Sharp ESO
3 types of Ventricular Tachycardia: - ✅✅-1. Stable
2. Unstable
3. Pulseless
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
Asystole treatment - ✅✅ -Asystole represents total absence of
ventricular activity/contraction. There is no pulse associated with this
rhythm. Initiate CPR immedicately.
a. CPR for 2 minutes
b. O2 at 15ml/min. ambu bag (10 breaths per minute)
c. Epinephrine 1mg IVP/IO (Use Epinephrine 0.1mg/ml) repeat every 3-5
minutes
d. Repeat CPR and Epinephrine administrations if not signs of ROSC
-NO defibrillation
-Transcutaneous pacing for asystole is not recommended as it is
ineffective
Asystole treatment - ✅✅ -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 q 3-5
minutes
iv. Repeat CPR and Epinephrine administration if no signs of ROSC
Availability of medications required for ESOs: - ✅✅
-Medications that
are part of an ESO must be readily available for administration to the
patient
,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.)
Bradycardia-Unstable (includes heart blocks) - ✅✅ -1. Bradycardia is
defined as heart rate less than 50 beats per minute. This rhythm is too
slow to maintain an adequate blood pressure.
2. The patient must be symptomatic, exhibiting one or more of the
"unstable" signs/symptoms related to the slow rate.
3. Bradycardias range from sinus bradycardia to complete, third degree
heart block.
Chest Pain - ✅✅ -i. O2 start at minimum 4L/min. NC and titrate to
maintain SPO2 greater than or equal to 94%.
ii. Nitroglycerin 0.4mg sublingual if SBP greater than or equal to 90
mmHg and HR greater than 50. May repeat every 3-5 minutes x2.
iii. Morphine sulfate 2mg IVP/IO, if SBP greater than or equal to 90
mmHg every 5 minutes up to a total of 10mg.
iv. Give aspirin 325 mg non-enteric coated, chewed or crushed. If not
contraindicated and no dose give on this date.
v. If hypotension develops and no evidence of pulmonary congestion,
give 250ml NS IV/IO (may be substituted with LR if currently infusing)
and resume treatment for chest pain if not relieved.
vi. 12 lead EKG
, Chest pain -✅✅ -The most common presentation of an acute coronary
syndrome (ex: unstable angina; non-Q wave MI; Q-wave MI
Chest pain suggestive of ischemia may be described as: - ✅✅ -a.
Uncomfortable pressure, fullness, squeezing, or pain in the center of the
chest lasting several minutes (usually more than 15 minutes)
b. Pain spreading to the shoulders, neck, arms, jaw; or pain in the back
or between the shoulder blades
c. Chest discomfort with light-headedness, fainting, sweating, nausea, or
shortness of breath
d. A global feeling of distress, anxiety or impending doom
It is important to respond immediately when symptoms of myocardial
ischemia are present. A high priority is to provide pain relief.
✅✅
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.
Coarse and fine V Fib - ✅✅-Used to describe the amplitude of the
rhythm
Coarse VFib - ✅✅ -Usually indicates a recent onset of V-Fib that may
be corrected with immediate defibrillation
Comatose Adult - ✅✅-No eye opening to pain and no purposeful motor
response
CPR (cardiopulmonary resuscitation) - ✅✅-Includes circulation with
compressions, airway assessment and breathing (C-A-B)
Documentation for nurse instituting ESO - ✅✅ -a. Life threatening
condition
b. Precipitating factors
c. Specific ESO implemented (medication and/or treatment)
d. Patient's response
e. When and which physician was notified
3 types of Ventricular Tachycardia: - ✅✅-1. Stable
2. Unstable
3. Pulseless
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
Asystole treatment - ✅✅ -Asystole represents total absence of
ventricular activity/contraction. There is no pulse associated with this
rhythm. Initiate CPR immedicately.
a. CPR for 2 minutes
b. O2 at 15ml/min. ambu bag (10 breaths per minute)
c. Epinephrine 1mg IVP/IO (Use Epinephrine 0.1mg/ml) repeat every 3-5
minutes
d. Repeat CPR and Epinephrine administrations if not signs of ROSC
-NO defibrillation
-Transcutaneous pacing for asystole is not recommended as it is
ineffective
Asystole treatment - ✅✅ -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 q 3-5
minutes
iv. Repeat CPR and Epinephrine administration if no signs of ROSC
Availability of medications required for ESOs: - ✅✅
-Medications that
are part of an ESO must be readily available for administration to the
patient
,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.)
Bradycardia-Unstable (includes heart blocks) - ✅✅ -1. Bradycardia is
defined as heart rate less than 50 beats per minute. This rhythm is too
slow to maintain an adequate blood pressure.
2. The patient must be symptomatic, exhibiting one or more of the
"unstable" signs/symptoms related to the slow rate.
3. Bradycardias range from sinus bradycardia to complete, third degree
heart block.
Chest Pain - ✅✅ -i. O2 start at minimum 4L/min. NC and titrate to
maintain SPO2 greater than or equal to 94%.
ii. Nitroglycerin 0.4mg sublingual if SBP greater than or equal to 90
mmHg and HR greater than 50. May repeat every 3-5 minutes x2.
iii. Morphine sulfate 2mg IVP/IO, if SBP greater than or equal to 90
mmHg every 5 minutes up to a total of 10mg.
iv. Give aspirin 325 mg non-enteric coated, chewed or crushed. If not
contraindicated and no dose give on this date.
v. If hypotension develops and no evidence of pulmonary congestion,
give 250ml NS IV/IO (may be substituted with LR if currently infusing)
and resume treatment for chest pain if not relieved.
vi. 12 lead EKG
, Chest pain -✅✅ -The most common presentation of an acute coronary
syndrome (ex: unstable angina; non-Q wave MI; Q-wave MI
Chest pain suggestive of ischemia may be described as: - ✅✅ -a.
Uncomfortable pressure, fullness, squeezing, or pain in the center of the
chest lasting several minutes (usually more than 15 minutes)
b. Pain spreading to the shoulders, neck, arms, jaw; or pain in the back
or between the shoulder blades
c. Chest discomfort with light-headedness, fainting, sweating, nausea, or
shortness of breath
d. A global feeling of distress, anxiety or impending doom
It is important to respond immediately when symptoms of myocardial
ischemia are present. A high priority is to provide pain relief.
✅✅
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.
Coarse and fine V Fib - ✅✅-Used to describe the amplitude of the
rhythm
Coarse VFib - ✅✅ -Usually indicates a recent onset of V-Fib that may
be corrected with immediate defibrillation
Comatose Adult - ✅✅-No eye opening to pain and no purposeful motor
response
CPR (cardiopulmonary resuscitation) - ✅✅-Includes circulation with
compressions, airway assessment and breathing (C-A-B)
Documentation for nurse instituting ESO - ✅✅ -a. Life threatening
condition
b. Precipitating factors
c. Specific ESO implemented (medication and/or treatment)
d. Patient's response
e. When and which physician was notified
