Standardized Procedure- Emergency Standing Orders at Sharp Healthcare Study Guide 2024(Lat, Exams of Criminal procedure

Download Standardized Procedure- Emergency Standing Orders at Sharp Healthcare Study Guide 2024(Lat and more Exams Criminal procedure in PDF only on Docsity! Standardized Procedure- Emergency Standing Orders at Sharp Healthcare Study Guide 2024(Latest Exam Solutions) 1. General Procedure for all Life-Threatening Patient Conditions- what kind of access should a nurse obtain? - Correct Answer ✅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) 2. General Procedure for all Life-Threatening Patient Conditions- what kind of fluid should be started to KVO? - Correct Answer ✅b. Begin IV infusion of Normal Saline (NS) to keep vein open (KVO) 3. General Procedure for all Life-Threatening Patient Conditions- If IV access is not available what medications can be given and how is it administered? - Correct Answer ✅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 4. General Procedure for all Life-Threatening Patient Conditions- what's the process after giving each medication? - Correct Answer ✅d. Flush IV line with 20ml of NS after each IV medication given and elevate extremity if applicable. 5. General Procedure for all Life-Threatening Patient Conditions- In applicable situations, what should be readily available? - Correct Answer ✅e. Oxygen 6. What's the proper techniques using circulation, airway, and breathing? - Correct Answer ✅1. Compressions should be performed at a rate of 100/min for two minutes "push hard,push fast" allowing full chest recoil, and minimize interruptions in chest compressions after each intervention. 7. 2. All external electrical therapy will be cardioverted/defibrillated with biphasic monitors using appropriate energy dose as designated by condition. P a g e 1 | 11 8. True/False 9. In most cases, treatment (e.g. O2 administration) is administered concurrently. - Correct Answer ✅TRUE 10.True/False 11.Stickers with appropriate energy levels of cardioversion/defibrillation should be placed on all defibrillators for quick reference. - Correct Answer ✅TRUE 12.ASYSTOLE - Correct Answer ✅1. CPR (2 min) 13.2. O2 at 15ml/min ambu bag (8-10 breaths/min) 14.3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists. 15.BRADYCARDIA UNSTABLE (Heart Rate <60bpm) - Correct Answer ✅1. O2 at minimum 10ml/mim NRBM 16.2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator and initiate pacing control. 17.3. Atropine 0.5mg IVP/IO, repeat q3-5min up to a total of 0.04mg/kg (or 3mg) 18.4. Transcutaneous pacing as soon as available 19.5. 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. 20.6. If no response from above algorithm, initiate Isuprel infusion 1-10mcg/min IV/IO) 21.PULSELESS ELECTRICAL ACTIVITY (PEA) - Correct Answer ✅1. CPR (2min) and assess for possible causes. 22.2. O2 at 15ml/min ambubag (8-10breaths/min) 23.3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5mim 24.4. If hypovolemia known or suspected, infuse 250ml LR or NS. Repeat in 5 minutes if no clinical improvement. P a g e 2 | 11 68.3. If SBP <90mmHg, start Dopamine 400mg/250ml D5W infuse at 5mcg/kg/min. Titrate until SBP >/=90mmHg and or MAP >60mmHg or up to 20mcg/kg/min 69.4. In the presence of obvious blood loss, draw STAT H&H and Type & Cross 2 units PRBCs. 70.HYPOTENSION (SYMPTOMATIC) 71.For Immediate Post Anesthesia Patients - Correct Answer ✅ONLY ADMINISTERED BY PACU OR ICU NURSES: 72.O2 at min 10L/min NRBM 73.Infuse 250 ml LR or NS. Repeat in 5 min if no clinical improvement. 74.If fluid bolus ineffective, Ephedrine 5mg IVP/IO 75.If no improvement within 3 min, repeat Ephedrine at 10mg IVP/IO 76.In the presence of obvious blood loss, draw stat H&H and Type & Cross 2 units PRBCs. 77.HYPOGLYCEMIA - Correct Answer ✅Follow the Hypoglycemic Standardized Procedure for ANY patient with a serum glucose or fingerstick <70mg/dl (<60mg/dl if pregnant) 78.INCREASED INTRACRANIAL PRESSURE (IIP) - Correct Answer ✅In the neurologically impaired patient with dilated pupil associated with other signs of impending herniation. 79.(NOTE: IMPLEMENT ONLY IN THE ABSENCE OF SPECIFIC ICP ORDERS) 80.Raise HOB to at least 30 degrees if pt is not hypotensive; place pt's head in midline position. 