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Sharp ESO 2025/2026 Exam Papers
With Correct Answers.
Nurse initiating ESO will document
- Life threatening condition
- Precipitating factors
- Specific ESO implemented
- Patient response
- When and which physician was notified
ESO are initiated:
For life-threatening patient conditions in the absence of the physician or specific orders
Adequate CPR
- Push hard
- Full chest recoil
- Minimize interruptions
- 100-120 compressions/min
- 15 L O2 by bag mask (10 breaths per min)
- 30:
ETCO2 monitoring
Use to assess quality of CPR and evaluate return of rosc
How many breaths with advanced airway?
1 breath every 6 seconds
Targeted temperature management
Should be used on all patients not following commands or purposeful movement within 120 mins after ROSC
What is a rapid bolus?
Fluids administered in 5-15 mins
Non invasive cardiac monitoring
Device that uses bioreactane to determine cardiac output and is implemented where available by RRT or ICU RN to determine fluid responsiveness and guide fluid resuscitation
Passive leg raise
Position patient flat on their back, and their legs are elevated to 45 degrees.
Symptoms (subjective)
Dizziness, lightheadedness, chest pain, shortness of breath (SOB), chest pain, weakness, cold, diaphoresis, heart palpitations, anxiousness
What is the initial treatment for asystole?
Initiate CPR immediately
What is the recommended oxygen flow rate for a patient in asystole?
O2 at 15L/minute ambu bag (10 breaths/minute)
What medication is administered in asystole and how often?
Epinephrine 1mg IVP/IO (0.1 mg/mL), repeat every 3-5 min
How frequently should pulse checks be performed during CPR for asystole?
Every 2 minutes
What should be verified before initiating treatment for asystole?
Verify with pulse check and ensure that all leads are connected
Bradycardia - Initial Treatment
- O2 at minimum 10 L/minute (NRBM)
Bradycardia - Atropine Administration
- Atropine 1mg IVP/IO, repeat every 3-5 minutes up to a maximum of 3 mg
Bradycardia - Dopamine Administration
- Start Dopamine 400mg/250 mL D5W at 5 mcg/kg/minute if above algorithm is ineffective. ICU or RRT RN to titrate until patient is asymptomatic.
Bradycardia - Epinephrine Administration
- Start Epinephrine 2mg/250 mL NS at 2mcg/minute if above algorithm is ineffective. Titrate to patient response up to 10 mcg/minute. (RRT or ICU RN Only)
What are common causes of Pulseless Electrical Activity (PEA)?
Hypovolemia and hypoxia
What is the recommended initial intervention for PEA?
CPR
How should stable ventricular tachycardia be treated?
- Call physician for orders. 2. Administer oxygen at a minimum of 4L/min and titrate to patient response.
- Obtain a 12-lead ECG. 4. Draw serum potassium (K+) and magnesium (Mg++) levels.
What are the criteria for treating unstable ventricular tachycardia (VT)?
Patient must be symptomatic, exhibiting one or more of the 'unstable' symptoms related to the tachycardia.
How should unstable VT be treated?
The patient should be immediately cardioverted and treated with O2, synchronized cardioversion, medications like Midazolam, 12 Lead EKG, and serum K+ and Mg++ levels should be checked.
What is the reversal agent for benzodiazepines in the context of treating unstable VT?
Flumazenil (Romazicon) 0.2 mg IVP over 15 seconds.
What is Ventricular Fibrillation (VF)?
VF is characterized by disorganized ventricular depolarization that is irregular and unable to generate any cardiac output. It can be coarse or fine.
What is the difference between coarse VF and fine VF?
Coarse VF usually indicates a recent onset of VF that may be corrected with immediate defibrillation, while fine VF indicates a more prolonged VF that is approaching asystole.
How should Ventricular Fibrillation/Pulseless Ventricular Tachycardia be treated?
- CPR
- Giving medications during CPR,
- Immediate defibrillation if witnessed arrest and defibrillator is available
- Administering O
- Defibrillating with specific joules
- Giving medications like Epinephrine and Amiodarone.
