Standardized Procedure- Emergency
Standing Orders at Sharp Healthcare
General Procedure for all Life-Threatening Patient Conditions- what kind of get admission to
must a nurse gain? - ANSa. Obtain IV/intraosseous (IO) get right of entry to (big bore cannula
inside the antecubital vein have to be the primary goal for IV access if a central line isn't always
gift)
General Procedure for all Life-Threatening Patient Conditions- what sort of fluid should be
started to KVO? - ANSb. Begin IV infusion of Normal Saline (NS) to preserve vein open (KVO)
General Procedure for all Life-Threatening Patient Conditions- If IV get admission to isn't
available what medicinal drugs can be given and the way is it administered? - ANSc. If IV get
entry to isn't available: Narcan, Atropine, and Epinephrine may be administered through
endotracheal direction at doses of 2 times the IV dose diluted in 10ml NS flush
General Procedure for all Life-Threatening Patient Conditions- what's the system after giving
every medicine? - ANSd. Flush IV line with 20ml of NS after each IV remedy given and elevate
extremity if applicable.
General Procedure for all Life-Threatening Patient Conditions- In relevant situations, what
should be comfortably to be had? - ANSe. Oxygen
What's the proper strategies the usage of flow, airway, and breathing? - ANS1. Compressions
need to be carried out at a charge of 100/min for two mins "push difficult,push rapid" permitting
full chest balk, and minimize interruptions in chest compressions after every intervention.
2. All external electrical remedy may be cardioverted/defibrillated with biphasic video display
units the use of suitable strength dose as distinct via situation.
True/False
In most instances, treatment (e.G. O2 administration) is run simultaneously. - ANSTRUE
True/False
Stickers with suitable energy levels of cardioversion/defibrillation should be placed on all
defibrillators for brief reference. - ANSTRUE
ASYSTOLE - ANS1. CPR (2 min)
2. O2 at 15ml/min ambu bag (eight-10 breaths/min)
three. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.
, BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - ANS1. 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 reaction from above algorithm, provoke Isuprel infusion 1-10mcg/min IV/IO)
PULSELESS ELECTRICAL ACTIVITY (PEA) - ANS1. CPR (2min) and check for feasible
causes.
2. O2 at 15ml/min ambubag (eight-10breaths/min)
3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5mim
four. If hypovolemia recognised or suspected, infuse 250ml LR or NS. Repeat in five mins if no
clinical improvement.
Five. Stat CXR
What are the 7 H's viable reasons of PEA? - ANS1. Hypovolemia
2. Hypoxia
3. Hydrogen Ion (acidosis)
4. Hypokalemia
5. Hyperkalemia
6. Hypoglycemia
7. Hypothermia
What are the five T'# viable causes of PEA? - ANS1. Toxins
2. Tamponade
three. Thrombosis
four. Trauma
5. Tension pneumothorax
VENTRICULAR TACHYCARDIA (Wide Complex) STABLE - ANS1. Call the medical doctor for
orders
IN ADDITION TO CALLING THE MD PERFORM THE FF:
a. O2 at minimum 4L/min NC and adjust in keeping with patient popularity
b. Obtain 12 Lead EKG
c. Draw serum K, Mg
VENTRICULAR TACHYCARDIA (Wide Complex) UNSTABLE - ANS1. O2 at minimum 10ml
NRBM
2. If ventricular price is >150: BIPHASIC- Synchronized cardioversion in step with authorised
strength dose indexed on defibrillator
3. If patient is awake and responsive, provide Midazolam (versed) 0.5mg IVP/IO prior to
cardioversion. May repeat to a complete of 1mg to gain sedation.
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