Crash cart policy for nurses in clinical settings.pptx

Crash cart policy for nurses in clinical settings.pptx
how to bulide crash card .

1. CRASH CART POLICY

2. G
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3. CRASH CART

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> A crash cart is a set of trays/drawers/shelves on
wheels used in hospitals for transportation and
dispensing of emergency medication/equipment at
site of medical/surgical emergency(cardiopulmonary
resuscitation)

4. + DRAWER 1 - EMERGENCY MEDICINES
+ DRAWER 2 - DISPOSABLES
+ DRAWER 3 - IV FLUIDS

+ DRAWER 4 - CATHETERS ,MASKS AND
TUBINGS

+ DRAWER 5 — BAINS AND SCOPES

5. DRAWER 1-EMERGENCY MEDICINES

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7. INJ.ATROPINE
INJ.ADRENALINE
INJ.ADENOSINE
INJ.AMIODARONE
INJ.CALCIUM GLUCONATE
INJ.DEXAMETHASONE
INJ.DOPAMINE
INJ.EPHEDRINE

INJ. HYDROCORTISONE

INJ. LASIX

INJ.MAGNESIUM SULPHATE
INJ.NORADRENALINE
INJ.POTASIUM CHLORIDE
INJ. SCOLIN

INJ. SODIUMBICARBONATE
INJ.VASOPRESSIN
INJ.XYLOCARD
INJ.NITROGLYCERINE

8. INJ.ATROPINE
INJ.ADRENALINE
INJ.ADENOSINE
INJ.AMIODARONE

INJ.CALCIUM
GLUCONATE

INJ.DEXAMETHASONE
INJ.DIGOXIN
INJ.DOPAMINE
INJ.EPHEDRINE

INJ.
HYDROCORTISONE
INJ.ISOLIN

INJ. LASIX

INJ.MAGNESIUM
SULPHATE

+ INJ.NORADRENALINE

INJ. POTASIUM
CHLORIDE

INJ. SCOLIN
INJ.SODIUM
BICARBONATE
INJ.VASOPRESSIN
INJ.XYLOCARD
INJ.DOBUTAMINE
INJ.NITROGLYCERINE

9. PICU , PEAD-EMR

INJ.EPHEDRINE

INJ.ATROPINE INJ.VECURONIUM
INJ.ADRENALINE INJ.PHENOBARBITONE
INJ.AMIODARONE INJ.HEPARIN

INJ.CALCIUM GLUCONATE
INJ.DEXAMETHASONE

INJ.LIGNOCAINE 2%
INJ.DOBUTAMIN

INJ.DOPAMINE INJ.LASIX
INJ.EPHEDRINE INJ.AMINOPHYLLIN
INJ. HYDROCORTISONE INJ,GLYCOPYROLATE
INJ.MAGNESIUM SULPHATE INJ.ADENOSINE

INJ.POTASIUM CHLORIDE
INJ. SODIUM BICARBONATE
INJ.DIAZEPAM
INJ.EPSOLIN
INJ.NORADRENALINE
INJ.MIDAZOLAM

= INJ.ZEEPAM

10. INJ.ATROPINE
INJ.ADRENALINE
INJ.AMINOPHYLLIN
INJ.PHENOBARBITONE
INJ.CALCIUM GLUCONATE
INJ.POTASIUM CHLORIDE

INJ. SODIUM
BICARBONATE

INJ.XYLOCARD
INJ.DOPAMINE
INJ.NORADRENALINE

INJ.MAGNESIUM
SULPHATE

INJ.EPHEDRINE
INJ.HEPARIN

INJ. HYDROCORTISONE
INJ.XYLOCAINE2%
INJ.MIDAZOLAM
INJ.DEXAMETHASONE
INJ.LASIX
INJ.AMIODARONE
INJ.ADENOSINE
INJ.NITROGLYCERINE

11. Drawer -2 DISPOSABLE

f

12. DRAWER 2
+ VENFLON: + IVSET > SIZE 6.5
- 14G + STERILE WATER + SIZE7
- 16G + PMOLINE3 WAY + SIZE 7.5
+ 18G Bee + SIZES
- ° 3 WAY + HAND CARE
Bo EXTENSION(10 or
SYRINGES: en
© Beh + NEEDLE:

20ML Me
- 10ML EE
o Ge + GLOVES:
© mL - SIZE6
+ 1ML
+ INSULIN SYRINGE

13. Drawer-3 IV FL UIDS

14. IV FLUIDS:
RL 500ML
NS 500ML
DNS 500ML
3% NS 100ML
NS 100ML

15. DRAWER-4 TUBING ,MASKS AND
CATHBTERS

16. MASKS

O

20. TRACHEOSTOMY MASK

21. Nasal cannula

1 LPM = 24% to $ Both prongs are in pts nares. Never more than 23 LPM lo COPD, CF (chronic

HEN
a 5) Low Row LPM = 44% Each conditions). Not for severe hypoxia, poor respiratory effort, blocked nasal
ae liter+4% pasages, apnec or mouth breathes. Humidifier w/ > 4 LPM
Masks — not well jolerated by chidren, Humidity bottle may be needed
7 [Simple mask STOP M=35 Increased deivered need for short period (<12 hours)
SN Low Flow 0% Check placement of mask, claustrophobia and MD's order to reploce mask
SLPMi w/nasal cannula during meal fime. Good for blocked nasal passages and
minimum mouth breathers. Guard against aspiration. Humidifier is optional SLPM is
minimum setting because of risk of retaining CO:
Partial &-15LPM = 70%- Permis conservation of O2
ER rebreather 20% Set flow rate so mask remains 2/3 full during inspiration. Keep fee of twists or
Se | mask kinks. PRBM can be achieved by removing valves from the NRBM. PALS
SIR. Low Row recommend removal on infants and children to prevent possible suffoca fon.
Nonrebreather &-15LPM = 60%- Highest concentration of Oz vic mask to a spontaneously breathing patient.
=) | mask 100% Prevents rebreathing of exhaled air.
NL | Low Row- Maintain flow rate so reservoir bag collapses only slightly during inspiration.
SET | High Flow Check valves/ru bber flaps are functioning (open during expiratory and
f closed during inhalation).
7% | Venture mask 410LPM= 24 Most precise concentration of Oz. Requires careful monitoring to verify FiO2 at
e mare 55% flow rate ordered. Check that air intake valves are not blocked by clothes.
Oxygen tent shouldbe> Children who need a cool and highly humidified aifiow (pneumonia). Rarely
TOLPM Used with other patients. Circulates cool air in tent. Check linens and gown

for wetness. Check temperature. Does not allow maintenance of a
satisfactory or precise Oz concentration.

AEROSOL (MIST MASK) SYSTEM delivers FiO, from 25 -100% when FiO, is greater than 50% they mot be set up in tandem. This device delivers tomidity along with

Oxygen. If the upper airway is bypassed, ie intubated or tracheostomy patent, then the aerosol needs to be heated with an electric heater provide adequate humidity. This.

Prevents drying of mucosa, plugs, altered cilia function and humidity deficit. Aerosols may be used in conjunction with aerosol fac emasks, face tents, teach collars, or T-Piaces.
FiO: - action of inspred oxygen in a ga: mhoure * 21 = 28% * FIO2 of room oi is 21%" Hypaxia in chidren SoO of < 92

23. OROPHARYNGEAL AIRWAY

«Sizes available

«Colour coding i Length (mm)

30

24. Oropharyngeal airway
insertion

25. ASOPHARYNGEAL AIRWA

Oz

26. SUCTION CATHETERS

——— u u a O u

en
ch/fr 18
ch/fr 16 =
= 1
ch 12
ch/fr 1
ch/fr8
ch/fr 6

27. suction catheter of di

| Light Green

Esa ~~
8 | Blue [Ba -$-
10 Black pee .
12 ze
14 ma fan
: m | +
18 [Red [ma =
20 | Yellow Es: ==
2 jolet [a -$-
24

| Light Blue
|

ectors

I

Plain type

$

Y-type
transparent

ne type
control)

28. Procedure for suctioning

Place patient in semi-fowler’s position _ ( ÍL

Select appropriate sized suction catheter

Hyper oxygenate BEFORE each suction pass AS

(except patients with long-term tracheostomy)

Insert catheter to a pre-measured depth
Apply suction on withdrawal of catheter

Limit suctioning to 5 seconds

Use suction pressure between 80 — 120 mmHg
Limit suctioning to 3 passes

Discontinue if HR drops by 20; increases by 40,
produces arrhythmias, or decreases 02 < 90%

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29. Shandong Zhushi Pharmaceutical Grup co.Lro CE EI: FDA)

31. PROCEDURE- NASOGASTIC

INSERTION :
=

Wash hand thoroughly

Measure distance of tube from tip of
patients ear lobe to nose to tipoff xiphoid process.

Mark the distance of the tube

Lubricate the tube of about 6 to 8 inches with the

lubricant using a rag pieces or a paper square.

Hold the tube coiled in the right hand introduces the tip

into the left nostril.

Pass the tube gently but quickly backwards momentary

resistance may occur as the tube is passed into the

naso-pharynx.

