The crash cart

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

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The crash cart

  1. 1. The Crash Cart <br />
  2. 2. The CRASH CART<br />PREPARED BY:<br />ER STAFF NURSE<br />Mr. Jaber Ali Al-Nami<br />
  3. 3. Objectives<br />To identify what is the crash cart consist of<br />To identify how to arrange crash cart contents according to policy listed from CBAHI<br />To determine role of nurse during checking on the crash cart<br />
  4. 4. Out lines:<br />Definition of the crash cart<br />History of the crash cart<br />Policy about crash cart<br />Arrangement of the crash cart<br />
  5. 5.
  6. 6. Definition :<br />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 .<br />
  7. 7.
  8. 8. The crash cart should be kept in an easily accessible position which is central to the patient care areas .<br />
  9. 9. History in the United States<br />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<br />
  10. 10. Function<br />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.<br />
  11. 11. The arrangement of the equipment in the crash carts should be standardized throughout the institution .<br />
  12. 12. Policy:<br />Crash cart must be checked by head nursestaff nurse every shift and document in checklist.<br />Standarizationmust be maintained.<br />Defibrillator will be checked by biomed department regularly or as necessary.<br />crash cart items must be checked monthly for expiry dates.<br />Each unit will have crash cart placed in an easily place acceaaible location.<br /> <br />
  13. 13. Arrangement of Crash Cart:<br /> Top shelf<br />Defibrillator<br />Spo2 Probe<br />ECG strips<br />Ultrasound Jelly for DC shock<br />Ambu bag Adult with mask<br />Ambu bag pedia with mask<br />
  14. 14. Defibrillator<br />
  15. 15. Defibrillator<br />Chest leads<br />Chest electrodes<br />Conductive gel<br />ECG recording paper<br />Defibrillator paddles<br />, to know rhythm and or delivering shock<br />
  16. 16. Ambu bag<br />
  17. 17. First Drawer<br />
  18. 18. Emergency Drugs<br /><ul><li>Adrenaline</li></ul>Atropine sulfate<br />Adenosine<br />Amiodarone<br />Verapamil<br />Digoxin<br />Dopamine<br />Dobutamine<br />Levophed<br /><ul><li>Calcium Gluconate
  19. 19. Lasix
  20. 20. Hydrocortisone
  21. 21. Dilantin</li></li></ul><li>Second Drawer<br />Dextrose 50%<br />Lidocaine 1%<br />Plasil<br />Potassium Chloride KCL<br />Sodium Bicarbonate<br />
  22. 22. Third Drawer<br /> Laryngoscope (various sizes of blade)<br />Elecrtrodes<br />Xylocaine jelly<br />Stylet<br />Oropharyngeal Airway<br />Gauze bandage<br />Plaster<br />
  23. 23. laryngoscope<br />
  24. 24. Oropharyngeal airway<br />
  25. 25. Fourth Drawer<br /> ETT ( various sizes)<br />Tracheostomy Tube<br />Airway<br />Suction Catheter (all sizes)<br />Gloves<br />
  26. 26. Endotracheal tube<br />
  27. 27.  INTUBATION<br />Laryngoscope with Blades ( curved , straight)<br />ETT of various sizes ( adult , child and infant )<br />5 & 10 ml syringes<br />Lubricating Gel<br />Stylet<br />
  28. 28.
  29. 29. Endotracheal Tube<br />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 .<br />
  30. 30. Emergency Drugs<br />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. <br />
  31. 31. 2- Atropine sulfate<br />Drug classes<br />Parasympatholytic.<br />Anticholinergic.<br />Antidote<br />Agent used for symptomatic bradycardia,<br /> PEA: 0.5-1 mg IV push<br />, repeat at 3-5 min. <br />Intervals to max. Total dose of .04 mg/kg<br />. May be given via endotracheal route. Stocked 1 mg/10 ml.<br />
  32. 32. Atrpoine is antidote for organophosphate poisoning.<br />
  33. 33. Pediatric dose<br />
  34. 34. 3-Verapamil hydrochloride<br />Drug class:<br />Antianginal<br />Antiarrhythmic<br />Antihypertensive<br />Calcium Channel blocker<br />Therapeutic actions:<br />Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells.<br />
  35. 35.  <br />Indications:<br />Treatment of SVT<br />Essential hypertension<br /> <br />Adult Dose:<br />I.V : initial dose , 5-10 mg over 2 min ; may repeat dose of 10 mg 30 min after first dose.<br /> <br />Pediatric Dose:<br />1 year and younger : initial dose 0.1 -0.2 mgkg over 2 min.<br />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.<br />
  36. 36. Nursing Considerations:<br />Monitor patient carefully ( BP , cardiac rhythm , and <br />Output)<br />Protect IV solution from light<br />Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.<br />
  37. 37. 4- AmiodaroneHydrpchloride<br />-Drug Classes:<br />Adrenergic blocker<br />Antiarrhythmic<br /> <br />-Therapeutic action:<br />Type III antiarrhythmic. Acts directly on cardiac cell membrane.<br />-Indications :<br />Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias.<br />Recurrent ventricular fibrillation.<br />Unstable ventricular tachycardia.<br />
  38. 38. -Dose :<br />IV (Adult)<br />150 mg loading dose over 10 min , followed by 360 mg over 6 hr at rate of 1 mg/ min .<br />For maintenance infusion 540 mg at 0.5 mg / min over 18 hr.<br /> <br />Remember<br />Amiodarone should be diluted with D5W))<br />
  39. 39. 5- Adenosine<br />-Drug class and indications:<br />Antiarrhythmic<br />Conversion to sinus rhythm of paroxysmal supraventricular tachycardia.<br /> <br />-Dose :<br />6 mg by rapid IV bolus ; for repeat dose , use 12 mg by IV bolus within 1 – 2 min<br /> <br />
  40. 40. DOBUTAMINE<br />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). <br />
  41. 41. DOPAMINE<br />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.<br />

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