What are the common presentations of an acute coronary syndrome?
Chest pain is the most common presentation of an acute coronary syndrome, including unstable angina, non Q wave MI, and Q-wave MI.
How is chest pain suggestive of ischemia described?
Chest pain suggestive of ischemia may be described as uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting several minutes, pain spreading to the shoulders, neck, arms, jaw, or back, chest discomfort with light-headedness, fainting, sweating, nausea, or shortness of breath, and a global feeling of distress, anxiety, or impending doom.
Symptoms of Symptomatic Hypotension
Symptomatic hypotension is indicated by unstable symptoms such as decreased level of consciousness and confusion.
Treatment of Hypotension
Hypotension should be treated based on its cause, such as fluid replacement for hypovolemia and addressing arrhythmias first if present.
Management of Post-Anesthesia Hypotension
Post-anesthesia hypotension is treated with fluid replacement and Ephedrine.
How should symptomatic hypotension be treated if hypovolemia is known or suspected?
Infuse 250ml NS rapid bolus. Repeat in 5 minutes if no clinical improvement.
What is the next step if SBP is less than 90mmHg after two 250 ml fluid boluses?
Start Norepinephrine 4mg/250 mL NS at 2mcg/minute. Titrate until SBP ≥ 90 mmHg and/or MAP ≥ 65 mmHg (max dose 32 mcg/minute).
What should be done if obvious blood loss is present?
Draw stat hemoglobin and hematocrit (H&H) and type and cross for 2 units PRBC.
What is the protocol for treating immediate post-anesthesia patients with persistent hypotension?
Administer Ephedrine 5mg IVP/IO. If no improvement within 3 minutes, repeat Ephedrine at 10mg IVP/IO. In the presence of obvious blood loss, draw stat H&H and Type & Cross 2 units PRBCs.
What is the first sign of increased intracranial pressure (ICP)?
Decreased level of consciousness
What are signs of increased ICP that may indicate herniation?
Hemiparesis, decorticate or decerebrate posturing, fixed and dilated pupils
How is increased ICP defined when being monitored?
ICP > 15 mmHg or as specified by the MD
How should increased ICP be treated?
- Elevate HOB at least 30°
- Hyperventilate the intubated patient with 100% FIO2 to maintain PCO2 26-30 mmHg.
- Draw serum BMP, serum osmolality, and ABG
Note - flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias and patients who chronically take benzodiazepines.
What should be done if respiratory depression is suspected to be associated with combined opioid and benzodiazepine?
Administer naloxone first. If patient receives a reversal agent, complete an RL and initiate continuous capnography monitoring if not already implemented.
What are the signs of respiratory distress?
Respiratory distress is demonstrated by a change in respiratory rate, use of accessory muscles, altered level of consciousness, or cyanotic nail beds.
What are some causes of respiratory distress related to pulmonary disorders?
Respiratory distress can be caused by bronchospasm, cardiogenic or noncardiogenic pulmonary edema, parenchymal infiltrates, pneumothorax, hemothorax, and atelectasis.
Why is obtaining a stat portable chest x-ray important in cases of respiratory distress?
Obtaining a stat portable chest x-ray is important to assess the underlying cause of respiratory distress.
How should respiratory distress be treated?
Treat respiratory distress with oxygen at a minimum of 10 L/minute NRBM, titrate to patient response, stat portable chest x-ray, Albuterol (Ventolin) for bronchospasm, and appropriate suctioning for secretions.
Definition of Prolonged Seizures
Prolonged seizures are considered generalized tonic-clonic (grand mal) movements lasting more than 3 minutes or recurrent seizures without return of consciousness.
Causes of Prolonged Seizures
Prolonged seizures can be caused by withdrawal from anticonvulsant medications, acute alcohol withdrawal, CNS infections, brain tumors, metabolic disorders, or cerebral edema.
Airway Management During Seizures
During a seizure, the patient's airway is vulnerable, therefore maintaining a patent airway is essential.
Drug of Choice for Seizures
Lorazepam (Ativan) is the drug of choice for treating seizures.
