crash cart

CRASH CARTPrepared by

FARIDA KHOGLI, BSN, RN`MEEQAT GENERAL HOSPITAL

MADINA MUNAWARH KINGDOM OF SAUDI ARABIA

crash cartObjectives To identify what is the crash cart

consist of. To identify how to arrange crash cart

contents according to policy listed from CBAHI To determine the role of nurse during

checking crash cart To know the maintenance of crash

cart

Crash CartDefinition A crash cart - is a special cart (with

drawers) containing emergency drugs and equipment needed when a cardiac pulmonary arrest occurs.

It provides an easily accessible position which is central to the patient care area.

Crash Cart Function Is to provide mobile station with in

the hospital that contains every thing needed to treat a life threatening situation .The advantage of mobility is that it allows the treatment to come to the patient when needed .

Crash Cart Policy : Crash cart must be checked by head

nurse/staff nurse every shift and document in checklist.

Standardization must be maintained . Defibrillator will be checked by biomed

department regularly or as necessary . crash cart item must be checked monthly for

expiry dates . Each unit will have crash cart placed in an

easily place accessible location

Crash CartMaintenance:

Follow is a maintenance routine that should be completed at least monthly:

Expiration dates on medications should be checked on the first day of the month

Expired medications should be removed and replaced The defibrillation pads on the AED or the defibrillator

should be checked for expiration date The battery charge on the monitor and/or AED should

be checked and documented

Crash Cart

Arrangement Top shelf Defibrillator Spo2 probe ECG Strips Ultrasound jelly for DC shock Ambu bag adult with mask Ambu bag pedia with mask

Crash CartProcedure: 1. The cart is inspected for the following External contents: 1.1. Portable suction apparatus with connecting tubing if not available in each patient’s room. 1.2. Portable monitor/defibrillator unit with charged batteries, multi-function cable, multifunction pads (pedi, adult or both as appropriate), pacer cable (if pacer capable machine), ECG electrodes, appropriate sized paddles (adult, pediatric), defibrillation gel, monitor paper, blood pressure cuff (adult carts), SpO2 probe.

Crash Cart

Procedure: 1.3. Sharps container. 1.4. Cardiopulmonary Resuscitation

records 1.5. Emergency Crash Cart Check Sheet. 1.6. List of cart contents. 1.7. Emergency drug information sheets

as appropriate for unit

Crash Cart Defibrillator chest leads Chest electrodes Conductive jell ECG recoding paper Defibrillator paddles To know rhythm and delivering shock

Crash Cart

Ambu bag

Crash Cart

Crash Cart

First drawer

Medications

Crash CartSecond Drawer Dextrose 50% Lidocaine 1% Plasil Potassium chloride KCL Sodium bicarbonate

Crash CartThird drawer: Laryngoscopy( various sizes of blade) electrodes Xylocaine jelly Stylet Oropharyngeal airway Gauze bandage Plaster

crash cart

Laryngoscope

Crash CartFourth drawer: ETT(various sizes ) Tracheostomy tube Airway Suction catheter (all sizes) Gloves

Crash Cart

Crash CartIntubation Laryngoscope with

blades(curved ,straight) ETT of various sizes (adult , child ) 5&10ml syringe Lubricating gel Stylet

Crash Cart

Endotracheal Tube  Is a catheter  that is inserted into

the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide

MEDICATIONS. Introduction A list of the drugs kept in the crash carts. This list has been approved by the

Pharmacy and Therapeutic Committee. The most important indications,

contraindications and dosage and administration of these drugs are reviewed as a reminder for the physicians, nurses and pharmacists who serve on cardiac arrest (code) teams or who are involved in other emergency situations.

MEDICATIONS.Intraosseous (IO) Access In older children and adults:

• Distal radius and ulna Proximal tibia

MEDICATIONS.Trans -tracheal Administration TT 1. Lipid-soluble drugs such as

lidocaine, epinephrine, atropine, and naloxone ("LEAN") can be given via the endotracheal tube.

2. Flush with a minimum of 5 mL normal saline followed by 5 assisted manual ventilations.

MEDICATIONS. What is ?

1-Adrenergic blocker A drug that blocks the secretion of epinephrine and norepinephrine  . By blocking these adrenergic substances, which cause constriction of bloodvessels and increased cardiac output, adrenergic blocking agents produce a dilatation of the blood vessels and a decrease in cardiac output. 2-AnticholinergicsDrugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter, or a chemical messenger. It transfers signals between certain cells to affect how your body functions3-vasopressor Drugs cause vasoconstriction (contract blood vessels) and increase blood

pressure. They are used to treat hypotension, especially in critically ill patients

MEDICATIONS. 1- EPINEPHRINE Adrenergic agent, choice for cardiac arrest

_vasoconstrictor Uses :- In pulseless VF, VT, Asystole, and PEA: Dose:-1 mg IV or IO every 3 – 5 minutes. May be

given via endotracheal route. Stocked 1 mg/ 10ml 1:10,000

MEDICATIONS.2-Atropine sulfate Parasympatholytic Anticholinergic Antidote Agent used in symptomatic bradycardia PEA o.5- 1mg IV push Repeat at 3-5minute Total dose .o4mg/kg May be given endotracheal route

MEDICATIONS. 3- verapamil :Antianginal AntiarrhythmicAntihypertensiveCalcium channel blockerTherapeutic action : inhibits the movement of calcium ion across the membranes of cardiac and arterial muscle cell

MEDICATIONS. Indications :

Treatment of SVT Essential hypertension

Adult dose : Initial IV initial dose 5-10mg over2min

may repeat dose 10 mg 30min after first dose

Stocked 2.5mg/ml

MEDICATIONS. Nursing consideration Monitor patient carefully (BP, Cardiac

rhythm and out put ) Protect IV solution from light Monitor patient with renal or hepatic

impairment carefully for possible drug accumulation and adverse reactions.