81.Hyperventilate the intubated pt with FiO2 100% to maintain pCO2 30- 35mmHg 82.Mannitol 20% 500 ml (100gm) rapid IVP/IO using a filter (if filter is readily available) 83.Draw baseline serum K, Na, BUN, Cr, Glucose, ABG 84.Insert urinary catheter P a g e 5 | 11 85.RESPIRATORY DEPRESSION- associated with prior narcotic or benzodiazepine administration - Correct Answer ✅1. O2 at min 10L/min NRBM 86.2. Narcotic-associated respiratory depression: administer Naloxone (Narcan) as follows (maximum dose of 0.4mg) a. Apnea:0.4mg IVP/IO once b.RR <10: 0.1mg IVP/IO every min, may repeat 3x. 87.RESPIRATORY DEPRESSION- associated with prior narcotic or benzodiazepine administration at SMH and SCOR - Correct Answer ✅For benzodiazepine-associated respiratory depression administer Flumazenil (Romazicon) as follows (max dose of 0.6mg): 88.Apnea: 0.2mg IVP/IO (may repeat every min for a total of 3 doses) 89.RR <10: Romazicon 0.1mg IVP/IO over 15 sec, may repeat in 45 sec based on pt's response, not to exceed 0.6mg. 90.RESPIRATORY DEPRESSION- associated with prior narcotic or benzodiazepine administration at SGH - Correct Answer ✅Narcotic- associated respiratory depression: 91.administer Naloxone (Narcan) 0.1mg q 60 sec up to 0.4mg IVP/IO 92.For benzodiazepine-associated Respiratory depression, administer Flumazenil (Romazicon) as follows: 93.b. Romazicon 0.2mg IVP/IO ober 15 sec. May repeat in 45 sec based on pt's response, not to exceed 0.6 mg. 94.RESPIRATORY DISTRESS - Correct Answer ✅1. O2 at min 10L/min NRBM 95.2. STAT portable CXR 96.3. In the presence of bronchospasm : albuterol 0.5 in 3ml NS aerosol inhalation 97.4. The RRT may obtain an ABG 98.At SMH and SCV The RRT may initiate non-invasive ventilation (NIV) for the ff conditions in the absence of any contraindications : exacerbation of COPD, ASTHMA, ACUTE CHF, AS A BRIDGE TO MECHANICAL VENTILATION 99.What are the contraindications for non invasive ventilation NIV? - Correct Answer ✅1. Respiratory arrest P a g e 6 | 11 100. 2. Inability to maintain a pateny airway or clear secretions 101. 3. Risk for aspiration of hastric contents (nausea,vomiting, or bowel obstruction) 102. 4. Preexisting pneumothorax without chest tube or pneumomediastinum 103. Epistaxis 104. Recent facial, oral or skull surgery or trauma 105. Encephalopathy/AMS 106. Hypotension due to suspected intravascular volume depletion 107. Unable to tolarate bipap 108. STATUS EPELIPTICUS (generalized tonic-clonic movements lasting more than 3 min or recurrent seizures without return of consciousness) - Correct Answer ✅1. Protect airway, position in lateral decubitus position, protect pt fr injury 109. 2. O2 min 10l/min NRBM 110. 3. Lorazepam (Ativan) 2 mg IVP/IO over 1 min 111. 4. Draw Na, K, glucose, BUN, Cr, and anticonvulsant levels if appropriate 112. SEVERE ANAPHYLAXIS (stridor, wheezing, respiratory distress, pallor, cyanosis, or clinical signs of shock) - Correct Answer ✅1. O2 at min 10L NRBM 113. 2. Epinephrine (1:1000) 0.3mg IM. Repeat in 5 mins. If no clinic improvement 114. 3. If no response and pt still showing signs of shock, give Epinephrine (1:10,000) 0.1mg IVP/IO slowly over 5 mins. 115. 4. (Hydrocortisone) Solucortef 100 mg IVP/IO 116. 5. DIPHENHYDRAMINE (Benadryl) 25mg IVP/IO 117. INFUSE 250 ml LR or NS. Repeat in 5 minutes if no clinical improvement. 118. DOCUMENTATION - Correct Answer ✅Will be made by RN performing ESO standardized procedure including: P a g e 7 | 11 154. ESO Competent Nurse - Correct Answer ✅RN who has successfully demonstrated the knowledge and skills in identification and treatment of life threatening conditions 155. RRT - Correct Answer ✅Rapid Response Team- a team of healthcare professionals who bring critical care expertise to the patient bedside 156. Circulation, Airway,Breathing - Correct Answer ✅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) 157. Intraosseous Therapy (IO) - Correct Answer ✅Special catheter inserted into the intraosseous space by a train physician or IO insertion competency validated RN. Safe and alternate route to IV therapy is initiated when IV access is urgently needed but is not available. 158. Unstable conditions Signs & Symptoms - Correct Answer ✅SIGNS: 159. Tachypnea 160. Apnea 161. Respiratory depression 162. Tachycardia 163. Bradycardia 164. Arrhythmia 165. Hypotension 166. Decrease 02 saturation 167. Dyspnea 168. Change in LOC 169. Increased Intracranial Pressure 170. Status Epilepticus 171. SYMPTOMS: P a g e 10 | 11 172. Dizziness 173. Lightheaded ness 174. Shortness of breath 175. Chest pain 176. Weakness 177. Cold 178. Diaphoretic 179. Heart palpitations 180. Anxiousness P a g e 11 | 11