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ESO
Emergency standing order
| Question | Answer |
|---|---|
| When to start compression? | Start compression within 10 seconds if no pulse |
| How hard and fast to push? | At least 100/min with a depth of at least 2 inches in adults. Ensure full recoil. |
| How many compression and breaths in one cycle? | 30 compression and 2 breaths |
| When to check pulse? | Check pulse every 2 mins |
| How long does pulse check need to take? | Pulse check takes no more than 10 seconds |
| 5 cycles of CPR is equal to how many minutes? | 2 min equals 5 cycles of CPR |
| What does the rescuers do after an advanced airway (ETT or trach) is placed? | Rescuer no longer deliver 'cycles' of CPR. Give continuous chest compressions without pauses for breaths. Give 8-10 breaths/minute |
| What medication can be administered via endotracheal route and at what dose? | Atropine, Narcan, and Epinephrine at doses of 2-2.5 times the IV dose diluted in 10ml NS and inject directly into ETT |
| How to confirm Asystole? | Confirm unresponsiveness, check leads and cables, confirm in a second lead, increase gain, and R/O fine Vfib. |
| How to treat Asystole? | -CPR(2min) at least 100 compression/min -100%O2 at 15L/min ambu bag (8-10 breaths/min) -Epinephrine (1:10,000) 1mg IVP, repeat q 3-5 minutes as long as asystole persists. Give first dose within 5 minutes of initiating Code Blue |
| Signs and symptoms of Unstable life-threatening conditions? | Chest pain (MI or major vascular or pulmonary events), SOB, Foreign body airway obstruction, Hypotension, Hypoglycemia, Decreased level of consciousness, Increased ICP, Status epilepticus, Anaphylaxis, Pulmonary congestion, CHF, AMI, VS changes |
| How to treat Pulseless Electrical Activity(PEA)? | -CPR (2min) assess for poss causes -100% O2 at 15L/min ambu bag (8-10 breaths/min) -Epi (1:10,000)1mg IVP, repeat q3-5min as long as PEA persists. 1st dose w/in 5 min of initiating Code Blue -If hypovolemia, 250ml LR/NS. Repeat in 5min -Stat CXR |
| What are possible causes of PEA? | H - Hypovolemia, Hypoxia, Hydrogen ion[acidosis], Hypo/Hyperkalemia, Hypoglycemia, Hypothermia T - Toxins, Tamponade, Thrombosis, Trauma |
| How to treat unstable Bradycardia? | O2 10L/min NRBM; transvenous/epicardial pacing wires present initiate pacing protocol, if no response; Atropine 0.5mg IVP, 3-5min (total 3mg), if ineffective start transcutaneous;then Dopamine 2-10mcg/kg/min; then Isoproterenol 2-10mcg/kg/min |
| How to treat Ventricular Tachycardia (stable)? | O2 at minimum 4L/min NC and adjust per pt status; Obtain 12 lead EKG; Draw serum K+, Mg++; Call MD for orders. |
| How to treat Ventricular Tachycardia (unstable)? | O2 at minimum 10L/min NRBM; If ventricular rate>150, perform synchronized cardioversion: Biphasic 100, 120, 150, then 200J; if awake, give Midazolam (Versed) 0.5mg IVP prior to cardioversion. May repeat total 1mg to achieve sedation; Draw serum K+, Mg++. |
| How to treat Ventricular Fibrillation/Pulseless Ventricular Tachycardia (No Stacked Shocks)? | CPR (2min); 100%O2 at 15L/min ambu bag; Defib (3min from CB): Bi 120J; CPR; check rhythm, shockable; Defib: 150J; CPR; Epi 1mg IV/IO. 1st dose 5min from CB. repeat 3-5min; Check rhythm; shockable; Defib 200j; Amio 300mg IV/IO once, consider add 150mg |
| How to treat Chest Pain: | O2 at 4L/min NC(SpO2>94%); NTG 0.4mg SL if SBP>90mmhg & HR>50, repeat 3-5 min x2(total 3mg); Morphine Sulfate 2mg IVP q3-5min total dose 10mg if SBP>90; Obtain 12 lead EKG. |
| How to treat Hypotension:Symptomatic? | O2 10L/min NRBM; If hypovolemia, 250ml LR/NS. May repeat x1; SBP<90, Dopamine 400mg/250ml D5W 5mck/kg/min, max dose 20mcg/kg/min; Obvious blood loss, stat H/H & type and cross 2units PRBCs |
| How to treat for Immediate Post Anesthesia Patients? | O2 at 10L/min NRBM; Infuse 250ml LR/NS, repeat in 5min if no improvement; if bolus ineffective, Ephedrine 5mg IVP; In 3min no improvement, Ephedrine 10mg IVP; Obvious bld loss, Draw stat H/H & type and cross 2 units PRBCs |
| How to treat Respiratory Depression (associated with prior narcotic administration, RR <10/min)? | O2 10L/min NRBM Narcotic-associted respiratory depression administer Naloxone (Narcan) as follows (max dose 0.4mg): a. Apnea: 0.4mg IVp b. RR <10: 0.1mg IVP q 1min, may repeat x3 |
| How to treat Respiratory Distress? | O2 10L/min NRBM; Stat portable CXR; Bronchospasm, Albuterol (Ventolin) 2.5mg/0.5ml in 3ml aerosol inh; In RRT, ABG may be obtain |
| How to treat Increased Intracranial Pressure (in neurologically impaired pt w/dilated pupil associated w/ other signs of impending herniation)? | Raise HOB 30degrees, if not hypotensive. Pt head midline position; Hyperventilate w/ 100% to maintain pCO2 30-35mmHg; Mannitol 20% 500ml (100gm) rapid IVP, 0.5micron filter; Draw serum K, Mg, Na, BUN, Cr, Glucose, and ABG. Insert Foley. |
| How to treat Status Epilepticus? | Protect airway, position pt in lateral decubitus, protect pt from injury; O2 10L/min NRBM; Lorazepam (Ativan) 2mg IVP over 1min; Draw Na, K, glucose, BUN, Cr, ABG (anticonvulsant if appropriate) |
| How to treat Severe Anaphylaxis(stridor, wheezing, resp. distress, pallor, cyanosis or clinical sign of shock)? | O2 10L/min NRBM; Epi (1;1000)0.5mg IM. Repeat in 5min if no impr.; If no response, Epi 0.1mg IV slowly over 5min; Hydrocortisone (Solucortef) 100mg IVP; Diphenhydramine (Benadryl) 25mg IVP; 250ml LR/NS. Repeat in 5min if no improvement |
Created by:
romma75
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