Treatment Protocol for Prolonged Seizures
Treat prolonged seizures by protecting the airway, positioning the patient in lateral decubitus position, protecting the patient from injury, administering O2 at minimum 10 L/min NRBM, and administering Lorazepam (Ativan) 2mg IVP/IO over 1 minute, repeat x1 in 3-5 minutes if seizure persists. Also, draw BMP and anticonvulsant levels if appropriate.
What are the organ dysfunction criteria for suspected sepsis?
- SBP < 90, MAP < 65, or SBP drop > 40
- Lactate > 2
- Creatinine > 2.0 or urinary output (UOP) < 0.5 mL/kg/hr
- T. Bili > 2
- Platelet < 100,
- INR > 1.5, aPTT > 60 sec
What actions should be taken if a patient meets sepsis criteria?
Obtain serum lactate, blood cultures x 2. Rapid Response Team may order a POC lactate.
What should be done if Noninvasive Cardiac Output Monitoring (NICOM) is available in suspected sepsis?
- RRT or ICU RN to obtain, document, and communicate baseline and post bolus measurements to include cardiac output (CO), stroke volume (SV), and stroke volume index (SVI)
- RRT or ICU RN to perform a Passive Leg Raise (PLR) maneuver to determine fluid responsiveness. If patient has SVI change of 10% or greater, rapid bolus 500 mL of NS/LR x 1 IV/IO and reassess SVI using
PLR on bolus completion. Further boluses will require a provider order in the absence of departmental specific protocol
- If SBP remains < 90 mmHg or MAP remains < 65 mmHg after completion of boluses, RRT or ICU RN will start Norepinephrine
4 mg/250 mL at 2 mcg/minute and titrate until SBP≥90 mmHg and MAP≥65 mmHg, up to 32 mcg/minute
If NICOM unavailable:
- Administer LR or NS fluid bolus of 30 mL/kg at 126 mL/hr
- If SBP remains < 90 mmHg or MAP remains < 65 mmHg, RRT or ICU RN will start Norepinephrine 4 mg/250 mL at 2 mcg/min and titrate until SBP≥ 90 mmHg and MAP≥65 mmHg, up to 32 mcg/minute
Amiodarone
Antiarrhythmic agent that prolongs refractory period, lengthens cardiac action potential, and causes negative chronotropic effect. Has vasodilator action that decreases cardiac workload and myocardial oxygen consumption VF/Pulseless VT
Amiodarone dose
300 mg IVP followed by 20 mL NS flush, may repeat with 150 mg IVP if rhythm persists
Amiodarone side effects
Why should Atropine not be given slowly?
May cause paradoxical slowing of pulse
What receptors does dopamine stimulate?
Dopaminergic, B-adrenergic, and alpha adrenergic receptors
What effect does dopamine have at low doses?
Causes renal, mesenteric, and cerebrovascular dilation
What effect does dopamine have at moderate doses?
Increased myocardial contractility, cardiac output, and blood pressure
What effect does dopamine have at high doses?
Peripheral arterial and venous vasoconstriction
What is a potential complication of dopamine administration related to the heart?
May induce/exacerbate supraventricular and ventricular arrhythmias
What complication can occur if dopamine extravasates?
Tissue necrosis and sloughing
Dopamine dose
5 - 20 mcg/kg/minute, titrate to patient response
What are the effects of epinephrine on the cardiovascular system during pulseless arrhythmia?
Increases BP, HR, systemic vascular resistance (SVR), automaticity, AV conduction, myocardial contraction, myocardial oxygen requirements (MVO2)
What is the recommended dose and administration frequency of epinephrine for pulseless arrhythmias?
1mg IVP/IO (0.1mg/mL), repeat every 3-5 minutes
How should epinephrine be administered via endotracheal tube (ETT) for pulseless arrhythmias?
2 - 2.5 times IV dose diluted in 10mL NS
What caution should be taken when administering epinephrine to patients receiving digoxin for pulseless arrhythmias?
May induce or exacerbate ventricular ectopy, especially in patients receiving digoxin
