CRASH CART PHC final-LAPTOP-LVQ2EU83.pptx

A crash cart, also known as a code cart or emergency trolley, is a crucial piece of equipment in hospitals and medical facilities. It's designed to provide immediate access to life-saving medications and tools during a medical emergency, such as cardiac arrest. Let's dive deep into its components, organization, and importance in detail:

Components of a Crash Cart
Medications:

Epinephrine: Used for cardiac arrest and severe allergic reactions.

Atropine: Administered for certain types of bradycardia (slow heart rate).

Amiodarone: Used for life-threatening arrhythmias.

Sodium Bicarbonate: Helps correct acidosis during prolonged cardiac arrest.

Lidocaine: Another antiarrhythmic medication.

Vasopressin: Sometimes used in place of epinephrine in cardiac arrest.

Naloxone (Narcan): Reverses opioid overdoses.

Aspirin: Chewable aspirin is often included for suspected myocardial infarction (heart attack).

Airway Equipment:

Endotracheal Tubes: Various sizes to secure the airway.

Laryngoscope: With different blade sizes for intubation.

Ambu Bag: Manual resuscitator for providing breaths to patients.

Oxygen Masks and Nasal Cannulas: To deliver supplemental oxygen.

Intravenous (IV) Supplies:

IV Catheters: Various sizes for establishing IV access.

IV Fluids: Normal saline and Ringer's lactate.

IV Tubing: For fluid administration.

Needles and Syringes: For drawing medications and starting IV lines.

Defibrillator:

Automated External Defibrillator (AED) or Manual Defibrillator: For delivering shocks to correct life-threatening arrhythmias.

Monitoring Equipment:

Cardiac Monitor: To display heart rhythm.

Pulse Oximeter: To monitor oxygen saturation.

Blood Pressure Cuff: For measuring blood pressure.

Miscellaneous Supplies:

Gloves and Masks: Personal protective equipment for caregivers.

Scissors and Tweezers: For various tasks.

Suction Catheter and Machine: To clear airways.

Backboard: For CPR support.

Organization of a Crash Cart
A well-organized crash cart is essential for efficient use during emergencies. Here's how it’s typically arranged:

Top:

Defibrillator

Cardiac monitor

Ambu bag

Drawer 1 (Medications):

Pre-loaded syringes

Ampoules and vials of emergency drugs

Labels and medication guides

Drawer 2 (Airway Equipment):

Endotracheal tubes

Laryngoscope with blades

Suction catheters

Drawer 3 (IV Supplies):

IV catheters

IV tubing

Needles and syringes

Drawer 4 (Fluids and Miscellaneous):

IV fluids

Personal protective equipment

Scissors and tweezers

Importance of a Crash Cart
The crash cart’s role in healthcare cannot be overstated. Its importance includes:

Immediate Response:

Provides ready access to necessary tools and medications during a cardiac arrest or other critical event.

Reduces the time needed to initiate life-saving procedures.

Standardization:

Ensures that all necessary supplies are in one place, reducing confusion and delays.

Follows a standardized layout so healthcare providers can quickly locate

1. CRASH CART BY: S.D.U, AL AMIRI HOSPITAL

2. Objectives To discuss the meaning of crash cart. To identify the contents and how to arrange it. To familiarize with nurses responsibilities in handling crash cart.

3. Definition A crash cart is a special cart with drawers containing emergency drugs and equipments needed when cardiopulmonary arrest occurs. It is a means of storing and transporting emergency vital equipment and drugs to the location.

4. Guidelines and nursing responsibilities Each unit should have the cart placed in an easily accessible location. Standardization must be maintained throughout the PHC. Crash cart including defibrillator must be checked at the beginning of each shift by the assigned staff nurse. Defibrillator must be always charged. Suction machine should be always ready with accessories. O2 cylinder should be full and flowmeter available.

