Crash Cart

Hospital “Crash Cart” - MICU

Yatska CartagenaJuan Morales

Objectives

After this presentation the students will be able to:

• Define the term crash cart.• Understand the purpose of

crash cart.• Identify the content of crash

cart, their use and the nursing consideration for all the:• Medications• Supplies

Definition crash cart

• A crash cart or code cart is a special mobile storage unit with drawers used in health care facilities and emergency rooms that contain the necessary medications and equipment to respond to a cardiopulmonary arrest.

Purpose of the Crash Cart

• The purpose of the crash cart is to have a portable life saving unit that contains all the medications, equipment and supplies necessary to initiate a treatment in emergency and life threatening situations on all health care facilities.

Medications Classification

Action Indication

Contraindication Side effect

Nursing Consideration

Medications included in the Crash Cart

First Line drugs• Oxygen• Epinephrine• Atropine Sulfate

Antiarrhythmic Agents• Lidocaine (Xylocaine)• Procainamide (Ponestyl)• Bretylium (Bretylol)• Verapamil (Calan)• Diltiazem (Cardizem)• Adenosine (Adenocard)• Aminoradone (Cordaron)


Miscellaneous• Magnesium Sulfate• Sodium Bicarbonate• Calcium Chloride• Calcium Gluconate• Dextrose 50%

Second Line Drugs• Norepinephrine (Levophed)• Dopamine (Intropin)• Dobutamine (Dobutrex)• Isoprotenerol (Isuprel)


Vasodilators/ Antihypertensive

• Nitroglycerine (Tridil)Anti-diuretic• Vasopressin

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations

• Epinephrine (1:10000)• Classification

– Beta2 Adrenergic Agonists

• Action – Stimulates beta receptors in lung.– Relaxes bronchial smooth muscle. – Increases vital capacity– Increases BP, HR, PR – Decreases airway resistance.

• Indication – Asthma– Bronchitis– Emphysema– All cardiac arrest, anaphylaxis– Used for symptomatic bradycardia.– Relief of bronchospasm occurring during anesthesia– Exercised-induced bronchospasm

• Side Effects/Adverse Reactions– nervousness, tremor, vertigo, pain, widened pulse pressure,

hypertension, nausea– headache

• Contraindications – With angle-closure glaucoma, shock (other than anaphylactic

shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage)

– In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia.

– In pregnant woman, drug is contraindicated.– In breast feeding do not use the drug or stop breast feeding.

• Nursing Management– Monitor V/S. and check for cardiac dysrrhythmias – Drug increases rigidity and tremor in patients with

Parkinson’s disease – Epinephrine therapy interferes with tests for urinary

catecholamine – Avoid IM use of parenteral suspension into buttocks. Gas

gangrene may occur – Massage site after IM injection to counteract possible

vasoconstriction. – Observe patient closely for adverse reactions. Notify doctor if

adverse reaction develop – If blood pressure increases sharply, rapid-acting vasodilators

such as nitrates or alpha blockers can be given to counteract


• Atropine Sulfate (4mg/mL)• Classification

– Anticholinergic• Indication

– Pre-op meds/pre-anesthetic meds– To restore cardiac rate and arterial pressure during

anesthesia when vagal– To lessen the degree of A-V heart block– To overcome severe carotid sinus reflex– Antidote for cholinergic toxicity

• Side effects– CNS: restlessness, ataxia, disorientation, hallucinations,

delirium, coma, insomnia, agitation, confusion.– CV: tachycardia, angina, arrhythmias, flushing.– EENT: photophobia, blurred vision, mydriasis.– GI: dry mouth, constipation, vomiting.– GU: urine retention.– Hematologic: leukocytosis– Other: anaphylaxis

• Adverse effects – CNS: headache, excitement.– CV: palpitations– GI: thirst, nausea

• Contraindications– Hypersensitivity– With acute angle closure glaucoma, obstructive

uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis.

– Pregnant women.• Nursing Management

– Monitor VS.– Report increase HR– Monitor for constipation, oliguria.– Instruct to take 30 minutes before meals– Eat foods high in fiber and drink plenty fluids.– Can cause photophobia– Instruct client not to drive a motor vehicle or

participate in activities requiring alertness.– Advise to use hard candy, ice chips, etc. for dry

mouth.


