SHARP EKG UPDATED EXAMS SET QUESTIONS
AND ANSWERS SET A+
✔✔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
✔✔2nd degree block type 1 (Wenckebach) - ✔✔progressively longer PRI and after 3 it
keeps P drops QRS, then repeats pattern.
✔✔2nd degree type 2 - ✔✔PRI consistent but some QRS's not conducted. AMI can turn
into CHB.
✔✔3rd degree block - ✔✔Independent and extra P waves, and QRS complex. P & V is
regular (irregular 2nd type 1).
✔✔PEA - ✔✔any rhythm )other than vfib or wide-complex tachycardia) that doesn't
produce a pulse. Usually reversable and part of the H's and T's.
✔✔vtach (wide-complex tachycardia) - ✔✔3 or more beats>100. Wide complex
tachycardia w/out pulse and polymorphic vtach (Torsades de Pointes) must be treated
as vfib.
✔✔Vfib - ✔✔NO cardiac output (BP). Most important is immediate uninterrupted CPR
and defib asap.
✔✔Amiodarone - ✔✔1. Main Actions: Effects sodium, potassium, and calcium channels
as well as having alpha and beta- adrenergic blocking properties. Indications:
ventricular rate control in rapid atrial rhythms in patients with severe LV dysfunction,
acts as an adjunct to cardioversion of wide complex tachycardia, and pharmacological
cardioversion of atrial fibrillation 2. Standing Order: Ventricular Fibrillation/ Pulseless V-
tach 3. Considerations: Will produce hypotension and/or bradycardia when given too
quickly. If side effects occur, fluids, pressors, chronotropic agents or temporary pacing
may be useful
AND ANSWERS SET A+
✔✔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
✔✔2nd degree block type 1 (Wenckebach) - ✔✔progressively longer PRI and after 3 it
keeps P drops QRS, then repeats pattern.
✔✔2nd degree type 2 - ✔✔PRI consistent but some QRS's not conducted. AMI can turn
into CHB.
✔✔3rd degree block - ✔✔Independent and extra P waves, and QRS complex. P & V is
regular (irregular 2nd type 1).
✔✔PEA - ✔✔any rhythm )other than vfib or wide-complex tachycardia) that doesn't
produce a pulse. Usually reversable and part of the H's and T's.
✔✔vtach (wide-complex tachycardia) - ✔✔3 or more beats>100. Wide complex
tachycardia w/out pulse and polymorphic vtach (Torsades de Pointes) must be treated
as vfib.
✔✔Vfib - ✔✔NO cardiac output (BP). Most important is immediate uninterrupted CPR
and defib asap.
✔✔Amiodarone - ✔✔1. Main Actions: Effects sodium, potassium, and calcium channels
as well as having alpha and beta- adrenergic blocking properties. Indications:
ventricular rate control in rapid atrial rhythms in patients with severe LV dysfunction,
acts as an adjunct to cardioversion of wide complex tachycardia, and pharmacological
cardioversion of atrial fibrillation 2. Standing Order: Ventricular Fibrillation/ Pulseless V-
tach 3. Considerations: Will produce hypotension and/or bradycardia when given too
quickly. If side effects occur, fluids, pressors, chronotropic agents or temporary pacing
may be useful
