SHARP ESO UPDATED EXAM SCRIPT QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔Ventricular Tachycardia (Wide Complex): Stable - ✔✔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 - ✔✔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 - ✔✔Reversal agent for midazolam
✔✔Standard Procedure Functions - ✔✔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) - ✔✔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 - ✔✔RN who had successfully demonstrated the knowledge
and skills in identification and treatment of life-threatening conditions
✔✔Rapid Response Team - ✔✔A team PF health care professionals who bring critical
care expertise to the patient bedside
✔✔CPR (cardiopulmonary resuscitation) - ✔✔Includes circulation with compressions,
airway assessment and breathing (C-A-B)
✔✔Intraosseous (IO) Therapy - ✔✔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 - ✔✔No eye opening to pain and no purposeful motor response
,✔✔Unstable - ✔✔Serious signs and symptoms related to the life-threatening rhythm or
conditions which may include:
Signs: tachypnea; apnea; respiratory depression; tachycardia; bradycardia; arrhythmias;
hypotension; decreased O2 saturation; dyspnea; change in level of consciousness;
increased intracranial pressure (ICP); status epilepticus
Symptoms: Dizziness; lightheadedness; shortness of breath; chest pain; weakness;
cold; diaphoretic; heart palpitations; anxiousness
✔✔Titrate to patient's response: - ✔✔For the purpose of this policy, "patient response"
means improvement in the patient's symptom for which the intervention was intended to
relieve
✔✔Circumstance under which an ESO Competent RN may perform ESO standarized
procedures: - ✔✔Emergency standing orders will be initiated by ESO competency-
validated RNs in the absense of a physician.
✔✔Scope of Supervision - ✔✔The ESO standarized procedure will be institued only in
the absence of a physician and in accordance with the patient's code status
✔✔Notification of patient's physician - ✔✔When a patient presents with a life-
threatening condition, the following steps will be taken:
A. Code Blue will be called immedicately, if appropriate (cardiac of respiratory arrest)
B. Rapid Response Team may be called whenever critical care expertise is needed.
C. Appropriate physicians will be notified immediately.
✔✔Availability of medications required for ESOs: - ✔✔Medications that are part of an
ESO must be readily available for administration to the patient
✔✔General Procedure for all Life-Threatening Patient Conditions - ✔✔A. Obtain
intravenous (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.
B.Begin IV infustion of normal saline (NS) to keep vein open (KVO)
c. If IV access is unavailable, naloxone, atropine, and epinephrine may be administered
via endotracheal route at doses 2-2 1/2 times the IV dose diluted in 10ml NS flush.
d. Flush IV with 20ml NS after each IV medications given and elevate extremity if
applicable.
e. In applicable situations, treatment (ex: O2) will be administered concurrently. Obtain
oxygen (O2) saturation per pulse oximeter if readily available. Proper assessment and
intervention techniques using circulation, airway, and breathing would be used:
i. Compressions and ventilation should be performed at a rate of 30:2 compression-
ventilation ratio if no advanced airway in place, or continuous compression rate of 100-
120/min. and ventilation of 1 breath every 6 seconds (!0 breaths/min.) if advanced
airway in place, for two minutes "push hard, push fast", allowing complete chest recoil,
and minimizing interruptions in chest compressions after each intervention.
, ii. Consider EtCO2 to assess CPR quality and evaluate ROSC.
iii. All external electrial therapy will use biphasic monitors using appropriate energy dose
as designed by condition.
a. Defibrillation joules: 200
b. Cardioversion joules: 200 (physician may order 75-100-150-200 for conditions not
covered in ESO policy
f. Consider initiation of therapeutic hypothermia for the patient not following commands
of showing purposeful movement within 120 minutes after ROSC
✔✔antecubital vein - ✔✔First target for IV access if a central line is not present
✔✔Asystole - ✔✔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 every 3-5 minutes
iv. Repeat CPR and epinephrine administration if no signs of ROSC
✔✔Bradycardia unstable (Heart Rate less than 50bpm) - ✔✔i. O2 at minimum 10L/min.
non-rebreather mask
ii. If transvenous leads or epicardia pacing wires present, connect to a pulse generator
and initiate pacing per protocol.
If no response, perform the following:
iii. Atropine 1mg IVP/IO, repeat every 3-5 minutes (max 3 mg)
iv. Transcutaneous pacing as soon as possible.
v. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate to patient response up to 20mcg/kg/minute.
vi. If above is ineffective, start epinephrine 2mg/250ml NS at 2mcg/min., titrate to patient
reponse up to 10mcg/minute
NOTE: Assess patient for adequate intravascular volume and volume status when using
vasoconstrictors.)
✔✔Ventricular Fibrillation/Pulseless Ventricular Tachycardia - ✔✔Provide continuous
CPR unless defibrillating. Give medications during CPR.
Immediate defibrillation if witnessed arrest and defibrillator is available.
i. CPR (2 min.) or until defibrillator arrives.
ii. O2 at minimum 15L/min. ambu bag.
iii. Defibrillate: Biphasic: joules per approved energy dose
iv. Epinephrine 1mg/IVP/ IO (use epinephrine 0.1mg/ml)
v. Defibrilate 200 joules
vi. Amiodarone 300mg IVP/IO
vii. Defibrillate 200 joules
viii. Amiodarone 150mg IVP/IO
xi. If rhythm persists, defibrillate, CPR, epinephrine 1mg IVP/IO (Use epinephrine
0.1mg/ml) every 3 to 5 minutes until ROSC is achieved.
✔✔Chest Pain - ✔✔i. O2 start at minimum 4L/min. NC and titrate to maintain SPO2
greater than or equal to 94%.
