The crash cart

this is a brief description of the cart cart , i hope u will get benifit ..good luck

1. The Crash Cart

2. The CRASH CART PREPARED BY: ER STAFF NURSE Mr. Jaber Ali Al- Nami

3. Objectives 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 role of nurse during checking on the crash cart

4. Out lines: Definition of the crash cart History of the crash cart Policy about crash cart Arrangement of the crash cart

5. Definition : It is a means of storing and transporting vital equipment and drugs which may be required during a code blue ( cardiac emergency ) to the location of the emergency .

6. The crash cart should be kept in an easily accessible position which is central to the patient care areas .

7. History in the United States The first cardiac crash cart was created in 1962 at Bethany Medical Center in Kansas City, Kansas , home to the first Cardiac Care Unit in the country . The first crash cart was fabricated by one of the doctor's fathers. It contained an Ambu bag , defibrillator paddles, a bed board and endotracheal tubes

8. Function The function of a crash cart is to provide a mobile station within the hospital that contains everything needed to treat a life-threatening situation. The advantage of mobility is that it allows the treatment to come to the patient when needed.

9. The arrangement of the equipment in the crash carts should be standardized throughout the institution .

10. Policy: Crash cart must be checked by head nurse\staff nurse every shift and document in checklist. Standarization must be maintained. Defibrillator will be checked by biomed department regularly or as necessary. crash cart items must be checked monthly for expiry dates. Each unit will have crash cart placed in an easily place acceaaible location.  

11. Arrangement of Crash Cart:   Top shelf Defibrillator Spo2 Probe ECG strips Ultrasound Jelly for DC shock Ambu bag Adult with mask Ambu bag pedia with mask

12. Defibrillator

13. Defibrillator Chest leads Chest electrodes Conductive gel ECG recording paper Defibrillator paddles , to know rhythm and or delivering shock

14. Ambu bag

15. First Drawer

16. Emergency Drugs Adrenaline Atropine sulfate Adenosine Amiodarone Verapamil Digoxin Dopamine Dobutamine Levophed Calcium Gluconate Lasix Hydrocortisone Dilantin

17. Second Drawer Dextrose 50% Lidocaine 1% Plasil Potassium Chloride KCL Sodium Bicarbonate

18. Third Drawer  Laryngoscope (various sizes of blade) Elecrtrodes Xylocaine jelly Stylet Oropharyngeal Airway Gauze bandage Plaster

19. laryngoscope

20. Oropharyngeal airway

21. Fourth Drawer  ETT ( various sizes ) Tracheostomy Tube Airway Suction Catheter (all sizes) Gloves

22. Endotracheal tube

23.   INTUBATION Laryngoscope with Blades ( curved , straight) ETT of various sizes ( adult , child and infant ) 5 & 10 ml syringes Lubricating Gel Stylet

24. Endotracheal Tube The endotracheal tube serves as an open passage through upper airway. The purpose of endotracheal intubation is to permits air to pass freely to and from the lungs in order to ventilate the lungs .

25. Emergency Drugs EPINEPHRINE Adrenergic agent of choice for cardiac arrest, vasopressor used in Pulsless VT/VF, Asystole and PEA: 1 mg IV every 3-5 min. Or more frequently. May be given endotracheal route. Stocked 1 mg/10 ml 1:10,000. If using for hypersensitivity reaction 0.1-0.25mg SQ, SIVP.

26. 2- Atropine sulfate Drug classes Parasympatholytic . Anticholinergic . Antidote Agent used for symptomatic bradycardia , PEA: 0.5-1 mg IV push , repeat at 3-5 min. Intervals to max. Total dose of .04 mg/kg . May be given via endotracheal route. Stocked 1 mg/10 ml.

27. Atrpoine is antidote for organophosphate poisoning.

28. Pediatric dose Dose (mg) Weight 0.1 3.2-7.3 kg 0.15 7.3-10.9 kg 0.2 10.9-18.1 kg 0.3 18.1- 29.5 kg 0.4 29.5-40.8 0.4-0.6 >40.8 kg

29. 3-Verapamil hydrochloride Drug class: Antianginal Antiarrhythmic Antihypertensive Calcium Channel blocker Therapeutic actions: Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells.

30.   Indications: Treatment of SVT Essential hypertension   Adult Dose: I.V : initial dose , 5-10 mg over 2 min ; may repeat dose of 10 mg 30 min after first dose.   Pediatric Dose: 1 year and younger : initial dose 0.1 -0.2 mg\kg over 2 min. 1-15 years : initial dose 0.1-0.3 mg \kg over 2 min .Do not exceed 5 mg .Repeat above dose 30 min after initial dose if response is not adequate. Repeat dose should not exceed 10 mg.

31. Nursing Considerations: Monitor patient carefully ( BP , cardiac rhythm , and Output) Protect IV solution from light Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.

32. 4- Amiodarone Hydrpchloride -Drug Classes : Adrenergic blocker Antiarrhythmic   -Therapeutic action : Type III antiarrhythmic . Acts directly on cardiac cell membrane. - Indications : Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias. Recurrent ventricular fibrillation. Unstable ventricular tachycardia.

33. -Dose : IV (Adult) 150 mg loading dose over 10 min , followed by 360 mg over 6 hr at rate of 1 mg/ min . For maintenance infusion 540 mg at 0.5 mg / min over 18 hr.   Remember Amiodarone should be diluted with D5W) )

34. 5- Adenosine -Drug class and indications: Antiarrhythmic Conversion to sinus rhythm of paroxysmal supraventricular tachycardia.   -Dose : 6 mg by rapid IV bolus ; for repeat dose , use 12 mg by IV bolus within 1 – 2 min  

35. DOBUTAMINE Vasopressor : IV infusion: 500 mg Dobutamine in 250 ml IV solution. Usual dose 2-5mcg/kg/min. May titrate to upper dose of 20mcg/kg/min. Primarily stimulates B-1 receptors in the heart and is used for inotropic support with mild chronotropic effect. Adequate hydration of patient imperative in blood pressure support. When mixing more than 500mg. Dobutamine in IV solution, equal volume must be removed (e.g. 1gm/40ml Dobutamine , remove 40ml from IV solution).

36. DOPAMINE Vasopressor , IV infusion: Usual dose in code situation is 5-20mcg/kg/min. Renal perfusion dosing 2-5mcg/kg/min, increase of cardiac output 5-10mcg/kg/min and peripheral vasoconstriction 10-20mcg/kg/min. As approaching 20mcg/kg/min assess urine output. Extravasation treatment is with phentolamine . Adequate hydration of patient imperative in blood pressure support. Premix drip of 400 mg Dobutamine in 250 ml IV solution.