Hospital "Crash Cart" - MICU: Yatska Cartagena Juan Morales

Hospital
“Crash Cart” - MICU
Yatska Cartagena
Juan Morales
Objectives
After this presentation the students
will be able to:
• Define the term crash cart.
• Understand the purpose of
crash cart.
• Identify the content of crash
cart, their use and the nursing
consideration for all the:
• Medications
• Supplies
Definition crash cart
• A crash cart or code cart is a special mobile storage unit with drawers
used in health care facilities and emergency rooms that contain the
necessary medications and equipment to respond to a cardiopulmonary
arrest.
Purpose of the Crash Cart
• The purpose of the crash cart is to have a portable life saving unit that
contains all the medications, equipment and supplies necessary to initiate a
treatment in emergency and life threatening situations on all health care
facilities.
Medications
 Classification
 Action
 Indication
 Contraindication
 Side effect
 Nursing Consideration
Medications included in the Crash Cart
First Line drugs Antiarrhythmic Agents

• Oxygen • Lidocaine (Xylocaine)
• Epinephrine • Procainamide (Ponestyl)
• Atropine Sulfate • Bretylium (Bretylol)
• Verapamil (Calan)
• Diltiazem (Cardizem)
• Adenosine (Adenocard)
• Aminoradone (Cordaron)
Miscellaneous Second Line Drugs

• Magnesium Sulfate • Norepinephrine (Levophed)
• Sodium Bicarbonate • Dopamine (Intropin)
• Calcium Chloride • Dobutamine (Dobutrex)
• Calcium Gluconate
• Isoprotenerol (Isuprel)
• Dextrose 50%
Vasodilators/ Antihypertensive Anti-diuretic

• Nitroglycerine (Tridil) • Vasopressin
Medication Classification, Mechanism of action, uses,
contraindication, side effects and nursing considerations
• Epinephrine (1:10000) • Contraindications

– With angle-closure glaucoma, shock (other than anaphylactic
• Classification
shock), organic brain damage, cardiac dilation, arrhythmias,
– Beta2 Adrenergic Agonists coronary insufficiency, or cerebral arteriosclerosis. Also
• Action contraindicated in patient receiving general anesthesia with
halogenated hydrocarbons or cyclopropane and in patients in
– Stimulates beta receptors in lung.
labor (may delay second stage)
– Relaxes bronchial smooth muscle.
– In conjunction with local anesthesia, epinephrine is
– Increases vital capacity contraindicated for use in finger, toes, ears, nose, and genitalia.
– Increases BP, HR, PR – In pregnant woman, drug is contraindicated.
– Decreases airway resistance. – In breast feeding do not use the drug or stop breast feeding.
• Indication • Nursing Management
– Asthma – Monitor V/S. and check for cardiac dysrrhythmias
– Drug increases rigidity and tremor in patients with Parkinson’s
– Bronchitis
disease
– Emphysema
– Epinephrine therapy interferes with tests for urinary
– All cardiac arrest, anaphylaxis catecholamine
– Used for symptomatic bradycardia. – Avoid IM use of parenteral suspension into buttocks. Gas
– Relief of bronchospasm occurring during anesthesia gangrene may occur
– Exercised-induced bronchospasm – Massage site after IM injection to counteract possible
vasoconstriction.
• Side Effects/Adverse Reactions – Observe patient closely for adverse reactions. Notify doctor if
– nervousness, tremor, vertigo, pain, widened pulse pressure, adverse reaction develop
hypertension, nausea – If blood pressure increases sharply, rapid-acting vasodilators
– headache such as nitrates or alpha blockers can be given to counteract
• Atropine Sulfate (4mg/mL) • Contraindications

• Classification – Hypersensitivity
– Anticholinergic
– With acute angle closure glaucoma, obstructive
• Indication
– Pre-op meds/pre-anesthetic meds uropathy, obstructive disease of GI tract, paralytic
– To restore cardiac rate and arterial pressure during anesthesia ileus, toxic megacolon, intestinal atony, unstable CV
when vagal status in acute hemorrhage, asthma, or myasthenia
– To lessen the degree of A-V heart block
gravis.
– To overcome severe carotid sinus reflex
– Antidote for cholinergic toxicity – Pregnant women.
• Side effects • Nursing Management
– CNS: restlessness, ataxia, disorientation, hallucinations, delirium, – Monitor VS.
coma, insomnia, agitation, confusion.
– CV: tachycardia, angina, arrhythmias, flushing. – Report increase HR
– EENT: photophobia, blurred vision, mydriasis. – Monitor for constipation, oliguria.
– GI: dry mouth, constipation, vomiting.
– Instruct to take 30 minutes before meals
– GU: urine retention.
– Hematologic: leukocytosis – Eat foods high in fiber and drink plenty fluids.
– Other: anaphylaxis – Can cause photophobia
• Adverse effects
– Instruct client not to drive a motor vehicle or
– CNS: headache, excitement.
– CV: palpitations participate in activities requiring alertness.
– GI: thirst, nausea – Advise to use hard candy, ice chips, etc. for dry mouth.
• Lidocaine (Xylocaine) • Contraindications

