Sharp ESO Exam Rated A+ (verified)
. Invasive Temporary Pacing - ANS - 1. If transvenous leads or epicardial wires are
present, connect to a generator and initiate emergency invasive pacing
2. Default values for emergency pacing on the Medtronic 5392: mode-DOO, rate-80, A
Output-20, V Output 25, AV Interval-170ms
3. If competition occurs or anticipated, change mode to demand by pressing 'on'. It is
appropriate to initiate drug therapy and pacing simultaneously to stabilize the patient as
quickly as possible
Adequate CPR - ANS - 1. Push hard
2. Full chest recoil
3. Minimize interruptions
4. 100-120 compressions/min
5. 15 L O2 by bag mask (10 breaths per min)
6. 30:2
Airway Management During Seizures - ANS - During a seizure, the patient's airway is
vulnerable, therefore maintaining a patent airway is essential.
Amiodarone - ANS - Antiarrhythmic agent that prolongs refractory period, lengthens
cardiac action potential, and causes negative chronotropic effect. Has vasodilator action
that decreases cardiac workload and myocardial oxygen consumption VF/Pulseless VT
Amiodarone dose - ANS - 300 mg IVP followed by 20 mL NS flush, may repeat with
150 mg IVP if rhythm persists
Amiodarone side effects - ANS - May produce hypotension, bradycardia, exacerbation
of arrhythmia, and prolong QT interval
Amiodarone use - ANS - VF/Pulseless VT
Ativan dose - ANS - 2 mg IVP/IO over 1 minute, repeat x1 in 3-5 minutes if seizure
persists
,Bradycardia - Atropine Administration - ANS - 1. Atropine 1mg IVP/IO, repeat every
3-5 minutes up to a maximum of 3 mg
Bradycardia - Dopamine Administration - ANS - 1. Start Dopamine 400mg/250 mL
D5W at 5 mcg/kg/minute if above algorithm is ineffective. ICU or RRT RN to titrate until
patient is asymptomatic.
Bradycardia - Epinephrine Administration - ANS - 1. Start Epinephrine 2mg/250 mL NS
at 2mcg/minute if above algorithm is ineffective. Titrate to patient response up to 10
mcg/minute. (RRT or ICU RN Only)
Bradycardia - Initial Treatment - ANS - 1. O2 at minimum 10 L/minute (NRBM)
Causes of Prolonged Seizures - ANS - Prolonged seizures can be caused by
withdrawal from anticonvulsant medications, acute alcohol withdrawal, CNS infections,
brain tumors, metabolic disorders, or cerebral edema.
Changes from 2021-23 ESO Anaphylaxis Algorithm: - ANS - Epinephrine 0.1 IV mg
removed
Changes from 2021-23 ESO Asystole/PEA Algorithm: - ANS - Separation of CPR
cycles and Epinephrine doses
Changes from 2021-23 ESO Bradycardia-Unstable Algorithm: - ANS - Clarification of
Epinephrine drip to be started by RRT or ICU RN only
Changes from 2021-23 ESO Chest Pain Algorithm: - ANS - i. Addition of labs: CBC,
BMP, PT/INR, PTT, Troponin-HS if not done within 6 hours
Changes from 2021-23 ESO Hypotension-Symptomatic Algorithm: - ANS - .
NORepinephrine added for vasopressor if bolus ineffective, dopamine removed
Changes from 2021-23 ESO Increase Intracranial Pressure Algorithm: - ANS - Labs:
K+, Na+, BUN, Cr, Glucose labs condensed to BMP
Changes from 2021-23 ESO Respiratory Depression Algorithm: - ANS - i. If patient is
apneic, administration of oxygen by ambu bag added
ii. Narcan repeat doses and IM route of administration added
, iii. Direction to treat with Naloxone first in cases of suspected combined opioid and
benzodiazepine associated respiratory depression/arrest
iv. Note of potential harm from Flumazenil in patients at risk for seizures or
dysrhythmias
v. End Tidal CO2 monitoring added vi. Note to call a Code Blue for life-threatening
respiratory arrest
Changes from 2021-23 ESO Respiratory Distress Algorithm: - ANS - i. Suctioning
added
Changes from 2021-23 ESO Status Epilepticus Algorithm - ANS - i. Name changes
from "Status Epilepticus" to "Prolonged Seizures"
ii. Repeat dose of Ativan added
iii. Labs: Na+, K+, Ca, Glucose, BUN, Cr labs simplified to BMP
Changes from 2021-23 ESO Suspected Sepsis Algorithm: - ANS - i. Noninvasive
Cardiac Output Monitoring (NICOM) added where available
ii. If indicated by NICOM, ICU/RRT RN may administer a 500 mL bolus of LR. No
change to fluid administration if NICOM unavailable
Changes from 2021-23 ESO Unstable VT Algorithm: - ANS - 1. Clarification of number
and frequency of cardioversion attempts
2. 12 Lead ECG added to algorithm
Changes from 2021-23 ESO Ventricular Fibrillation Algorithm: - ANS - i. Clarification of
"per approved energy dose" to 200 joules
ii. Separation of CPR cycles and Epinephrine/Amiodarone doses
iii. Addition of Lidocaine 1 mg/kg for refractory Ventricular Fibrillation/Pulseless
Ventricular Tachycardia
. Invasive Temporary Pacing - ANS - 1. If transvenous leads or epicardial wires are
present, connect to a generator and initiate emergency invasive pacing
2. Default values for emergency pacing on the Medtronic 5392: mode-DOO, rate-80, A
Output-20, V Output 25, AV Interval-170ms
3. If competition occurs or anticipated, change mode to demand by pressing 'on'. It is
appropriate to initiate drug therapy and pacing simultaneously to stabilize the patient as
quickly as possible
Adequate CPR - ANS - 1. Push hard
2. Full chest recoil
3. Minimize interruptions
4. 100-120 compressions/min
5. 15 L O2 by bag mask (10 breaths per min)
6. 30:2
Airway Management During Seizures - ANS - During a seizure, the patient's airway is
vulnerable, therefore maintaining a patent airway is essential.
Amiodarone - ANS - Antiarrhythmic agent that prolongs refractory period, lengthens
cardiac action potential, and causes negative chronotropic effect. Has vasodilator action
that decreases cardiac workload and myocardial oxygen consumption VF/Pulseless VT
Amiodarone dose - ANS - 300 mg IVP followed by 20 mL NS flush, may repeat with
150 mg IVP if rhythm persists
Amiodarone side effects - ANS - May produce hypotension, bradycardia, exacerbation
of arrhythmia, and prolong QT interval
Amiodarone use - ANS - VF/Pulseless VT
Ativan dose - ANS - 2 mg IVP/IO over 1 minute, repeat x1 in 3-5 minutes if seizure
persists
,Bradycardia - Atropine Administration - ANS - 1. Atropine 1mg IVP/IO, repeat every
3-5 minutes up to a maximum of 3 mg
Bradycardia - Dopamine Administration - ANS - 1. Start Dopamine 400mg/250 mL
D5W at 5 mcg/kg/minute if above algorithm is ineffective. ICU or RRT RN to titrate until
patient is asymptomatic.
Bradycardia - Epinephrine Administration - ANS - 1. Start Epinephrine 2mg/250 mL NS
at 2mcg/minute if above algorithm is ineffective. Titrate to patient response up to 10
mcg/minute. (RRT or ICU RN Only)
Bradycardia - Initial Treatment - ANS - 1. O2 at minimum 10 L/minute (NRBM)
Causes of Prolonged Seizures - ANS - Prolonged seizures can be caused by
withdrawal from anticonvulsant medications, acute alcohol withdrawal, CNS infections,
brain tumors, metabolic disorders, or cerebral edema.
Changes from 2021-23 ESO Anaphylaxis Algorithm: - ANS - Epinephrine 0.1 IV mg
removed
Changes from 2021-23 ESO Asystole/PEA Algorithm: - ANS - Separation of CPR
cycles and Epinephrine doses
Changes from 2021-23 ESO Bradycardia-Unstable Algorithm: - ANS - Clarification of
Epinephrine drip to be started by RRT or ICU RN only
Changes from 2021-23 ESO Chest Pain Algorithm: - ANS - i. Addition of labs: CBC,
BMP, PT/INR, PTT, Troponin-HS if not done within 6 hours
Changes from 2021-23 ESO Hypotension-Symptomatic Algorithm: - ANS - .
NORepinephrine added for vasopressor if bolus ineffective, dopamine removed
Changes from 2021-23 ESO Increase Intracranial Pressure Algorithm: - ANS - Labs:
K+, Na+, BUN, Cr, Glucose labs condensed to BMP
Changes from 2021-23 ESO Respiratory Depression Algorithm: - ANS - i. If patient is
apneic, administration of oxygen by ambu bag added
ii. Narcan repeat doses and IM route of administration added
, iii. Direction to treat with Naloxone first in cases of suspected combined opioid and
benzodiazepine associated respiratory depression/arrest
iv. Note of potential harm from Flumazenil in patients at risk for seizures or
dysrhythmias
v. End Tidal CO2 monitoring added vi. Note to call a Code Blue for life-threatening
respiratory arrest
Changes from 2021-23 ESO Respiratory Distress Algorithm: - ANS - i. Suctioning
added
Changes from 2021-23 ESO Status Epilepticus Algorithm - ANS - i. Name changes
from "Status Epilepticus" to "Prolonged Seizures"
ii. Repeat dose of Ativan added
iii. Labs: Na+, K+, Ca, Glucose, BUN, Cr labs simplified to BMP
Changes from 2021-23 ESO Suspected Sepsis Algorithm: - ANS - i. Noninvasive
Cardiac Output Monitoring (NICOM) added where available
ii. If indicated by NICOM, ICU/RRT RN may administer a 500 mL bolus of LR. No
change to fluid administration if NICOM unavailable
Changes from 2021-23 ESO Unstable VT Algorithm: - ANS - 1. Clarification of number
and frequency of cardioversion attempts
2. 12 Lead ECG added to algorithm
Changes from 2021-23 ESO Ventricular Fibrillation Algorithm: - ANS - i. Clarification of
"per approved energy dose" to 200 joules
ii. Separation of CPR cycles and Epinephrine/Amiodarone doses
iii. Addition of Lidocaine 1 mg/kg for refractory Ventricular Fibrillation/Pulseless
Ventricular Tachycardia