32. ET TUBES:

Murphy's Eye
To reduce the risk of
occlusion and to help
maintain gas flow

High volume, low
pressure cuff
Providing even pressure
distribution over a large
surface area, reducing
pressure on the delicate
issues of the trachea.
The cuff also allows some
movement of the ET tube

Depth marker Precise
lines calibration
To assist with

correct placement

of the InTubo.

Radio-opaque line
Allowing clear

High quality valve identification of
To ensure continual the InTube on

cuff integrity

a net

High quality
15mm connector

33. What Size Endotracheal Tube ?

Adult male
7.5-8 mm

Adult female
7-7.5 mm

Pediatric
(16 + AGE)/4

Nasal intubation
Size reduced 1-2

35. Larynx Trachea

36. Rapid Sequence Intubation

Prepare equipment (IV. ECG, oximeter.
BVM, mean ETT

<-Spine = ees ization p.r.n.
Preoxygenate with 100% Oz Eis Fe Are RTI alee
hyperventilate wWO2

Give Sedative:

- Midazolam 0.1—0.3 mg/kg IV or

- Thiopental 1—3 mg/kg IV or

- Ketamine 1—2 mg/kg IV or

- Etomidate 0.3 mg/kg IV or

- Diazepam 0.2 mg/kg IV (max. 20 mg)
ced Lin tongue leftward &

If Pt. <2 y.o.. give Atropine 0.02 mg/kg DT tongue leftward &

IV (Blocks reflex bradycardia)
y

Give Succinyicholine 1—1.5 mg/kg IV.

or: Rocuronium 0.6-1.2 mg/kg Iv.

er: Vecuronium 0.1 mg/kg IV

+

intubate (apply cricoid pressure p-r-m-)

inflate Cuff:

Verify Tube Placement:

- Check Chest Expansion

- Check Lung Sounds

- Fegsing of tube

- Apply COz Detector

- Secure with ETT holder =
<-coltar

check breath sounds

37. DRAWER 5 —BAINS ,CIRCUITS AND SCOPES

38. EMERGENCY EQUIPMENTS:
AMBU BAG-ARTIFIC L MANUAL
BREATHING UNIT ee

Expiratory Air-inlet One-way Valve

Valve PEEP Self-inflating & O2 Reservoir Socket
Valve Bag
| Air-inlet & Pressure
Release Valves

Face Pop off Oxygen inlet Reservoir
mask valve & tubing Bag

39. + Also known as bag valve mask.

e Used for Positive pressure ventilation.

e deliver between 500 and 800 milliliters of air to a
normal male adult patient's lungs.

e Squeezing the bag once every 5 to 6 seconds for an
adult or once every 3 seconds for an infant or child
provides an adequate respiratory rate.

40. Bu A O nn

41. am
Il Breathing circuit: components

Fresh gas flow (FGF) inlet
Reservoir bag (2 liter)
Corrugated tubing — 1 meter

One-way pressure relief
valve (Heidbrink) (APL

valve)

Elbow or straight connector
to face mask or ET tube
Breathing filter (passive
humidification, bacterial and
Viral filter)

42. + used to deliver oxygen, remove carbon dioxide, and
deliver inhalational anesthetic agents to a patient.

+ Types:open,semi open, closed.

CORRUGATED
APL VALVE EXPIRATORY TUBE

FRESH GAS TUBING

TO PATIENT

BAINS SYSTEM

43. Parts Of Laryngoscope
@ Handle
@ Blade
»Base
pHeel
» Tongue (Spatula)
»Flange
»Web
»Tip (Beak)
»Light source
2 Hook-on (hinged, folding)
connection between the
handle and blade.

44. STYLET BOUGIE

45. Apart from the pre-defined emergency medicines and equipment, no
other medications are allowed to store in the crash cart.

Crash cart is available in all the floors in order to meet the medical
emergencies.

All crash cart are kept closed with a transparent Rexene cover with zip
to prevent the misuse of the stocked medicines. The zip of the cover is
sealed with a plastic tag and the date and time of closure is

documented.

Crash cart is checked in every 15 days by the clinical pharmacist to
verify the quantity and the expiry of the medicines. Once the crash cart
seal is opened, the opening time and closing time is noted along with

the date and is duly signed by the clinical pharmacist.

46. All the near expiry medicines aré removed three months prior to

expiry, from the crash cart during each ver ation and are sent to the
pharmacy stores. The drugs are replaced within 2 hours from opening.
During medical emergencies, crash carts are opened to utilize
medications and make the patient stable. The opening time is noted
and the clinical pharmacist is informed about the same.

Once the event comes to an end, the clinical pharmacist makes a count
of the drugs that are used.

The used quantity of drugs is replenished within the defined time frame
of two hours and the cart is sealed by documenting time and date

along with the signature of the clinical pharmacist.