• 100 mg bolus
• 1 gm – Hypersensitivity
• Classification – Heart block
– CV drugs: Antiarrhythmics – Hypovolemia
– Anesthetic – Adams stroke syndromes
• Action – Infection at site of injection
– Increases electrical stimulation of ventricle and His-Purkinje
system by direct action on tissues, resulting to decrease • Nursing Management
depolarization, automaticity and excitability in ventricles – Assess pt before and after therapy
during diastolic phase
• Indication
– Pts infusion must be on cardiac monitor
– Anesthesia – Monitor ECG, if QT or QRS increases by 50% or
– Arrhythmias more, withhold the drug
– Control of Status Epilepticus refractory to other treatments – Monitor BP, check for rebound HPN after 1-2
• Side Effects and Adverse Reactions hrs
– GI disturbances, bradycardia, hypotension, convulsion, – Assess respiratory status, oxygenation and
numbness of tongue, muscle twitching, restlessness,
pulse deficits
nervousness, dizziness, tinnitus, blurred vision, fetal
intoxication, light headedness, drowsiness, apprehension, – Assess renal and liver function
euphoria, vomiting, sensation of heat, respiratory arrest and – Monitor CNS symptoms
CV collapse
– Monitor blood levels
• Procainamide (Pronestyl) • Contraindications

• 1 gm
– Heart block
• Classification
– Antiarrhythmics – Heart failure
• Action – Hypotension
– Blocks open Na channels and prolong the cardiac – Myesthenia gravis
action potential. This results in slowed conduction
and ultimately the decreased rate of rise of the – Digoxin toxicity
action potential may result on the widening of QRS – Lactation
on ECG
• Indication
• Nursing Management
– Supraventricular and ventricular arrhythmias. – Assess cardiovascular status before
– Treatment of Wolf-Parkinson-White Syndrome therapy.
• Side Effects and Adverse Reactions – Assess pulmonary, hepatic and thyroid.
– Severe hypotension, ventricular fibrillation and function before and during therapy.
asystole.
– Monitor fluid and electrolytes, I&O, K,
– Drug induced SLE syndrome, blood disorders, fever,
myocardial depression, heart failure, agrunulocytosis, Na and Cl.
psychosis, angioedema, hepatomegaly, skin irritation, – Monitor ECG, BP.
hypergammaglobulinemia, GI and CNS effects.
– Assess vision.
• Bretylium (Breytol) (500mg/10mL) • Contraindications

• Classification
–Antidysrhythmic –There are no contraindications to use in
• Action treatment of ventricular fibrillation or life-
–Bretylol produces a prompt increase in ventricular fibrillation
threshold, perhaps through postganglionic adrenergic blockade. It
threatening refractory ventricular
causes an initial release of norepinephrine from postganglionic nerve arrhythmias.
terminals. At present, its use is reserved for patients who fail to
respond to lidocaine or other first-line antidysrhythmics.
• Indication –Assess and notify the doctor if the patient's
–Indicated in the prophylaxis and therapy of ventricular fibrillation.
medical history include: any allergies, kidney
–Indicated in the treatment of life-threatening ventricular arrhythmias.
• Side effect/ Adverse effect disease, heart disease, blocked blood vessels
–Hypotension Hypotension and postural hypotension (aortic stenosis), lung problems (pulmonary
–Nausea and vomiting hypertension) because the medication is
–Vertigo, dizziness, light-headedness and syncope
–Bradycardia, increased frequency of premature ventricular
contraindicated with this conditions
contractions, transitory hypertension, initial increase in arrhythmias, –To avoid dizziness and lightheadedness, the
precipitation of anginal attacks, and sensation of substernal pressure.
–Renal dysfunction, diarrhea, abdominal pain, hiccups, erythematous
patient should remain lying down or, if
macular rash, flushing, hyperthermia, confusion, paranoid psychosis, necessary, get up slowly when rising from a
emotional liability, lethargy, generalized tenderness, anxiety, shortness seated or lying position.
of breath, diaphoresis, nasal stuffiness and mild conjunctivitis.
–Hyperthermia –This medication should be avoid during
pregnancy unless is clearly needed.
• Verapamil (Calan, Isoptin) (5mg/2mL)

