activities (PEA)
1. CPR (2 min) and assess for possible causes*.
2. O2 at 15 L/min ambu bag
3. Epinephrine 1 mg IVP/IO (use 0.1mg/ml), repeat q 3-5 minutes.
4. If hypovolemia known or suspected, infuse 250 mL NS (may be substitute with LR if currently
infusing). Repeat in 5 minutes if no clinical improvement.
5. Stat CXR.
Possible Cause of PEA
1. Hypovolemia
2. Hypoxia
3. Hydrogen ion (Acid)
4. Hypo/Hyperkalemia
5. Hypoglycemia
6. Hypothermia
7. Tamponade
8. Toxins
9. Thrombosis
10. Trauma
11. Tension Pneumothorax
Ventricular Tachycardia: Stable
1. Call the physician for orders
2. O2 at minimum 4L/min NC and adjust per patient status
3. Obtain 12 lead EKG
4. Draw serum K and Mag
** Administer Amio 150mg SLOW PIVvover 10 mins.
**Consider Adenosine (only if regular and monomorphic)
Ventricular Tachycardia: Unstabel
1. O2 at minimum 10 L/min NRBM
, 2. If ventricular rate greater than 150, Biphasic, synchronized cardioversion per approved energy dose
listed on defibrillator.
3. If patient is awake and responsive, give midazolam (Versed) 0.5 mg IVP/IO prior to cardioversion.
May report to a total of 1mg to achieve sedation.
4. Draw serum K and Mag
Reverse agent for Midazolam
Romazicon. If patient has signs and symptoms of oversedation (e.g. decreased level of consciousness,
respiratory rate less than 10 breaths/ min), Romazicon 0.2 mg IVP/IO, over 15 second. May repeat in
45 seconds based on patient's response, not to exceed 0.6 mg
Unstable signs
1. Hypotension
2. Tachycardia
3. Bradycardia
4. Arrhythmia
5. Tachypnea
6. Respiratory Depression
7. Apnea
8. Dyspnea
9. Decreased O2 sat
10. Change in level of consciousness
11. Increased intracranial pressure
12. Status Epilepticus
Unstable symptoms
1. Dizziness
2. Lightheadedness
3. Short of breath
4. Chest pain
5. Weakness
6. Cold
7. Diaphoretic
8. Heart palpitation
9. Anxious
Ventricular Fibrillation/Pulseless Ventricular Tachycardia
***No Stacked Shocks
***Provide continuous CPR unless defibrillating. Give medications during CPR.
***Immediate defibrillation if witnessed arrest and defibrillator is available.
1. CPR (2mins) or until defibrillator is available.
2. O2 at 15 L/min ambu bag
3. Defibrillate: Biphasic, joules per approved energy dose.
4. Epinephrine 1 mg IVP/IO (use epinephrine 0.2mg/ml)
5. Defibrillate
6. Amiodarone 300 mg IVP/IO
7. Defibrillate
8. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/ml)
9. Defibrillate
10. Amiodarone 150 mg IVP/IO
11. If rhythm persists, defibrillate, CPR, epinephrine 1 mg IVP/IO (use epinephrine 0.1mg/ml) q 3-5
mins
Asystole
1. CPR (2 mins)
2. O2 at 15 L/min ambu bag
3. Epinephrine 1 mg IVP/IO (Use Epinephrine 0.1 mg/1ml) Repeat 3-5 mins
Bradycardia - Unstable
1. O2 at minimum 10 L/min NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator and initiate
pacing per protocol.
3. Atropine 0.5 mg IVP/IO, repeat q3-5 minutes (max 3mg)
4. Transcutaneous pacing as soon as available.
5. If above algorithm is ineffective, start Dopamine 400 mg/250ml D5W infusion at 5 mcg/kg/min.
Titrate to patient response up to 20 mcg/kg/min.
6. If above algorithm is ineffective, start epinephrine 2 mg/250mL NS at 2 mcg/min, titrate to patient
response up to 10 mcg/min.
(Note: Assess patient for adequate intravascular volume and volume status when using
vasoconstrictors)
Pulseless Electrical Activities (PEA)
1. CPR (2 min) and assess for possible causes*.
2. O2 at 15 L/min ambu bag
3. Epinephrine 1 mg IVP/IO (use 0.1mg/ml), repeat q 3-5 minutes.
4. If hypovolemia known or suspected, infuse 250 mL NS (may be substitute with LR if currently
infusing). Repeat in 5 minutes if no clinical improvement.
5. Stat CXR.
Possible Cause of PEA
1. Hypovolemia
2. Hypoxia
3. Hydrogen ion (Acid)
4. Hypo/Hyperkalemia
5. Hypoglycemia
6. Hypothermia
7. Tamponade
8. Toxins
9. Thrombosis
10. Trauma
11. Tension Pneumothorax
Ventricular Tachycardia: Stable
1. Call the physician for orders
2. O2 at minimum 4L/min NC and adjust per patient status
3. Obtain 12 lead EKG
4. Draw serum K and Mag
** Administer Amio 150mg SLOW PIVvover 10 mins.
**Consider Adenosine (only if regular and monomorphic)
Ventricular Tachycardia: Unstabel
1. O2 at minimum 10 L/min NRBM
, 2. If ventricular rate greater than 150, Biphasic, synchronized cardioversion per approved energy dose
listed on defibrillator.
3. If patient is awake and responsive, give midazolam (Versed) 0.5 mg IVP/IO prior to cardioversion.
May report to a total of 1mg to achieve sedation.
4. Draw serum K and Mag
Reverse agent for Midazolam
Romazicon. If patient has signs and symptoms of oversedation (e.g. decreased level of consciousness,
respiratory rate less than 10 breaths/ min), Romazicon 0.2 mg IVP/IO, over 15 second. May repeat in
45 seconds based on patient's response, not to exceed 0.6 mg
Unstable signs
1. Hypotension
2. Tachycardia
3. Bradycardia
4. Arrhythmia
5. Tachypnea
6. Respiratory Depression
7. Apnea
8. Dyspnea
9. Decreased O2 sat
10. Change in level of consciousness
11. Increased intracranial pressure
12. Status Epilepticus
Unstable symptoms
1. Dizziness
2. Lightheadedness
3. Short of breath
4. Chest pain
5. Weakness
6. Cold
7. Diaphoretic
8. Heart palpitation
9. Anxious
Ventricular Fibrillation/Pulseless Ventricular Tachycardia
***No Stacked Shocks
***Provide continuous CPR unless defibrillating. Give medications during CPR.
***Immediate defibrillation if witnessed arrest and defibrillator is available.
1. CPR (2mins) or until defibrillator is available.
2. O2 at 15 L/min ambu bag
3. Defibrillate: Biphasic, joules per approved energy dose.
4. Epinephrine 1 mg IVP/IO (use epinephrine 0.2mg/ml)
5. Defibrillate
6. Amiodarone 300 mg IVP/IO
7. Defibrillate
8. Epinephrine 1 mg IVP/IO (use epinephrine 0.1 mg/ml)
9. Defibrillate
10. Amiodarone 150 mg IVP/IO
11. If rhythm persists, defibrillate, CPR, epinephrine 1 mg IVP/IO (use epinephrine 0.1mg/ml) q 3-5
mins