• Lidocaine (Xylocaine)• 100 mg bolus• 1 gm

• Classification– CV drugs: Antiarrhythmics– Anesthetic

• Action – Increases electrical stimulation of ventricle and His-

Purkinje system by direct action on tissues, resulting to decrease depolarization, automaticity and excitability in ventricles during diastolic phase

• Indication – Anesthesia– Arrhythmias– Control of Status Epilepticus refractory to other

treatments• Side Effects and Adverse Reactions

– GI disturbances, bradycardia, hypotension, convulsion, numbness of tongue, muscle twitching, restlessness, nervousness, dizziness, tinnitus, blurred vision, fetal intoxication, light headedness, drowsiness, apprehension, euphoria, vomiting, sensation of heat, respiratory arrest and CV collapse

• Contraindications – Hypersensitivity– Heart block– Hypovolemia– Adams stroke syndromes– Infection at site of injection

• Nursing Management– Assess pt before and after therapy– Pts infusion must be on cardiac monitor– Monitor ECG, if QT or QRS increases by

50% or more, withhold the drug– Monitor BP, check for rebound HPN after

1-2 hrs– Assess respiratory status, oxygenation

and pulse deficits– Assess renal and liver function– Monitor CNS symptoms– Monitor blood levels


• Procainamide (Pronestyl)• 1 gm

• Classification– Antiarrhythmics

• Action – Blocks open Na channels and prolong the cardiac

action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG

• Indication – Supraventricular and ventricular arrhythmias.– Treatment of Wolf-Parkinson-White Syndrome

• Side Effects and Adverse Reactions– Severe hypotension, ventricular fibrillation and

asystole. – Drug induced SLE syndrome, blood disorders, fever,

myocardial depression, heart failure, agrunulocytosis, psychosis, angioedema, hepatomegaly, skin irritation, hypergammaglobulinemia, GI and CNS effects.

• Contraindications – Heart block– Heart failure– Hypotension– Myesthenia gravis– Digoxin toxicity– Lactation

• Nursing Management– Assess cardiovascular status before

therapy.– Assess pulmonary, hepatic and thyroid.

function before and during therapy.– Monitor fluid and electrolytes, I&O, K,

Na and Cl.– Monitor ECG, BP.– Assess vision.


• Bretylium (Breytol) (500mg/10mL)• Classification

– Antidysrhythmic• Action

– Bretylol produces a prompt increase in ventricular fibrillation threshold, perhaps through postganglionic adrenergic blockade. It causes an initial release of norepinephrine from postganglionic nerve terminals. At present, its use is reserved for patients who fail to respond to lidocaine or other first-line antidysrhythmics.

• Indication– Indicated in the prophylaxis and therapy of ventricular fibrillation.– Indicated in the treatment of life-threatening ventricular

arrhythmias. • Side effect/ Adverse effect

– Hypotension Hypotension and postural hypotension – Nausea and vomiting – Vertigo, dizziness, light-headedness and syncope– Bradycardia, increased frequency of premature ventricular

contractions, transitory hypertension, initial increase in arrhythmias, precipitation of anginal attacks, and sensation of substernal pressure.

– Renal dysfunction, diarrhea, abdominal pain, hiccups, erythematous macular rash, flushing, hyperthermia, confusion, paranoid psychosis, emotional liability, lethargy, generalized tenderness, anxiety, shortness of breath, diaphoresis, nasal stuffiness and mild conjunctivitis.

– Hyperthermia

• Contraindications– There are no contraindications to use in

treatment of ventricular fibrillation or life-threatening refractory ventricular arrhythmias.

• Nursing Management– Assess and notify the doctor if the

patient's medical history include: any allergies, kidney disease, heart disease, blocked blood vessels (aortic stenosis), lung problems (pulmonary hypertension) because the medication is contraindicated with this conditions

– To avoid dizziness and lightheadedness, the patient should remain lying down or, if necessary, get up slowly when rising from a seated or lying position.

– This medication should be avoid during pregnancy unless is clearly needed.