ANSWERS GUARANTEE A+
✔✔Ventricular Tachycardia (Wide Complex): Stable - ✔✔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 - ✔✔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 - ✔✔Reversal agent for midazolam
✔✔Standard Procedure Functions - ✔✔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) - ✔✔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 - ✔✔RN who had successfully demonstrated the knowledge
and skills in identification and treatment of life-threatening conditions
✔✔Rapid Response Team - ✔✔A team PF health care professionals who bring critical
care expertise to the patient bedside
✔✔CPR (cardiopulmonary resuscitation) - ✔✔Includes circulation with compressions,
airway assessment and breathing (C-A-B)
✔✔Intraosseous (IO) Therapy - ✔✔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 - ✔✔No eye opening to pain and no purposeful motor response
,✔✔Unstable - ✔✔Serious signs and symptoms related to the life-threatening rhythm or
conditions which may include:
Signs: tachypnea; apnea; respiratory depression; tachycardia; bradycardia; arrhythmias;
hypotension; decreased O2 saturation; dyspnea; change in level of consciousness;
increased intracranial pressure (ICP); status epilepticus
Symptoms: Dizziness; lightheadedness; shortness of breath; chest pain; weakness;
cold; diaphoretic; heart palpitations; anxiousness
✔✔Titrate to patient's response: - ✔✔For the purpose of this policy, "patient response"
means improvement in the patient's symptom for which the intervention was intended to
relieve
✔✔Circumstance under which an ESO Competent RN may perform ESO standarized
procedures: - ✔✔Emergency standing orders will be initiated by ESO competency-
validated RNs in the absense of a physician.
✔✔Scope of Supervision - ✔✔The ESO standarized procedure will be institued only in
the absence of a physician and in accordance with the patient's code status
✔✔Notification of patient's physician - ✔✔When a patient presents with a life-
threatening condition, the following steps will be taken:
A. Code Blue will be called immedicately, if appropriate (cardiac of respiratory arrest)
B. Rapid Response Team may be called whenever critical care expertise is needed.
C. Appropriate physicians will be notified immediately.
✔✔Availability of medications required for ESOs: - ✔✔Medications that are part of an
ESO must be readily available for administration to the patient
✔✔General Procedure for all Life-Threatening Patient Conditions - ✔✔A. Obtain
intravenous (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.
B.Begin IV infustion of normal saline (NS) to keep vein open (KVO)
c. If IV access is unavailable, naloxone, atropine, and epinephrine may be administered
via endotracheal route at doses 2-2 1/2 times the IV dose diluted in 10ml NS flush.
d. Flush IV with 20ml NS after each IV medications given and elevate extremity if
applicable.
e. In applicable situations, treatment (ex: O2) will be administered concurrently. Obtain
oxygen (O2) saturation per pulse oximeter if readily available. Proper assessment and
intervention techniques using circulation, airway, and breathing would be used:
i. Compressions and ventilation should be performed at a rate of 30:2 compression-
ventilation ratio if no advanced airway in place, or continuous compression rate of 100-
120/min. and ventilation of 1 breath every 6 seconds (!0 breaths/min.) if advanced
airway in place, for two minutes "push hard, push fast", allowing complete chest recoil,
and minimizing interruptions in chest compressions after each intervention.
, ii. Consider EtCO2 to assess CPR quality and evaluate ROSC.
iii. All external electrial therapy will use biphasic monitors using appropriate energy dose
as designed by condition.
a. Defibrillation joules: 200
b. Cardioversion joules: 200 (physician may order 75-100-150-200 for conditions not
covered in ESO policy
f. Consider initiation of therapeutic hypothermia for the patient not following commands
of showing purposeful movement within 120 minutes after ROSC
✔✔antecubital vein - ✔✔First target for IV access if a central line is not present
✔✔Asystole - ✔✔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 every 3-5 minutes
iv. Repeat CPR and epinephrine administration if no signs of ROSC
✔✔Bradycardia unstable (Heart Rate less than 50bpm) - ✔✔i. O2 at minimum 10L/min.
non-rebreather mask
ii. If transvenous leads or epicardia pacing wires present, connect to a pulse generator
and initiate pacing per protocol.
If no response, perform the following:
iii. Atropine 1mg IVP/IO, repeat every 3-5 minutes (max 3 mg)
iv. Transcutaneous pacing as soon as possible.
v. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate to patient response up to 20mcg/kg/minute.
vi. If above is ineffective, start epinephrine 2mg/250ml NS at 2mcg/min., titrate to patient
reponse up to 10mcg/minute
NOTE: Assess patient for adequate intravascular volume and volume status when using
vasoconstrictors.)
✔✔Ventricular Fibrillation/Pulseless Ventricular Tachycardia - ✔✔Provide continuous
CPR unless defibrillating. Give medications during CPR.
Immediate defibrillation if witnessed arrest and defibrillator is available.
i. CPR (2 min.) or until defibrillator arrives.
ii. O2 at minimum 15L/min. ambu bag.
iii. Defibrillate: Biphasic: joules per approved energy dose
iv. Epinephrine 1mg/IVP/ IO (use epinephrine 0.1mg/ml)
v. Defibrilate 200 joules
vi. Amiodarone 300mg IVP/IO
vii. Defibrillate 200 joules
viii. Amiodarone 150mg IVP/IO
xi. If rhythm persists, defibrillate, CPR, epinephrine 1mg IVP/IO (Use epinephrine
0.1mg/ml) every 3 to 5 minutes until ROSC is achieved.
✔✔Chest Pain - ✔✔i. O2 start at minimum 4L/min. NC and titrate to maintain SPO2
greater than or equal to 94%.
