Sharp HealthCare Emergency Standing Orders (ESO) Study Guide

A complete set of 100 flashcards based on the 2024-2026 Sharp HealthCare Emergency Standing Orders study guide, covering code blue procedures, ACLS rhythms, and drug pharmacology.

Under what designation are RN electronic orders for ESO treatments placed in the electronic health record (EHR)?

$$\text{"Per Protocol: no cosign required."}$$

Under what condition are ESOs initiated?

ESOs are initiated for life-threatening patient conditions in the absence of the physician.

Who must be notified once ESOs have been initiated?

The physician must be notified.

What five elements must the nurse document when instituting ESOs?

The life-threatening condition, precipitating factors, the specific ESO implemented, the patient's response, and which physician was notified (including the time).

What is the most important factor in survival for a pulseless condition?

Good $\text{BLS}$ care beginning with high-quality $\text{CPR}$.

What is the recommended compression rate for high-quality CPR?

$$100\text{-}120/min$$

What are the three core principles of high-quality compressions?

Push hard and fast, ensure full chest recoil, and minimize interruptions to chest compressions.

What is the structure of one cycle of CPR without an advanced airway?

$2\,minutes$ of $100\text{-}120\,\text{compressions/min}$ with a $30:2$ ratio and $O_2$ delivered at $15\,L/min$ by bag mask.

What monitoring is used to assess CPR quality and evaluate the return of spontaneous circulation (ROSC)?

$\text{End tidal carbon dioxide (ETCO2)}$ monitoring.

After an advanced airway is placed, how should chest compressions be delivered?

Continuous chest compressions should be given without pauses for breaths.

What is the breath rate for a patient with an advanced airway during CPR?

$10\,\text{breaths/minute}$ (or $1\,\text{breath every 6 seconds}$).

How frequently should the rhythm and pulse be checked during CPR?

Every $2\,minutes$ with minimal pause in compressions.

What is the target time from event recognition to the first defibrillation for VF or pulseless VT?

$$< 3\,minutes$$

What is the target time from recognized pulselessness to the first IV or IO dose of Epinephrine?

$$< 5\,minutes$$

At what rate should Normal Saline (NS) be infused initially during emergency interventions?

At $\text{keep vein open (KVO)}$ rate.

Which three medications may be administered via the endotracheal tube (ETT) if IV access is unavailable?

Epinephrine, atropine, and naloxone ($\text{Narcan}$).

What is the recommended dosage for medications given via the endotracheal route?

$2\text{-}2\,\frac{1}{2}$ times the $IV$ dose.

How should endotracheal medications be diluted before administration?

Diluted in $10\,mL$ of $\text{normal saline}$.

What is the recommended volume for flushing the IV line after each emergency medication is administered?

$20\,mL$ of $NS$.

A sudden increase in ETCO2 to what level typically indicates return of spontaneous circulation (ROSC)?

$$\ge 40\,mmHg$$

How is 'unstable' defined regarding serious signs and symptoms of a life-threatening rhythm?

Signs like tachypnea, apnea, hypotension, and symptoms like dizziness, chest pain, and shortness of breath ($\text{SOB}$).

What does asystole represent on an ECG?

Total absence of ventricular activity or contraction (though atrial activity/$\text{P waves}$ may be present).

Is defibrillation recommended for a patient in asystole?

No, shocks are potentially harmful and not recommended.

What is the dosage and frequency for Epinephrine in the Asystole algorithm?

$1\,mg\,IVP/IO$ ($0.1\,mg/ml$), repeat every $3\text{-}5\,minutes$.

Is transcutaneous pacing recommended for treatment of asystole?

No, transcutaneous pacing for asystole is ineffective and not recommended.

What heart rate defines bradycardia in the unstable bradycardia algorithm?

A heart rate ($\text{HR}$) less than $50\,\text{beats per minute}$.

How is First-Degree AV Block characterized?

By a constant long $\text{PR}$ interval (> 0.20\,seconds).

What characterizes Second-Degree AV Block, Type I (Wenckebach)?

Progressive prolongation of the $\text{PR}$ interval until a $\text{P wave}$ is not conducted.

What is the danger associated with Second-Degree AV Block, Type II?

It carries a high risk of progressing to a $\text{complete heart block}$.

What characterizes Third-Degree AV Block (Complete Heart Block)?

Complete absence of conduction between atria and ventricles; independent atrial and ventricular rhythms with no consistent $\text{PR}$ intervals.

What is the first-line medication for unstable bradycardia?

Atropine $1\,mg\,IVP/IO$, repeated every $3\text{-}5\,minutes$ up to a maximum of $3\,mg$.

If Atropine and pacing are ineffective for bradycardia, what is the dose for a Dopamine infusion?

$400\,mg/250\,mL\,D5W$ infused at $5\,mcg/kg/min$, titrating up to $20\,mcg/kg/min$.