• Classification
• Contraindications
– Anti-anginal – Hypersensitivity
– Anti-arrhythmics
– Anti-hypertensive – Sick sinus syndrome
– Vascular headache suppressants
• Action – 2nd or 3rd degree AV block
– Inhibits calcium transport into myocardial smooth muscle cells
– Decreases SA and AV conduction and prolongs AV node
– CHF
refractory period in conduction tissue – Cardiogenic shock
• Indication
– Hypertension – Concurrent IV beta-blocker
– Angina Pectoris
– Supraventricular Arrhythmia • Nursing Management
– Atrial flutter/fibrillation
• Side Effects and Adverse Reactions
– Monitor BP and pulse before
– CNS: abnormal dreams, anxiety, confusion, dizziness and therapy, during titration and
headache
– EENT: blurred vision, epistaxis and tinnitus
therapy
– CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and – Monitor ECG, I&O, serum
palpitations
– GU: dysuria, nocturia and polyuria potassium and weight.
– GI: abnormal liver function, anorexia, constipation, diarrhea,
nausea and vomiting – Assess for CHF
• Diltiazem (Cardizem) (50mg/10mL)

• Classification
– Anti-anginals – Hypersensitivity
– Antiarrhythmics
– Antihypertensive – Sick sinus syndrome
– Ca channel blocker
• Action
– 2nd or 3rd degree AV block
– Inhibits calcium transport into myocardial smooth muscle cells – CHF
– Systemic and coronary vasodilation
• Indication – Cardiogenic shock
– Hypertension
– Angina Pectoris
– Concurrent IV beta-blocker
– Supraventricular Arrhythmia • Nursing Management
– Atrial flutter/fibrillation
• Side Effects and Adverse and Reactions – Monitor BP and pulse before
– CNS: abnormal dreams, anxiety, confusion, dizziness and therapy, during titration and
headache
– EENT: blurred vision, epistaxis and tinnitus therapy
– CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and
palpitations
– Monitor I&O and weight
– GU: dysuria, nocturia and polyuria – Assess for CHF
– GI: abnormal liver function, anorexia, constipation, diarrhea,
nausea and vomiting – Routine serum Digoxin monitoring
• Adenosine (Adenocard) (6mg/2mL) • Contraindication

• Classification – Contraindicated in patients hypersensitivity to
drugs.
– Nucleoside
– Contraindicated in those with second or third-
• Indication degree heart block or sinus node disease (such as
– To convert paroxysmal supraventicular sick sinus syndrome and symptomatic
tachycardia (PSVT) to sinus rhythm bradycardia), except those with a peacemaker.
• Action – Use cautiously in patients with asthma,
emphysema, or bronchitis because
– A naturally occurring nucleoside that bronchoconstriction may occur.
acts on the AV node to slow conduction • Nursing Management
and inhibit reentry pathways. Also
– ALERT: by decreasing conduction through the AV
useful in treating PSVTs, including those node, drug may produce first-, second-or third-
with accessory bypass tracts (Wolff- degree heart block. Patients who develop high-
Parkinson-White syndrome) level heart block after a single dose shouldn’t
• Adverse Reaction receive additional doses.
– CNS: dizziness, lightheadedness, – ALERT: new arrhythmias, including heart block
and transient asystole, may develop; monitor
numbness, tingling in arms, headache. cardiac rhythm and treat as indicated.
– CV: facial flushing. – If solution is cold, crystals may form; gently warm
– GI: nausea. solution to room temperature. Don’t use
– Respiratory: dyspnea, shortness of solutions that aren’t clear.
– Drug lacks preservatives. Discard unused portion.
breath, chest pressure.
• Magnesium sulfate (50%(500mg/mL)) • Adverse Reactions

• Classification – flushing, sweating, hypotension, muscular weakness,
– Anticonvulsant sedation & confusion
– decreased deep tendon reflexes
• Indication
– resp. paralysis
– Treatment of hypomagnesaemia accompanied by signs of
tetany
– Heart block or myocardial damage
– Control of HTN
– Encephalopathy & convulsions
– Monitor the following: I.V.: Rapid administration: ECG
– Prevention & control of convulsions in patients w/ monitoring, vital signs, deep tendon reflexes; magnesium,
preeclampsia or eclampsia calcium, and potassium levels; renal function during
– Prevention of hypomagnesaemia in patients receiving TPN administration.
• Action – Obstetrics: Patient status including vital signs, oxygen
– May decrease acetylcholine released by nerve impulses, saturation, deep tendon reflexes, level of consciousness,
but its anticonvulsant mechanism is unknown fetal heart rate, maternal uterine activity.
– Oral: Renal function; magnesium levels; bowel movements.
• Sodium Bicarbonate • Contraindications

• 8.4% 50mEq/50mL – Contraindicated in patients with metabolic or
• Pediatric 4.2% 50 mEql respiratory alkalosis;
• Classification – Patients who are losing chlorides from vomiting or
– Alkalinizers continuous GI suction;
• Indication – Patients taking diuretics known to produce
hypochloremia alkalosis; and
– Metabolic acidosis
– Patients with hypocalcemia in which alkalosis may
– Systemic or urinary alkalinization
produce tetany, hypertension, seizures, or heart
– Antacid
failure.
– Cardiac arrest
– Oral sodium bicarbonate is contraindicated in patients
• Action with acute ingestion of strong mineral acids.
– