Sharp ESO Exam Questions and Answers

Sharp ESO Exam Questions and Answers End Tidal CO2 - Answer ️️ -the maximum CO2 concentration at the end of each tidal breath, which can be used to assess disease severity and response to treatment. Reflects cardiac output during CPR. Can be used to measure the effectiveness of cardiac compressions and assessment of return of spontaneous circulation (ROSC) after cardiac event ROSC - Answer ️️ -Return of spontaneous circulation is established with the presence of palpable pulse, blood pressure, abrupt sustained increase in end tidal CO2 (typically > 40mmHg) after cardiac arrest therapeutic hypothermia - Answer ️️ -Core temperature 32-36 C (89.6-96.8 F) joules for defibrillation - Answer ️️ -Defibrillation Joules: 200 joules joules for cardioversion - Answer ️️ -Cardioversion joules: 200 joules Physicians may order for conditions not covered in ESO policy For the patient not following commands after 120 minutes of ROSC - Answer ️️ -Consider initiation of therapeutic hypothermia Treatment of pulseless arrests - Answer ️️ -Provide 2 minutes of CPR-avoiding interruptions in compressions Asystole treatment - Answer ️️ -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 Unstable Bradycardia - Answer ️️ -i. O2 at minimum 10 L/min. NRBM ii. If transvenous leads or epicardial pacing wires present, connect to a pulse generator and initiate pacing per protocol. If no response, perform the following: iii. Atropine 1 mg IVP/IO, repeat q 3-5 minutes max 3 mg iv. Transcutaneous pacing as soon as possible If above algorithm is ineffective: v. Start dopamine 400 mg/250 ml D5W infusion at 5 mcg/kg/minute. Titrate to patient response up to 20mcg/kg/minute If above algorithm is ineffective, start epinephrine 2 mg/ 250 ml NS @ 2 mcg/min., titrate to patient response up to 10 mcg/minute Pulseless Electrical Activity - Answer ️️ -i. CPR 2 minutes and assess for possible causes The H's: -Hypovolemia -Hypoxia -Hydrogen ion (acidosis) -Hypokalemia -Hyperkalemia -Hypoglycemia -Hypothermia The T's: -Toxins -Cardiac Tamponade -Thrombosis -Trauma -Tension pneumothorax 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 v. If hypovolemia known or suspected, infuse 250 mL NS may be substituted with LF if currently infusing). Repeat in 5 minutes if no clinical improvement. vi. Stat CXR Ventricular Tachycardia (Wide Complex): Stable - Answer ️️ -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 - Answer ️️ -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 - Answer ️️ -Reversal agent for midazolam Standard Procedure Functions - Answer ️️ -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) - Answer ️️ -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 - Answer ️️ -RN who had successfully demonstrated the knowledge and skills in identification and treatment of life-threatening conditions Rapid Response Team - Answer ️️ -A team PF health care professionals who bring critical care expertise to the patient bedside CPR (cardiopulmonary resuscitation) - Answer ️️ -Includes circulation with compressions, airway assessment and breathing (C-A-B) Intraosseous (IO) Therapy - Answer ️️ -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 neede