What is the titration target for systolic blood pressure (SBP) when using Dopamine for bradycardia?

$$SBP \ge 90\,mmHg$$

What is the dose for an Epinephrine drip for unstable bradycardia (ICU/RRT only)?

$4\,mg/250\,mL\,NS$ at $2\,mcg/min$, titrating up to $10\,mcg/min$. administration.

Define Pulseless Electrical Activity (PEA).

The presence of electrical activity (other than $VF$ or $VT$) that fails to generate a detectable pulse.

What are the 'H' causes to assess for in PEA?

Hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypoglycemia, and hypothermia.

What are the 'T' causes to assess for in PEA?

Toxins, tamponade, thrombosis, trauma, and tension pneumothorax.

How is suspected hypovolemia treated in the PEA algorithm?

Infuse $250\,mL\,NS$ rapid bolus; repeat in $5\,minutes$ if no improvement.

What is the definition of Ventricular Tachycardia (VT)?

Three or more beats of ventricular origin in succession at a rate greater than $100\,\text{beats per minute}$.

What are the criteria for Stable VT?

Patient is conscious with a $SBP > 90$ and no unstable signs or symptoms.

What is the biphasic synchronized cardioversion dose for Unstable VT with a rate > 150?

$$200\,joules$$

What medication and dose should be given for sedation prior to cardioversion in unstable VT if the patient is awake?

Midazolam ($\text{Versed}$) $0.5\,mg\,IVP/IO$, may repeat to a total of $1\,mg$.

What is the reversal agent for benzodiazepines like Midazolam(versed), Ativan, Valium, Xanax?

Flumazenil ($\text{Romazicon}$) $0.2\,mg\,IVP$ over $15\,seconds$.

What is the difference between Coarse and Fine Ventricular Fibrillation (VF)?

Coarse $VF$ indicates recent onset and potential ease of correction; Fine $VF$ indicates prolonged activity approaching asystole and more difficult resuscitation.

What is the defibrillation energy level for VF/Pulseless VT in the current ESOs?

Biphasic: $200\,joules$

When should the first dose of Amiodarone be given in the VF/Pulseless VT algorithm?

$300\,mg\,IVP/IO$ administered after the second defibrillation attempt.

What is the second dose of Amiodarone if VF rhythm persists?

$150\,mg\,IV/IO$ administered $3\text{-}5\,minutes$ after the first dose.

What medication is administered if VF/Pulseless VT is refractory to treatment after two doses of Amiodarone?

Lidocaine $1\,mg/kg\,IV/IO$.

What are the parameters for administering sublingual Nitroglycerin (NTG) for chest pain?

$0.4\,mg\,SL$ if $SBP \ge 90\,mmHg$ and/or $MAP \ge 60\,mmHg$ and $HR > 50\,bpm$. Repeat $\times 2$ every $3\text{-}5\,minutes$.

What is the dose and maximum for Morphine sulfate in the chest pain algorithm?

$2\,mg\,IVP/IO$ every $5\,minutes$ up to a total of $10\,mg$ if $SBP \ge 90\,mmHg$.

What dose of Aspirin is given for chest pain and how is it administered?

$325\,mg$ non-enteric coated, chewed or crushed.

What is the goal time for PCI or thrombolytics in a STEMI patient?

$$< 90\,minutes$$

What ECG findings suggest STEMI?

ST segment elevation of $\ge 2\,mm$ in $2$ contiguous leads or the onset of a new bundle branch block ($\text{BBB}$).

What defines hypotension in the symptomatic hypotension algorithm?

A systolic blood pressure ($\text{SBP}$) less than $90\,mmHg$.

If hypotension occurs post-anesthesia in PACU, what medication and doses are used if fluid boluses fail?

Ephedrine $5\,mg\,IVP/IO$; if no improvement in $3\,minutes$, repeat at $10\,mg\,IVP/IO$.

What vasopressor is used in the Hypotension-Symptomatic algorithm if fluid boluses are ineffective?

Norepinephrine ($\text{Levophed}$) $4\,mg/250\,mL\,NS$ at $2\,mcg/min$, titrated up to $32\,mcg/min$. (ICU/RRT only)

What is the blood sugar threshold for initiating the hypoglycemia standardized procedure?

$< 70\,mg/dL$ (or $< 60\,mg/dL$ if pregnant).

How is increased Intracranial Pressure (ICP) defined if being monitored?

$ICP > 15\,mmHg$ or as specified by the physician.

What is the first sign of increased intracranial pressure?

A decreased level of consciousness.

What is the target PCO2 when hyperventilating an intubated patient with elevated ICP?

$$26\text{-}30\,mmHg$$

Why should PCO2 not be lowered to < 25 mmHg in ICP management?

It may cause excessive vasoconstriction resulting in hypoxia.

What respiratory rate and monitoring finding usually demonstrates respiratory depression?

Respiratory rate less than $10/min$ and elevated $ETCO_2$.

What is the Naloxone (Narcan) dose for code blue/apnea respiratory arrest?

$0.4\,mg\,IVP/IO/IM$, repeat $q\,2\,minutes\,x\,4$ to a maximum of $2\,mg$. administration.

What is the Naloxone dose for a respiratory rate < 10 but not apneic?

$0.1\,mg\,IVP/IO/IM$ every $2\,minutes\,x\,4$ until $RR > 10$. administration.

What is the Flumazenil dose for benzodiazepine-associated respiratory depression?

$0.2\,mg\,IVP/IO$ over $15\,seconds$, repeat in $45\,seconds$ up to a max of $0.6\,mg$. administration.

If a patient has combined opioid and benzodiazepine respiratory depression, which reversal agent is given first?

Naloxone ($\text{Narcan}$).

What medication is given for bronchospasm in the respiratory distress algorithm?

Albuterol ($\text{Ventolin}$) $0.5\,mL$ in $3\,mL\,NS$ aerosol inhalation.

Name three contraindications for Non-invasive Ventilation (NIV).

Respiratory arrest, epistaxis, and recent facial/oral/skull surgery or trauma.

What defines prolonged seizures (status epilepticus)?

Generalized tonic-clonic movements lasting more than $3\,minutes$ or recurrent seizures without return of consciousness.

What is the drug of choice and dose for prolonged seizures?

Lorazepam ($\text{Ativan}$) $2\,mg\,IVP/IO$ over $1\,minute$, repeated $\times 1$ in $3\text{-}5\,minutes$ if seizure persists.

What is the dose and route for Epinephrine in severe anaphylaxis?

$0.3\,mg\,IM$ ($1\,mg/ml$) preferably in the thigh; repeat in $5\,minutes$ if no improvement.

What adjunct medications are used for anaphylaxis in the ESO algorithm?

Hydrocortisone ($100\,mg$), Diphenhydramine ($25\,mg$), and Famotidine ($20\,mg$).

List the SIRS (Systemic Inflammatory Response Syndrome) criteria thresholds.

$\text{WBC} > 12,000$ or $< 4,000$ ($10\%\,\text{bands}$); $HR > 90\,bpm$; $RR > 20/min$; $\text{Temp} > 38.3^\circ C$ or $< 36^\circ C$.

What is the fluid bolus requirement for sepsis if NICOM is NOT available?

$30\,mL/kg$ at $126\,mL/hr$ of $LR$ or $NS$.

What Stroke Volume Index (SVI) change indicates fluid responsiveness during a Passive Leg Raise (PLR) maneuver?

An SVI change of $10\%$ or greater.

What are the responsibilities of the 1st responder in a Code Blue?

Call for help, begin CPR, and become the recorder.

What acronym is used to review patient info during a code, and what does it stand for?

$\text{CHAMP}$: $\text{C}$ode Status, $\text{H}$istory, $\text{A}$llergies, $\text{M}$edication history, $\text{P}$rocedures in past $24\,hours$.

What is the preferred pad placement for defibrillation and mandatory placement for pacing?

$\text{Anterior/Posterior placement}$.

What is the indication for defibrillation?

$\text{Pulseless wide complex tachycardia (pulseless VT)}$ and $\text{Ventricular fibrillation (VF)}$.

What action must be performed between each delivery of energy in synchronization mode?

You must press the $\text{SYNC}$ button again and check for a triangle indicator above the $\text{QRS}$.

What is the indication for Transcutaneous Pacing (TCP)?

$\text{Unstable bradycardia}$.

How is electrical capture defined during transcutaneous pacing?

A pacer spike followed by a $\text{QRS complex}$.

What range of current (mA) is typically required for transcutaneous pacing?

$$40\text{-}80\,mA$$

How much current should be set once stimulation threshold capture is achieved for TCP?

$10\%$ above the stimulation threshold.

How is mechanical capture verified during pacing?

By assessing the patient's pulse.

How often should pacing electrodes be changed?

Every $24\,hours$.

What are the default emergency values for a Medtronic 5392 invasive pacemaker?

Mode: $\text{DOO}$, Rate: $80$, A Output: $20$, V Output: $25$, AV Interval: $170\,ms$.

What side effect should you monitor for when administering Lidocaine?

$\text{CNS toxicity}$.

What is the main action of Amiodarone?

Prolongs the refractory period and action potential; has vasodilator action.

Why must Atropine not be delivered slowly?

Slow delivery may cause a paradoxical slowing of the heart rate.

What is the dose-related effect of Dopamine at 10-20 mcg/kg/min?

Alpha-adrenergic effect causing peripheral arterial and venous vasoconstriction.

What is the action of Benzodiazepines like Lorazepam?

Anti-epileptic, anti-anxiety, sedative, and amnesic.

Which medication reduces pulmonary congestion and increases venous capacitance?

$\text{Morphine Sulfate}$.