Sharp Memorial ESO Exam
Asystole - ANS - 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 - ANS - 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)
Chest Pain - ANS - 1. Give aspirin 325 mg non-enteric coasted, chewed or crushed, if
not contraindicated and nodose on this date.
2. O2 start at minimum 4 L/min and titrate to maintain SpO2 greater than or equal to
94%.
3. NTG 0.4 mg SL if SBP greater than or equal to 90 mmHg and/or MAP 60 mmHG and
HR greater than 50. May repeat every 3-5 minutes x2.
4. Morphine sulfate 2 mg IVP/IO. If SBP greater than or equal to 90 mmHg q5minutes
up to a total of 10 mg.
5. If hypotension develops and no evidence of pulmonary congestion, give 250 ml NS
IV/IO (may substituted with LR if currently infusing) and resume treatment for chest pain
if not relieved.
6. 12 lead EKG
For immediate Post Anesthesia Patients: (This is only administered by PACU nurse) -
ANS - 1. O2 at minimum 10 L/min NRBM
2. Infuse 250 mL NS (may be substituted with LR if currently infusing). Repeat in 5
minutes if no clinical improvement.
3. If fluid bolus ineffective, Ephedrine 5mg/IVP/IO
, 4. If no improvement within 3 minutes, repeat Epherdine at 10 mg IVP/IO.
5. In the presence of obvious blood loss draw stat H/H and Type & Cross 2 unites of
PRBCs.
Hypotension: Symptomatic - ANS - 1. O2 at minimum 10 L/min NRBM
2. If hypovolemia known or suspected, infuse 250 ml NS (may be substituted with LR if
currently infusing). Repeat in 5 minutes if no clinical improvement.
3. If SPB less than 90 mmHg, start dopamine 400mg/250mL D5W infuse at 5
mcg/kg/minutes. Titrate until SBP greater than or equal to 90 mmHg and /or MAP
greater than 60 mmHg or up to 20 mcg/kg/min.
4. In the presence of obvious blood loss draw stat H/H and Type & Cross 2 units of
pRBCs.
5. If suspecting Sepsis, follow SUSPECTED SEPSIS algorithm.
Increased Intracranial Pressure - ANS - In the neurologically impaired patient with
dilated pupil associated with other signs of impending herniation (Note: implement only
in the absence of specific ICP order)
1. Raise HOB to at least 30 degrees if patient is not hypotensive; place patient's head in
midline position.
2. Hyperventilate the intubated patient with FiO2 100% to maintain pCO2 30-35 mmHg
3. Mannitol 20% (100gm/500mL) rapid IVP/IO using a filter (if filter is readily available)
4. Draw baseline serum K, Na, BUN, Cr, Glucose, and ABG.
5. Insert urinary catheter.
Possible Cause of PEA - ANS - 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
Pulseless Electrical Activities (PEA) - ANS - 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.
Asystole - ANS - 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 - ANS - 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)
Chest Pain - ANS - 1. Give aspirin 325 mg non-enteric coasted, chewed or crushed, if
not contraindicated and nodose on this date.
2. O2 start at minimum 4 L/min and titrate to maintain SpO2 greater than or equal to
94%.
3. NTG 0.4 mg SL if SBP greater than or equal to 90 mmHg and/or MAP 60 mmHG and
HR greater than 50. May repeat every 3-5 minutes x2.
4. Morphine sulfate 2 mg IVP/IO. If SBP greater than or equal to 90 mmHg q5minutes
up to a total of 10 mg.
5. If hypotension develops and no evidence of pulmonary congestion, give 250 ml NS
IV/IO (may substituted with LR if currently infusing) and resume treatment for chest pain
if not relieved.
6. 12 lead EKG
For immediate Post Anesthesia Patients: (This is only administered by PACU nurse) -
ANS - 1. O2 at minimum 10 L/min NRBM
2. Infuse 250 mL NS (may be substituted with LR if currently infusing). Repeat in 5
minutes if no clinical improvement.
3. If fluid bolus ineffective, Ephedrine 5mg/IVP/IO
, 4. If no improvement within 3 minutes, repeat Epherdine at 10 mg IVP/IO.
5. In the presence of obvious blood loss draw stat H/H and Type & Cross 2 unites of
PRBCs.
Hypotension: Symptomatic - ANS - 1. O2 at minimum 10 L/min NRBM
2. If hypovolemia known or suspected, infuse 250 ml NS (may be substituted with LR if
currently infusing). Repeat in 5 minutes if no clinical improvement.
3. If SPB less than 90 mmHg, start dopamine 400mg/250mL D5W infuse at 5
mcg/kg/minutes. Titrate until SBP greater than or equal to 90 mmHg and /or MAP
greater than 60 mmHg or up to 20 mcg/kg/min.
4. In the presence of obvious blood loss draw stat H/H and Type & Cross 2 units of
pRBCs.
5. If suspecting Sepsis, follow SUSPECTED SEPSIS algorithm.
Increased Intracranial Pressure - ANS - In the neurologically impaired patient with
dilated pupil associated with other signs of impending herniation (Note: implement only
in the absence of specific ICP order)
1. Raise HOB to at least 30 degrees if patient is not hypotensive; place patient's head in
midline position.
2. Hyperventilate the intubated patient with FiO2 100% to maintain pCO2 30-35 mmHg
3. Mannitol 20% (100gm/500mL) rapid IVP/IO using a filter (if filter is readily available)
4. Draw baseline serum K, Na, BUN, Cr, Glucose, and ABG.
5. Insert urinary catheter.
Possible Cause of PEA - ANS - 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
Pulseless Electrical Activities (PEA) - ANS - 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.