MEDICATIONS.

4. Amiodarone :For refractory pulseless VT/VF- 5 mg/Kg rapid - 300 mg IV/IO; over 3 min. (dilute in 20-

30ml). Monitor ECG and BP - For per fusing tachycardia - Loading 5 mg/kg over 20-60 min - Max 15 mg/kg/day IV - (Should be diluted by D5W)

MEDICATIONS

4. Amiodarone Slows AV conduction, prolongs QT interval, and

slows ventricular conduction (widens the QRS). Amiodarone causes hypotension. The severity

of the hypotension is related to the infusion rate and is less common with the aqueous form of amiodarone:

1. It should be administered slowly to a patient with pulse.

2. May be given rapidly to a patient with cardiac arrest or ventricular fibrillation (VF).

MEDICATIONS

4. Amiodarone • Monitor the ECG because complications may

include: 1. Bradycardia, 2. Heart block, 3. Torsades de pointes ventricular tachycardia

(VT). Use extreme caution when administering with

another drug causing QT prolongation, such as procainamide.

Adverse effects may be long lasting because the half life is up to 40 days.

MEDICATIONS5-Adenosine :For symptomatic SVT

6 mg over 1-3 sec. Monitor ECG If no response within 1-2 min Repeat: 12 mg, Rapid IV/IO bolus

Remarks: Rapid IV push Max dose 12 mg

MEDICATIONS6-Dobutamine7-Dopamine2-20 mg/kg/min adrenergic effect at higher doses

Dopamine 200mg, 40mg/ml 5ml vial (2)Dobutamine 250 mg/ml 20ml Vials (2)

MEDICATIONS8. Glucose 0.5-1 g/kg IV/IO D10W: 5–10 mL/kg D25W: 2–4 mL/kg D50W: 1–2 mL/kg • Check blood glucose concentrations during and after

arrest.

MEDICATIONS 9-lidocaine Anti-arrhythmic -For treatment of ventricular ectopy, VT,

and VF. Initial dose: 0.5-1.5 mg/kg, repeat 0.5-

0.75 mg/kg every 5 to 10 minutes as necessary, up to a maximum

total dose of 3 mg/kg.

MEDICATIONS 10-MAGNESIUM Recommended for treatment of torsade's de pointes VT with

or without cardiac arrest. May be effective for rate control in patients with atrial fibrillation with rapid ventricular response. Not helpful for treatment of nontorsades pulseless arrest. Give 1 to 2 Gm diluted in D5W over 5 to 60 minutes. Slower rates are

preferable in the stable patient. Stocked in 1 Gm/2ml vials (torsades de pointes abnormal heart rhythm that can lead to

sudden cardiac death Torsade's de pointes :is a specific type of 

abnormal heart rhythm that can lead to sudden cardiac death

MEDICATIONS

11-NALOXONE (NARCAN) IS a narcotic antagonist Initial dose of 0.4 to 2 mg IV/IM/SQ,

repeat at 2 to 3 minute intervals. Use smaller doses (0.1-0.2 mg) in postoperative patients to avoid large cardiovascular changes

MEDICATIONS

12-NOREPINEPHRINE (LEVOPHED) Vasopressor To support blood pressure after return to

spontaneous circulation. Prepare IV infusion of 4 mg/250ml. Initial dose 2 to 12 mcg/minute (7.5 to 45 ml/hr) and titrate to adequate blood pressure.

Monitor urine output. Adequate hydration is imperative.

MEDICATIONS

13-SODIUM BICARBONATE: Used in metabolic acidosis: bicarbonate

therapy should be guided by the bicarbonate concentration of calculated base deficit obtained from blood gas analysis or laboratory measurement.. Usual initial dose 1 mEq/kg IV push. Incompatible with dopamine, norepinephrine, and amiodarone.

MEDICATIONS 14-VASOPRESSIN : Non-adrenergic peripheral vasoconstrictor. -40 units IV push may replace first or second dose of epinephrine to produce vasoconstriction and increased blood flow to the brain during CPR for VF or pulseless VT. Use epinephrine

- to follow up in 3 to 5 minutes if there is no response to vasopressin. Stocked in 20 unit/1ml vials

MEDICATIONS15. Calcium (10%, 1 g/10 mL) 20 mg/kg 500mg – 1 gm IV slowly For symptomatic hypocalcemia,

hyperkalemia and Ca channel blockers overdose.

Preferably administer calcium chloride via a central venous catheter because of the risk of sclerosis or infiltration with a peripheral venous line .

Calcium Chloride

10% 10ml 100mg/ml single dose vial (2)

Calcium Gluconate

10% 10ml 100mg/ml single dose vial (2)

Thank you