5. Guidelines and nursing responsibilities C hecklist should be documented and signed by the assigned staff nurse Crash cart items must be checked weekly for expiry dates. All drawers and medicines should be arranged and labelled as per the PHC emergency committee with accordance of pharmacy and accreditation policy. All staff should be familiar with the placement of content and it’s use during an emergency. The cart must be cleaned and drugs or articles used must be replaced immediately after any emergency situation.

6. DEFIBRILLATOR automated external defibrillators (AEDs) What is a defibrillator? A defibrillator is a device that provides an electric shock to your heart to allow it to get out of a potentially fatal abnormal heart rhythm, or arrhythmia, —  ventricular tachycardia  (with no pulse) or  ventricular fibrillation  — and back to a normal rhythm.

7. The general instructions and precautions for defibrillation. The nurse should ensure that the patient is in a supine position. The chest is dry and shaved, if necessary. The gel or pads are applied properly. The energy level is selected appropriately. The oxygen source is removed, and the “all clear” signal is given before delivering the shock. The nurse should also avoid touching the patient or the bed during defibrillation. Check for signs of burns, skin irritation, or bleeding at the electrode sites after defibrillation.

8. The post-defibrillation care and monitoring:- The nurse should assess the patient’s responsiveness, airway, breathing, circulation, cardiac rhythm, vital signs, and oxygenation after defibrillation. The nurse should also monitor for any arrhythmias, side effects of medications, or complications of defibrillation, such as myocardial damage, cardiac arrest, or embolism. The nurse should document the defibrillation procedure, including the date, time, energy level, number of shocks, and patient’s response and outcome.

9. PORTABLE SUCTION (a suction pump) Remove respiratory secretions from patients with respiratory conditions such as bronchitis, pneumonia, and cystic fibrosis. remove excess saliva or vomit from the mouth or throat during surgical procedures or in patients with swallowing difficulties. It works by creating a vacuum that pulls the unwanted material into a collection container or reservoir .

10. O2 CYLINDER WITH ACCESSORIES O2 MASK

11. CARDIAC BOARD A CPR board is a device that provides a flat and hard surface beneath a person who requires chest compressions to pump blood through his or her circulatory system. To use a CPR board, you need to follow these steps: Carefully maneuver the board beneath the person that requires chest compressions. Its short length and smooth surface allows it to easily slide under a patient. Position the board underneath the spine using the cut-out handles. Then, proceed with resuscitation according to the standard CPR guidelines.

12. ARTICLES

13. IV CANNULA

14. ORAL AIRWAY NASAL AIRWAY LARYNGOSCOPE WITH BLADES

15. ENDOTRACHAEL TUBES AMBU BAG ( Adult & paediatrics) STYLLET BOUGIE SUCTION CATHETER Non- Breather mask

16. ET TUBE TIE INTERNATIONAL CONNECTOR

17. Oxygen mask Nasal Cannula Non- Breather mask Artery forceps & Scissors

18. BLADE NO.11 SILK SUTURE

19. Other Items Stethoscope Torch Extension tubing. Sterile gloves ( different sizes) Tourniquet Alcohol swabs & Plaster.

20. MEDICATIONS

21. Emergency medication Propofol Generic Name: - propofol Trade Name: - Diprivan Diprivan is an emulsion for injection or infusion, available in the following packages: Diprivan 10 mg / ml hypnotic, produces amnesia with no analgesic properties . Action

22. Indications An intravenous anaesthetic used for procedural sedation. As an induction agent for general anaesthesia. Clinical uses of Propofol • Induction of general anaesthesia in patients ≥ three years old. • Maintenance of anaesthesia in patients > 2 months old • Sedation during monitored anaesthesia care for patients undergoing procedures. • Sedation in intubated, mechanically ventilated ICU patients

23. Adverse Effects • Transient local pain at the injection site is the most common adverse reaction. This may be decreased by administering IV lidocaine before propofol bolus. • Hypotension • Discoloured urine ( a green tint ) this adverse event is exceedingly rare.