• Verapamil (Calan, Isoptin) (5mg/2mL)• Classification

– Anti-anginal– Anti-arrhythmics– Anti-hypertensive– Vascular headache suppressants

• Action – Inhibits calcium transport into myocardial smooth muscle

cells– Decreases SA and AV conduction and prolongs AV node

refractory period in conduction tissue• Indication

– Hypertension– Angina Pectoris– Supraventricular Arrhythmia– Atrial flutter/fibrillation

• Side Effects and Adverse Reactions– CNS: abnormal dreams, anxiety, confusion, dizziness and

headache– EENT: blurred vision, epistaxis and tinnitus– CV: arrhythmia, CHF, chest pain, bradycardia, hypotension

and palpitations– GU: dysuria, nocturia and polyuria– GI: abnormal liver function, anorexia, constipation, diarrhea,

nausea and vomiting

• Contraindications – Hypersensitivity– Sick sinus syndrome– 2nd or 3rd degree AV block– CHF– Cardiogenic shock– Concurrent IV beta-blocker

• Nursing Management– Monitor BP and pulse before

therapy, during titration and therapy

– Monitor ECG, I&O, serum potassium and weight.

– Assess for CHF


• Diltiazem (Cardizem) (50mg/10mL)• Classification

– Anti-anginals– Antiarrhythmics– Antihypertensive – Ca channel blocker

• Action – Inhibits calcium transport into myocardial smooth muscle

cells– Systemic and coronary vasodilation

• Indication – Hypertension– Angina Pectoris– Supraventricular Arrhythmia– Atrial flutter/fibrillation

• Side Effects and Adverse and Reactions– CNS: abnormal dreams, anxiety, confusion, dizziness and

headache– EENT: blurred vision, epistaxis and tinnitus– CV: arrhythmia, CHF, chest pain, bradycardia,

hypotension and palpitations– GU: dysuria, nocturia and polyuria– GI: abnormal liver function, anorexia, constipation,

diarrhea, nausea and vomiting

• Contraindications – Hypersensitivity– Sick sinus syndrome– 2nd or 3rd degree AV block– CHF– Cardiogenic shock– Concurrent IV beta-blocker

• Nursing Management– Monitor BP and pulse before

therapy, during titration and therapy

– Monitor I&O and weight– Assess for CHF– Routine serum Digoxin

monitoring


• Adenosine (Adenocard) (6mg/2mL)• Classification

– Nucleoside• Indication

– To convert paroxysmal supraventicular tachycardia (PSVT) to sinus rhythm

• Action– A naturally occurring nucleoside that

acts on the AV node to slow conduction and inhibit reentry pathways. Also useful in treating PSVTs, including those with accessory bypass tracts (Wolff-Parkinson-White syndrome)

• Adverse Reaction– CNS: dizziness, lightheadedness,

numbness, tingling in arms, headache.– CV: facial flushing.– GI: nausea.– Respiratory: dyspnea, shortness of

breath, chest pressure.

• Contraindication– Contraindicated in patients hypersensitivity to

drugs.– Contraindicated in those with second or third-

degree heart block or sinus node disease (such as sick sinus syndrome and symptomatic bradycardia), except those with a peacemaker.

– Use cautiously in patients with asthma, emphysema, or bronchitis because bronchoconstriction may occur.

• Nursing Management– ALERT: by decreasing conduction through the

AV node, drug may produce first-, second-or third-degree heart block. Patients who develop high-level heart block after a single dose shouldn’t receive additional doses.

– ALERT: new arrhythmias, including heart block and transient asystole, may develop; monitor cardiac rhythm and treat as indicated.

– If solution is cold, crystals may form; gently warm solution to room temperature. Don’t use solutions that aren’t clear.

– Drug lacks preservatives. Discard unused portion.

http://www.buyemp.com/tmp_image.php?item_id=11229435


• Magnesium sulfate (50%(500mg/mL))• Classification

– Anticonvulsant• Indication

– Treatment of hypomagnesaemia accompanied by signs of tetany

– Control of HTN– Encephalopathy & convulsions– Prevention & control of convulsions in patients w/

preeclampsia or eclampsia– Prevention of hypomagnesaemia in patients receiving

TPN• Action

– May decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown

• Adverse Reactions– flushing, sweating, hypotension, muscular weakness,

sedation & confusion– decreased deep tendon reflexes – resp. paralysis

• Contraindications– Heart block or myocardial damage

• Nursing Management– Monitor the following: I.V.: Rapid administration: ECG

monitoring, vital signs, deep tendon reflexes; magnesium, calcium, and potassium levels; renal function during administration.

