Standardized Procedure- Emergency
Standing Orders at Sharp Healthcare
ASYSTOLE - ANS - 1. CPR (2 min)
2. O2 at 15ml/min ambu bag (8-10 breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.
BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - ANS - 1. O2 at minimum
10ml/mim NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator
and initiate pacing control.
3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg)
4. Transcutaneous pacing as soon as available
5. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate until SBP =/> 90mmHg and/or MAP >60mmHg up to
20mcg/kg/min.
6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min IV/IO)
CHEST PAIN - ANS - 1. Consider giving aspirin 325mg, if no dose was given on this
date
2. O2 start at minimum 4L/min NC
3. NTG 0.4mg SL if BP >/= 90 mmHG and /pr MAP >60mmHg and HR >50,may repeat
every 3-5min x 2.
4. Morphine Suldate 2mg, if SBP >/= 90, IVP/IO q5 min up to a total of 10mg
5. 12 Lead EKG
Circulation, Airway,Breathing - ANS - CPR- cardiopulmonary resuscitation which
includes Circulation with compressions , airway assessment and breathing.
Compressions are administered for 2 minutes at >100 compressions/min between all
interventions. During CPR, O2 should be delivered by 15L inspired O2 by bag mask
(8-10 breaths/min)
DOCUMENTATION - ANS - Will be made by RN performing ESO standardized
procedure including:
, Unstable or life-threatening condition, precipitating factors if any, treatment/medications
administered, biphasic defibrillation or joules, pt's response to interventions, and
when/which physician was notified. Code blue will be completed for all cardiac and
respiratory arrest events. The RRT record will be completed for all RRT events that
utilize ESOs.
Emergency Standing Orders (ESO) - ANS - Preestablished medical orders, approved
by appropriate medical staff to be administered in the absence of a physician. These
orders specify emergent treatment interventions for life threatening conditions.
ESO Competent Nurse - ANS - RN who has successfully demonstrated the knowledge
and skills in identification and treatment of life threatening conditions
General Procedure for all Life-Threatening Patient Conditions- If IV access is not
available what medications can be given and how is it administered? - ANS - c. If IV
access is not available: Narcan, Atropine, and Epinephrine may be administered via
endotracheal route at doses of 2 times the IV dose diluted in 10ml NS flush
General Procedure for all Life-Threatening Patient Conditions- In applicable situations,
what should be readily available? - ANS - e. Oxygen
General Procedure for all Life-Threatening Patient Conditions- what kind of access
should a nurse obtain? - ANS - a. Obtain IV/intraosseous (IO) access (large bore
cannula in the antecubital vein should be the first target for IV access if a central line is
not present)
General Procedure for all Life-Threatening Patient Conditions- what kind of fluid should
be started to KVO? - ANS - b. Begin IV infusion of Normal Saline (NS) to keep vein
open (KVO)
General Procedure for all Life-Threatening Patient Conditions- what's the process after
giving each medication? - ANS - d. Flush IV line with 20ml of NS after each IV
medication given and elevate extremity if applicable.
How do you order specific treatments for the unstable or life-threatening condition? -
ANS - It will be ordered electronically in Cerner by the RN as a standardized
procedure, or the Code Blue Record will be completed by RN and signed by the
physician, then placed in the chart, this acts as an oder sheet
Standing Orders at Sharp Healthcare
ASYSTOLE - ANS - 1. CPR (2 min)
2. O2 at 15ml/min ambu bag (8-10 breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.
BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - ANS - 1. O2 at minimum
10ml/mim NRBM
2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator
and initiate pacing control.
3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg)
4. Transcutaneous pacing as soon as available
5. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate until SBP =/> 90mmHg and/or MAP >60mmHg up to
20mcg/kg/min.
6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min IV/IO)
CHEST PAIN - ANS - 1. Consider giving aspirin 325mg, if no dose was given on this
date
2. O2 start at minimum 4L/min NC
3. NTG 0.4mg SL if BP >/= 90 mmHG and /pr MAP >60mmHg and HR >50,may repeat
every 3-5min x 2.
4. Morphine Suldate 2mg, if SBP >/= 90, IVP/IO q5 min up to a total of 10mg
5. 12 Lead EKG
Circulation, Airway,Breathing - ANS - CPR- cardiopulmonary resuscitation which
includes Circulation with compressions , airway assessment and breathing.
Compressions are administered for 2 minutes at >100 compressions/min between all
interventions. During CPR, O2 should be delivered by 15L inspired O2 by bag mask
(8-10 breaths/min)
DOCUMENTATION - ANS - Will be made by RN performing ESO standardized
procedure including:
, Unstable or life-threatening condition, precipitating factors if any, treatment/medications
administered, biphasic defibrillation or joules, pt's response to interventions, and
when/which physician was notified. Code blue will be completed for all cardiac and
respiratory arrest events. The RRT record will be completed for all RRT events that
utilize ESOs.
Emergency Standing Orders (ESO) - ANS - Preestablished medical orders, approved
by appropriate medical staff to be administered in the absence of a physician. These
orders specify emergent treatment interventions for life threatening conditions.
ESO Competent Nurse - ANS - RN who has successfully demonstrated the knowledge
and skills in identification and treatment of life threatening conditions
General Procedure for all Life-Threatening Patient Conditions- If IV access is not
available what medications can be given and how is it administered? - ANS - c. If IV
access is not available: Narcan, Atropine, and Epinephrine may be administered via
endotracheal route at doses of 2 times the IV dose diluted in 10ml NS flush
General Procedure for all Life-Threatening Patient Conditions- In applicable situations,
what should be readily available? - ANS - e. Oxygen
General Procedure for all Life-Threatening Patient Conditions- what kind of access
should a nurse obtain? - ANS - a. Obtain IV/intraosseous (IO) access (large bore
cannula in the antecubital vein should be the first target for IV access if a central line is
not present)
General Procedure for all Life-Threatening Patient Conditions- what kind of fluid should
be started to KVO? - ANS - b. Begin IV infusion of Normal Saline (NS) to keep vein
open (KVO)
General Procedure for all Life-Threatening Patient Conditions- what's the process after
giving each medication? - ANS - d. Flush IV line with 20ml of NS after each IV
medication given and elevate extremity if applicable.
How do you order specific treatments for the unstable or life-threatening condition? -
ANS - It will be ordered electronically in Cerner by the RN as a standardized
procedure, or the Code Blue Record will be completed by RN and signed by the
physician, then placed in the chart, this acts as an oder sheet