24. Nursing Considerations: - • Use cautiously with CVD, lipid disorder, increased ICP. • Can cause apnea, bradycardia, hypotension. • Burning and pain at insertion site. • Can turn urine green. • Assess respiratory status and hemodynamics. • Maintain patent airway. • Assess level of sedation.

25. Adenosine Generic name:  Adenosine. Brand names:  Adenocard ,  Adenoscan . Action: - Antiarrhythmic Agent used to treat Supraventricular Tachycardia (SVT) Dosing The first dose of adenosine should be 6 mg administered rapidly over 1-3 seconds followed by a 20 ml NS bolus. If the patient’s rhythm does not convert out of SVT within 1 to 2 minutes , A second 12 mg dose may be given in a similar fashion.

26. Common Adverse Effects: - Facial flushing Shortness of breath/dyspnea Chest pressure Nausea Headache, light headedness, dizziness, numbness Tingling in the arms.

27. Nursing considerations Have the patient on the cardiac monitor, including Pulse OX and BP cuff to document continuous vitals during the administration of adenosine. Have a 12 lead ECG attached to capture a rhythm strip before, during and after the administration of adenosine. Lastly, have the AED pads on the patient in case the electrical activity is reset to a life-threatening arrhythmia . Patient Education May feel flush after bolus. Avoid caffeine for at least 12 hours prior to pharmacologic stress testing.

28. Amiodarone Brand Names: Pacerone, Cordarone, Nexterone. Generic Name: Amiodarone Action: - A class III anti-arrhythmic medication that blocks specific electrical signals in the heart. Dosage Forms & Strengths • 50mg/mL 150 mg IV bolus in 10 minutes; may repeat q10min as necessary, THEN. 1 mg/min IV for 6 hours, THEN 0.5 mg/min IV for 18 hours; not to exceed 2.2 g/24hr.

29. Indication Ventricular fibrillation (VF) Hemodynamically unstable ventricular tachycardia (VT) Atrial fibrillation Contraindications Sinus nodal bradycardia A trioventricular block Second or third-degree heart block.

30. Adverse Effects Signs of an allergic reaction to amiodarone:   H ives ; difficulty breathing; swelling of your face, lips, tongue, or throat. W heezing, cough, chest pain, cough with bloody mucus, fever. A light-headed feeling, like you might pass out. B lurred vision , (your eyes may be more sensitive to light); Liver problems -  nausea , vomiting, stomach pain (upper right side), tiredness, dark urine, jaundice (yellowing of the skin or eyes); Nerve problems - loss of coordination, muscle weakness, uncontrolled muscle movement, or a prickly feeling in your hands or lower legs; Signs of overactive thyroid -  weight loss , thinning hair, feeling hot, increased sweating, tremors, feeling nervous or irritable, irregular menstrual periods, swelling in your neck ( goiter ); or Signs of underactive thyroid - weight gain, tiredness,  depression , trouble concentrating, feeling cold.

31. Nursing considerations • May lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension . • Monitor ECG continuously while on therapy • Increases digoxin levels • Increases activity of warfarin • Monitor liver function test. • Check dosage with another RN. • Teach pt to monitor pulse daily and report abnormalities. • Avoid drinking grapefruit juice.

32. Naloxone Generic name :   Naloxone Brand names:   Narcan . Dosage form:  Injectable solution (Zimhi 5 mg/0.5 mL), Nasal spray (Narcan 4 mg, Kloxxado 8 mg).   It can be given as a nasal spray or an injection, and it works for 30 to 90 minutes Drug class:   Antidotes . Naloxone is a life-saving medication that can prevent death from opioid overdose. Store it at room temperature (25°C). Protect from light

33. Signs of an opioid overdose may include: Slowed breathing, or no breathing. Very small or pinpoint pupils in the eyes. Slow heartbeats. Extreme drowsiness, especially if you cannot wake the person from sleep.