– Obstetrics: Patient status including vital signs, oxygen saturation, deep tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity.

– Oral: Renal function; magnesium levels; bowel movements.


• Sodium Bicarbonate• 8.4% 50mEq/50mL• Pediatric 4.2% 50 mEql

• Classification– Alkalinizers

• Indication – Metabolic acidosis – Systemic or urinary alkalinization – Antacid – Cardiac arrest

• Action– Restores buffering capacity of the body and

neutralizes excess acid• Adverse Reaction

– Tetany, edema, gastric distention, belching, flatulence, hypokalemia, metabolic alkalosis, hypernatremia, chemical cellulites because of alkalinity, pain, irritation, tissue necrosis, ulceration or sloughing at the site of infiltration

• Contraindications– Contraindicated in patients with metabolic or

respiratory alkalosis;– Patients who are losing chlorides from vomiting or

continuous GI suction; – Patients taking diuretics known to produce

hypochloremia alkalosis; and – Patients with hypocalcemia in which alkalosis may

produce tetany, hypertension, seizures, or heart failure.

– Oral sodium bicarbonate is contraindicated in patients with acute ingestion of strong mineral acids.

• Nursing Management– Do not take drug with milk to avoid hypercalcemia,

abnormally high alkalinity in tissues and fluids, or kidney stones.

– Do not give to patients with metabolic or respiratory alkalosis, and in those with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure.

– Monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and electrolyte levels


• Calcium Chloride (10% 100mg/mL)• Classification

– Electrolytes

• Indication– Hyperkalemia– Hypocalcemia– Hypermagnesia

• Action– Increase the force of cardiac contractility, by

initiating myofibril– shortening.– In normally functioning hearts calcium will

produce positive inotropic– and vasoconstrictive effects and increase systemic

arterial blood– pressure.– In abnormally functioning hearts calcium will

produce positive– inotropic effects may increase or decrease

systemic vascular– resistance.– It also appears to increase ventricular

automaticity.

• Adverse effect– Metallic taste– Burning– Heat waves– Bradycardia (may cause asystole)– Hypotension– Peripheral vasodilatation– Cardiac arrhythmias– Increased digitalis toxicity– Extravasations with necrosis, sloughing and abscess formation– Vasospasm in coronary and cerebral arteries.– N/V

• Contraindications– Hypercalcemia– Digitalis toxicity– VF during resuscitation

• Nursing Management– Have patient remain recumbent for a short time after IV

injection.– Administer into ventricular cavity during cardiac resuscitation not

in the myocardium– Teach the patient to report loss of appetite, nausea, vomiting,

abdominal pain, constipation, dry mouth, thirst, increased voiding.


• Dextrose 50% (500mL)• Classification

– Intravenous & Other Sterile Solutions• Indication

– Hypoglycemia– Coma/seizure of unknown etiology

• Action:– A simple water soluble sugar that minimizes

glyconeogenesis and promotes anabolism in patients whose oral caloric intake is limited

• Adverse Reactions– Local pain, vein irritation, thrombophlebitis &

tissue necrosis in the event of extravasations. – Fluid & electrolyte imbalance (eg hypokalemia,

hypomagnesemia & hypophosphatemia); edema or water intoxication

• Contraindications– Intracranial hemorrhage– Increased intracranial pressure

• Nursing Measures:– Monitor infusion rate frequently; if

signs of fluid overload, turn off IV drip. Infusion may result in fluid overload.

– Check IV site frequently and if infiltration is noted, turn off IV drip.

– Watch out for signs of fluid overload (distended neck veins (JVD), rapid respirations, shallow tidal volume, fine auscultator crackles, dyspnea, and peripheral edema)

– Watch out for signs of infiltration (swelling and pain around IV site).


• Norepinephrine (Levophed) (1mg/mL)• Classification

– Sympathomimetic– Adrenergic

• Action – Cause increase contractility and heart

rate by acting on beta receptor in heart; also acts on alpha receptor causing vasoconstriction in blood vessel.

