Sharp ESO [CEP Preparation]
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1) Notification of patient's physician - ANSWER
When a patient presents with
a life-threatening condition, the follo...
1) Notification of patient's physician - ANSWER When a patient presents with
a life-threatening condition, the following steps will be taken:
A. Code Blue will be called immedicately, if appropriate (cardiac of respiratory
arrest)
B. Rapid Response Team may be called whenever critical care expertise is needed.
C. Appropriate physicians will be notified immediately.
2) Availability of medications required for ESOs: - ANSWER Medications that
are part of an ESO must be readily available for administration to the patient
3) General Procedure for all Life-Threatening Patient Conditions - ANSWER A.
Obtain intravenous (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.
B.Begin IV infustion of normal saline (NS) to keep vein open (KVO)
,c. If IV access is unavailable, naloxone, atropine, and epinephrine may be
administered via endotracheal route at doses 2-2 1/2 times the IV dose diluted in
10ml NS flush.
d. Flush IV with 20ml NS after each IV medications given and elevate extremity if
applicable.
e. In applicable situations, treatment (ex: O2) will be administered concurrently.
Obtain oxygen (O2) saturation per pulse oximeter if readily available. Proper
assessment and intervention techniques using circulation, airway, and breathing
would be used:
i. Compressions and ventilation should be performed at a rate of 30:2
compression-ventilation ratio if no advanced airway in place, or continuous
compression rate of 100-120/min. and ventilation of 1 breath every 6 seconds (!0
breaths/min.) if advanced airway in place, for two minutes "push hard, push fast",
allowing complete chest recoil, and minimizing interruptions in chest
compressions after each intervention.
ii. Consider EtCO2 to assess CPR quality and evaluate ROSC.
iii. All external electrial therapy will use biphasic monitors using appropriate
energy dose as designed by condition.
a. Defibrillation joules: 200
b. Cardioversion joules: 200 (physician may order 75-100-150-200 for conditions
not covered in ESO policy
f. Consider initiation of therapeutic hypothermia for the patient not following
commands of showing purposeful movement within 120 minutes after ROSC
4) Antecubital vein - ANSWER First target for IV access if a central line is not
present
5) Asystole - 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 every 3-5
minutes
iv. Repeat CPR and epinephrine administration if no signs of ROSC
6) Bradycardia unstable (Heart Rate less than 50bpm) - ANSWER i. O2 at
minimum 10L/min. non-rebreather mask
ii. If transvenous leads or epicardia pacing wires present, connect to a pulse
generator and initiate pacing per protocol.
If no response, perform the following:
iii. Atropine 1mg IVP/IO, repeat every 3-5 minutes (max 3 mg)
iv. Transcutaneous pacing as soon as possible.
v. If above algorithm is ineffective, start dopamine 400mg/250ml D5W infusion at
5mcg/kg/minute. Titrate to patient response up to 20mcg/kg/minute.
vi. If above is ineffective, start epinephrine 2mg/250ml NS at 2mcg/min., titrate to
patient reponse up to 10mcg/minute
NOTE: Assess patient for adequate intravascular volume and volume status when
using vasoconstrictors.)
7) Ventricular Fibrillation/Pulseless Ventricular Tachycardia - ANSWER
Provide continuous CPR unless defibrillating. Give medications during CPR.
Immediate defibrillation if witnessed arrest and defibrillator is available.
i. CPR (2 min.) or until defibrillator arrives.
ii. O2 at minimum 15L/min. ambu bag.
iii. Defibrillate: Biphasic: joules per approved energy dose
iv. Epinephrine 1mg/IVP/ IO (use epinephrine 0.1mg/ml)
v. Defibrilate 200 joules
, vi. Amiodarone 300mg IVP/IO
vii. Defibrillate 200 joules
viii. Amiodarone 150mg IVP/IO
xi. If rhythm persists, defibrillate, CPR, epinephrine 1mg IVP/IO (Use epinephrine
0.1mg/ml) every 3 to 5 minutes until ROSC is achieved.
8) Chest Pain - ANSWER i. O2 start at minimum 4L/min. NC and titrate to
maintain SPO2 greater than or equal to 94%.
ii. Nitroglycerin 0.4mg sublingual if SBP greater than or equal to 90 mmHg and HR
greater than 50. May repeat every 3-5 minutes x2.
iii. Morphine sulfate 2mg IVP/IO, if SBP greater than or equal to 90 mmHg every 5
minutes up to a total of 10mg.
iv. Give aspirin 325 mg non-enteric coated, chewed or crushed. If not
contraindicated and no dose give on this date.
v. If hypotension develops and no evidence of pulmonary congestion, give 250ml
NS IV/IO (may be substituted with LR if currently infusing) and resume treatment
for chest pain if not relieved.
vi. 12 lead EKG
9) Hypotension: Symptomatic - ANSWER i. O2 at minimum 10L NRBM
ii. If hypovolemia is known or suspected, infuse 250ml NS (may be substituted
with LR if currently infusing). Repeat in 5 minutes if no clinical improvement.
iii. If SBP is less than 90mmHg, start dopamine 400mg/250ml D5W infuse at
5mcg/kg/minute. Titrate until SBP greater than or equal to 90mmHg and/or MAP
greater than 60mmHg or up to 20mcg/kg/min.
iv. In the presence of obvious blood loss, draw a stat H/H and Type and Cross 2
units PRBCs.
v. If suspecting Sepsis, follow Suspected Sepsis Algorithm.
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