34. What is Naloxone used for? An opioid antagonist Naloxone is used to treat a known or suspected opioid overdose emergency in children or adults. prescribed for morphine and most other opioid poisoning. It is used to reverse respiratory depression in the newborn when the mother was administered opioids during labor. It is also indicated for the diagnosis of suspected acute opioid over dosage . Dosing information 0.4 mg to 2 mg IV; alternatively, may give IM or subcutaneously. Doses should be repeated at 2-to-3-minute intervals. Usual Pediatric Dose:- ( Initial dose: 0.01 mg/kg IV, IM, or SC) repeat dose every 2 to 3 minutes as needed .

35. Adverse Effects If you have signs of an allergic reaction to naloxone. Because naloxone reverses opioid effects, the administration may cause sudden withdrawal symptoms such as: Nausea ,  vomiting ,  diarrhea , stomach pain. Fever, sweating, body aches, weakness. Tremors or shivering,  fast heart rate , pounding heartbeats, increased blood pressure. Goose bumps, shivering. Runny nose , yawning . Feeling nervous, restless, or irritable. Sudden withdrawal symptoms in a baby younger than 4 weeks old may be life-threatening if not treated the right way. Symptoms include crying, stiffness, overactive reflexes, and  seizures .

36. Nursing considerations Assessing the patient's level of consciousness, respiratory status, and opioid dependence before administering naloxone. Observing the patient closely, as the duration of action of some narcotics may exceed that of naloxone. Being prepared to manage opiate withdrawal symptoms, which may occur if the patient is opiate dependent. Monitoring respirations and other vital signs. Avoiding driving, alcohol, or other CNS depressants while taking naloxone.

37. Generic name:  clopidogrel Drug class:  Platelet aggregation inhibitors Plavix Plavix prevents platelets in your blood from sticking together to form an unwanted blood clot that could block an artery. Plavix is used to Lower your risk of having a stroke. Blood clot. Serious heart problem after you've had a heart attack. Severe chest pain (angina). Circulation problems.

38. Dosing information Usual Adult Dose for Acute Coronary Syndrome: Unstable Angina  (UA)/Non-ST-Elevation Myocardial Infarction (NSTEMI): -Loading dose: 300 mg orally once -Maintenance dose: 75 mg orally once a day -Duration of therapy: Optimal duration unknown. Plavix increases your risk of bleeding, which can be severe or life-threatening. if you have bleeding that will not stop. if you have blood in your urine, black or bloody stools. if you cough up blood or vomit that looks like coffee grounds. Plavix side effects

39. • May cause GI bleeding, neutropenia, hypercholesterolemia. • May increase risk for bleeding in warfarin, aspirin, heparin. • Can increase risk for bleeding with garlic, ginkgo, ginger. • Monitor for signs of bleeding. • Monitor bleeding times. • Monitor CBC and platelet count. • Discontinue use 5-7 days before surgery. Nursing considerations

40. ZOFRAN Generic Name:  ondansetron hydrochloride tablets and solution Brand Name: Zofran Drug Class:  Antiemetics Zofran® (ondansetron) is a medication that prevents nausea and vomiting caused by chemotherapy, radiation, or surgery. It blocks substances in your body that can cause nausea and vomiting.

41. Adverse Effects Allergic reactions —skin rash, itching, hives, swelling of the face, lips, tongue, or throat. Bowel blockage—stomach cramping , unable to have a bowel movement or pass gas, loss of appetite, vomiting. Chest pain (angina)—pain, pressure, or tightness in the chest, neck, back, or arms Heart rhythm changes —fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing. Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome.

42. Administering slowly over 2-5 minutes to avoid fatal QT prolongation and V-Tach, respiratory arrest. Observe for the improvements within the gastrointestinal symptoms to take down if the drug therapy is working well with the patients. Monitoring liver function tests. Assessing patient for nausea, vomiting, abdominal distention, and bowel sounds. Monitor for dizziness and drowsiness, for it may affect gait, balance, and movements. For chemotherapy patients, give Ondansetron at least 30 minutes before the treatment. In the case of radiation therapy, give Ondansetron 1 to 2 hours before the therapy. Check the status of fluid and electrolytes levels. Nursing considerations