• Indication – Cardiogenic shock– Neurogenic shock– Inotropic support– Hemodinamically significant hypotension

refractory to other sympathetic nerves

• Side Effects– CNS: Headache, anxiety, dizziness, cerebral

hemorrhage– CV: tachycardia, hypertension– GI: Nausea, vomiting– GU: decrease urine output– RESP: Dyspnea– SYST: Anaphylaxis

• Contraindications – Hypotensive patient with hypovolemia

• Nursing Management– ECG during administration continuously– Monitor BP and pulse q 2-3 minutes after

parenteral route– I/O ratio


• Dopamine (Intropin)• 400mgs/VIAL• 200 mg/10mL

• Classification– Adrenergic drugs

• Action – Stimulates dopaminergic and alpha and

beta receptors of the sympathetic nervous system resulting in positive inotropic effect and increased CO

• Indication – To treat shock and correct hemodynamic

imbalances– To correct hypotension– To improve perfusion of vital organs– To increase CO

• Side Effects– CNS: headache an anxiety– CV: tachycardia, angina, palpitations and

vasoconstriction– GI: nausea and vomiting

• Contraindications – Hypersensitivity– With uncorrected tachyarrhythmia’s– Pheochromocytoma– Ventricular Fibrillation

• Nursing Management– Most patients received less than 20 mcg/kg/min– Drugs isn’t substitute for blood or fluid volume

deficit– During infusion, monitor ECG, BP, CO, PR and

color and temp of the limbs– Do not confuse dopamine to dobutamine– Check urine output often


• Dobutamine (Dobutrex)• 250 mgs/20 mL• 250mgs/VIAL

• Classification– Adrenergic drugs

• Action – Stimulates heart beta receptors to increase

myocardial contractility and SV• Indication

– To increase CO– Treatment of cardiac decomposition

• Side Effects– CNS: headache– CV: HPN, tachycardia, palpitations and

vasoconstriction– GI: nausea and vomiting

• Contraindications – Hypersensitivity– Use cautiously in patients with history of HPN and

AMI

• Nursing Management– Before starting therapy, give a plasma volume

expander to correct hypovolemia and a cardiac glycoside

– Monitor ECG, BP, pulmonary artery wedge pressure and CO

– Monitor electrolyte levels– Don’t confuse dobutamine to dopamine


• Isoprotenerol (Isuprel) 0.2mg/mL• Classification

– Sympathomimetic• Action

– Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature

• Indication – Hemodinamically significant bradycardia refractive to other

therapy.• Side Effects

– Cardiovascular: Angina, flushing, hyper-/hypotension, pallor, palpitation, paradoxical bradycardia (with tilt table testing), premature ventricular beats, Stokes-Adams attacks, tachyarrhythmia, ventricular arrhythmia

– Central nervous system: Dizziness, headache, nervousness, restlessness, Stokes-Adams seizure

– Endocrine & metabolic: Hypokalemia, serum glucose increased

– Gastrointestinal: Nausea, vomiting– Neuromuscular & skeletal: Tremor, weakness– Ocular: Blurred vision– Respiratory: Dyspnea, pulmonary edema– Miscellaneous: Diaphoresis

• Contraindications – VF/VT– Hypotension– Ischemia Heart Disease– Cardiac arrest

• Nursing Management– Monitor ECG, heart rate,

respiratory rate, arterial blood gas, arterial blood pressure, CVP; serum glucose, serum potassium, serum magnesium


• Amrinone (Inocar)• Classification

– Calcium Channel Blockers– Cardiotonic Agents– Phosphodiesterase Inhibitor– Vasodilator Agents

• Action– Increases cardiac contractility, vasodilator. Acts by

inhibiting the breakdown of both cAMP and cGMP by the phosphodiesterase (PDE3) enzyme

• Indications– Only for treatment of the following documented life-

threatening recurrent ventricular arrhythmias that do not respond to other antiarrhythmics or when alternative agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug.

– Unlabeled uses: Treatment of refractory sustained or paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia; treatment of symptomatic atrial flutter.

