Thecrashcart

The Crash Cart

PREPARED BY:Areej aloraini

The CRASH CART

To identify what is the crash cart consist ofTo identify how to arrange crash cart

contents according to policy listed from CBAHI

To determine role of nurse during checking on the crash cart

Objectives

Definition of the crash cartHistory of the crash cartPolicy about crash cartArrangement of the crash cart

Out lines:

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 .

Definition :

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

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

History in the United States

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.

Function

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

1. Crash cart must be checked by head nurse\staff nurse every shift and document in checklist.

2. Standarization must be maintained.3. Defibrillator will be checked by biomed

department regularly or as necessary.4. crash cart items must be checked monthly for

expiry dates.5. Each unit will have crash cart placed in an

easily place acceaaible location. 

Policy:

 Top shelfDefibrillatorSpo2 ProbeECG stripsUltrasound Jelly for DC shockAmbu bag Adult with maskAmbu bag pedia with mask

Arrangement of Crash Cart:

Defibrillator

Chest leadsChest electrodesConductive gelECG recording paperDefibrillator paddles, to know rhythm and or delivering shock

Defibrillator

Ambu bag

First Drawer

AdrenalineAtropine sulfateAdenosineAmiodaroneVerapamilDigoxinDopamineDobutamineLevophed

Emergency Drugs

Calcium Gluconate Lasix Hydrocortisone Dilantin

Dextrose 50%Lidocaine 1%Plasil Potassium Chloride KCLSodium Bicarbonate

Second Drawer

 Laryngoscope (various sizes of blade)ElecrtrodesXylocaine jellyStyletOropharyngeal AirwayGauze bandagePlaster

Third Drawer

laryngoscope

Oropharyngeal airway

 ETT ( various sizes)Tracheostomy TubeAirwaySuction Catheter (all sizes)Gloves

Fourth Drawer

Endotracheal tube

Laryngoscope with Blades ( curved , straight)ETT of various sizes ( adult , child and infant )5 & 10 ml syringesLubricating GelStylet

 INTUBATION

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 .

Endotracheal Tube

1. 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.

Emergency Drugs

Drug classesParasympatholytic.Anticholinergic.AntidoteAgent 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.

2- Atropine sulfate

Atrpoine is antidote for organophosphate

poisoning.

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

Pediatric dose

Drug class:AntianginalAntiarrhythmicAntihypertensiveCalcium Channel blockerTherapeutic actions:Inhibits the movement of calcium ions across

the membranes of cardiac and arterial muscle cells.

3-Verapamil hydrochloride

 Indications:

Treatment of SVTEssential 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.

Monitor patient carefully ( BP , cardiac rhythm , and

Output)Protect IV solution from lightMonitor patients with renal or hepatic

impairment carefully for possible drug accumulation and adverse reactions.

Nursing Considerations:

-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.

4- Amiodarone Hydrpchloride

-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.

RememberAmiodarone should be diluted with D5W))

-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

5- Adenosine

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).

DOBUTAMINE

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.

DOPAMINE