• Side effects/ Adverse effect– CNS: Malaise, fatigue, dizziness, tremors, ataxia, paresthesias, lack of

coordination– CV: Cardiac arrhythmias, CHF, cardiac arrest, hypotension– EENT: Corneal microdeposits (photophobia, dry eyes, halos, blurred

vision); ophthalmic abnormalities including permanent blindness– Endocrine: Hypothyroidism or hyperthyroidism– GI: Nausea, vomiting, anorexia, constipation, abnormal liver function

tests, liver toxicity– Respiratory: Pulmonary toxicity—pneumonitis, infiltrates (shortness

of breath, cough, rales, wheezes)– Other: Photosensitivity, angioedema– Contraindications– Patients with history of hypersensitivity to the drug

• Nursing Management– Monitor cardiac rhythm continuously.– Monitor for an extended period when dosage adjustments are

made.– Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).– Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin

may need to be reduced one-third to one-half when amiodarone is started.

– Give drug with meals to decrease GI problems.– Arrange for ophthalmologic exams; reevaluate at any sign of optic

neuropathy.– Arrange for periodic chest x-ray to evaluate pulmonary status (every

3–6 mo).– Arrange for regular periodic blood tests for liver enzymes, thyroid

hormone levels.


• Nytroglycerin (Tridil)• 50mg/ VIAL• 250 mgs/ 10 mL

• Classification– Antianginal– Nitrate– Vasodilator– Coronary

• Action – Relaxes the vascular smooth system– Reduces myocardial oxygen consumption– Reduces left ventricular workload – Reduces arterial BP– Reduces venous return

• Indication– Angina pectoris– CHF associated with AMI– Cardiac load reducing agent– Hypertensive Crisis

• Side effects– CNS: headache, throbbing, dizziness, weakness.– GI: nausea, vomiting– Skin: Rash

• Adverse Reactions– CV: orthostatic hypotension, flushing, fainting.– EENT: sublingual burning.– Skin: Cutaneous vasodilation, contact dermatitis (patch)

• Contraindications– Contraindicated in patients hypersensitive to nitrates – With early MI. (S.L. form), severe anemia, increase ICP

angle-closure glaucoma, IV nitroglycerine is contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis.

• Nursing Interventions– Record characteristics and precipitating factors of anginal

pain.– Monitor BP and apical pulse before administration and

periodically after dose.– Have client sit or lie down if taking drug for the first time.– Client must have continuing EKG monitoring for IV

administration– Cardioverter/ defibrillator must not be discharged

through paddle electrode overlying– Nitro-Bid ointment or the Transderm-Nitro Patch. Assist

with ambulating if dizzy.– Instruct to take at first sign of anginal pain.– May be repeated q 5 minutes to max. of 3 doses. – If the client doesn’t experience relief, advise to seek

medical assistance immediately.– Keep in a dark colored container


• Calcium Gluconate• Classification:

– Electrolytes

• Indication/Dosage: – PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic

tetany 2.25 mmol via slow injection, then 58-77mL of 10% soln diluted and administered as a continuous IV infusion. Antidote in severe hypermagnesaemia; Severe hyperkalemia 10mL of 10% solution, repeat every 10 minutes if needed.

• Action: – replaces Calcium and maintains Calcium level

• Adverse Reactions: – GI irritation; soft-tissue calcification, skin sloughing or

necrosis after IM/SC inj. Hypercalcaemia characterized by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias and coma.

• Nursing Measures: – Make sure prescriber specifies form of

calcium to be given; crash carts may contain both calcium gluconate and calcium chloride.

– Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs.

– Give I.M. injection in gluteus region in adults and in lateral thigh in infants. Use I.M. route only in emergencies when no I.V. route is available because of irritation of tissue by calcium salts.

– Tell patient to take oral calcium with a full glass of water.

– Monitor calcium levels frequently. Hypercalcemia may result after large doses in chronic renal failure. Report abnormalities.


• Amiodarone• Classification:

– Cardiac Drugs • Indication:

– Ventricular and supraventricular arrhythmias. • Action:

– Blocks potassium chloride leading to prolongation of action potential duration.

• Adverse Reactions: – Blue-grey discoloration of skin, photosensitivity,

peripheral neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea, vomiting, metallic taste, hypothyroidism, hyperthyroidism, alopecia, sleep disturbances, corneal microdeposits, hot flushes, sweating. Heart block, bradycardia, sinus arrest, hepatoxicity, heart failure. Potentially Fatal: Pulmonary toxicity including pulmonary fibrosis and interstitial pneumonitis, hepatoxicity, thyrotoxicity. Ventricular arrhythmias, pulmonary alveolitis, exacerbation of arrhythmias and rare serious liver injury. Generally in patients with high doses and having preexisting abnormalities of diffusion capacity.

• Nursing Measures: – Monitor cardiac rhythm continuously. – Monitor for an extended period when dosage adjustments are made. – Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).– Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may

need to be reduced one-third to one-half when amiodarone is started. – Give drug with meals to decrease GI problems. – Arrange for ophthalmologic exams; reevaluate at any sign of optic

neuropathy. – Arrange for regular periodic blood tests for liver enzymes, thyroid

hormone levels. – Drug dosage will be changed in relation to response of arrhythmias; you

will need to be hospitalized during initiation of drug therapy; you will be closely monitored when dosage is changed.

– Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam, blood tests.

– These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or protective clothing when outdoors); constipation (a laxative may be ordered); tremors, twitching, dizziness, loss of coordination (do not drive, operate dangerous machinery, or undertake tasks that require coordination until drug effects stabilize and your body adjusts to it).


• Vasopressin• Classification:

– Antidiuretic• Action

– Increases cyclic adenosine monophosphate (cAMP) which increases water permeability at the renal tubule resulting in decreased urine volume and increased osmolality; causes peristalsis by directly stimulating the smooth muscle in the GI tract; direct vasoconstrictor without inotropic or chronotropic effects

• Adverse Reactions – Cardiovascular: Arrhythmia, asystole (>0.04

units/minute), blood pressure increased, cardiac output decreased (>0.04 units/minute), chest pain, MI, vasoconstriction (with higher doses), venous thrombosis

– Central nervous system: Pounding in head, fever, vertigo

– Dermatologic: Ischemic skin lesions, circumoral pallor, urticaria

– Gastrointestinal: Abdominal cramps, flatulence, mesenteric ischemia, nausea, vomiting

– Genitourinary: Uterine contraction – Neuromuscular & skeletal: Tremor – Respiratory: Bronchial constriction

• Indications– Adjunct in the treatment of GI hemorrhage and esophageal

varices; pulseless arrest (ventricular tachycardia [VT]/ventricular fibrillation [VF], asystole/pulseless electrical activity [PEA]); vasodilatory shock ; donor management in brain-dead patients .

• Contraindications– Hypersensitivity to vasopressin or any component of the

formulation• Nursing consideration

– Evaluate patient history closely for use cautions.– Assess potential for interactions with other

pharmacological agents patient may be taking (eg, concurrent use that will block or enhance antidiuretic response).

– Note: Dosing and administration vary according to purpose for use. I.V. requires use of infusion pump and close monitoring to prevent extravasation (may cause severe necrosis and gangrene).

– Assess results of laboratory tests, therapeutic effectiveness, and adverse response (eg, cardiac status, blood pressure, CNS status, fluid balance, signs or symptoms of water intoxication, intranasal irritation) on a regular basis during therapy.

– Teach patient possible side effects/appropriate interventions and adverse symptoms to report.

Crash Cart

*** It’s important to ensure that unless is being used, this cart need to have a security seal.

Equipment on top of the crash cart• Portable monitor/defibrillator• AMBU-SPUR• Laryngoscope set• Adult Pro-pads radiolucent electrodes• Pacer cable• Drip stand• 2 - #11 blade• Laryngoscope

Adult laryngoscope with bladePediatric laryngoscope with blade

Equipment basket on top of the crash cart• 5- tongue depressor• 2 – Sterile gauze• 2 – Berman Airways• 2- Sterilization Pouch• 2 – Septra 360 Electro Gel• 1- Intubation Stylet• 5 – Endotracheal tubes holder with releasable

cable tie.• 1 – Nasal Cannula tube• 1 – Medical Recording Chart

Equipment on side of the crash cart• Oxygen:

• Pressure reducing valve• Pressure gauge• Nipple adaptor

• Oxygen tubing connected to the flow meter

• 5 package - EKG Conductive Adhesive

Equipment on side of the crash cart

• Endotracheal tubes• Adult: 6.5, 7, 7.5, 8

1st Drawer on top of the crash cart

Equipment on Crash Cart 1st Drawer – Medications

• Epinephrine 1:10,000, (0.1 mg/mL) 5 IV JECT

• Dextrose 50 % 2 IV JECT

• Vasopressin 20 units/AMP 4 VIALS

• Atropine Sulfate 0.4 mg/ Ml 1 IV JECT

• Calcium Gluconate 10 % 5 VIALS

• Dopamine 200 mg/10 Ml - 5 VIALS

• Adenosine 6mg/2mL 2 IV JECT

• Dobutamine 250 mgs/20 mL - 3 VIALS

• Verapamil 5mg/ 2mL 2 AMP

2nd Drawer

Equipment on Crash Cart2nd Drawer - IV & Blood Draw Supply

• 15 - Angiocath Needles Sizes:

18G 20G 22G 1 and 1.5 in

• 6 - Butterflies Sizes:

18G 20G 22G

• 10 – Vacutainers• 6 - non sterile glove• 4 – Sterile Gauze 10 x 10• 20 – Syringes:

3mL 5mL 10mL 20mL

• Lab specimen tube• Alcohol• 4 – Tourniquet

Needles and Syringes

3rd DrawerMedications

Equipment on Crash Cart3rd Drawer - Medications

• Dextrose 50 % 4 IV JECT

• Vasopressin 20 units/AMP 2 AMPS

• Sodium Bicarbonate 8.4 % 50 mEq 10 IV JECT

• Sodium Bicarbonate Pediatric 4.2 % 50 mEq 5 IV JECT

• Lidocaine (Xylocaine) 100 mg Bolus - 5 IV JECT 1 GM – 3 VIAL

• Epinephrine 1:10,000, (0.1 mg/mL) 15 IV JECT

• Adenosine 6mg/2mL 5 VIALS

• Calcium Chloride10% 3 IV JECT

• Calcium Gluconate 10 % 5 VIALS

• Diltiazem, refrigerated 50 mg - 4 VIALS 50 mg/ 10mL – 6 VIALS

• Amioradone HCL 150 mg/ 3mL 3 AMP

Equipment on Crash Cart 3rd Drawer – Medications

• Atropine Sulfate 0.4 mg/mL 10 AMP 10 VIALS

• Verapamil 5mg/ 2mL 5 VIALS 3 AMP

• Magnesium Sulfate 50% 4 IV JECT

• Norepinephrine Bitartrate 1mg/ml 3 AMP

• Dobutamine 250 mgs/ VIAL – 5 VIALS

• Dopamine 200 mg/10 Ml - 4 VIALS 400mgs/VIAL – 5 VIALS

• Nitroglycerine 250mgs/ 10 Ml – 2 VIALS 50 mg/ VIAL – 2 VIALS

• Bretylium 500 mg/ 10mL 5 AMP

• Isoproterenol 0.2 mgmL 5 AMP

• Pronestyl 1GM 2 VIALS

4th DrawerIV Solutions and Tubing

Equipment on Crash Cart4th Drawer – IV solutions and Tubing

• 2 - IV care set• 2 - Micro-drip IV tubing• 2 - Macro-drip IV tubing• 2 - Secondary line IV tubing• 2 – Nitroglycerine IV set• 4 – 0.45 SS/50mL• 2 – D/W 250mL• 2 – D/W 500mL• 1 - N/S 9% 500mL• 1 - 0.45 SS/500mL• D/W 250mL Glass Bottle

5th Drawer

Equipment on Crash Cart5th Drawer – Miscellaneous

• 2- 0.9% Sodium Chloride Irrigation• 2- Irrigation Tray• 1- Adult Ambu bag with O2 connection• 1- Pediatric Ambu bag with O2 connection• 1 – Nasal cannula• 1- Sterile Water• 3 – Suction tubing• 1 – Suction tubing tip • 2 – Sterile Gloves• 2 - Surgical gown• 2 – Restraints• 2 – Double lumen Catheters• Endotracheal tubes:

Adult: 6.5, 7, 7.5, 8 Pediatrics:

2.0 ET tubes without cuff 3.0 ET tubes without cuff 3.5 ET tubes without cuff 4.0 ET tubes without cuff

Other equipmentOxygen and EKG machine

• On the side… • At the top…

Documents

Crash Cart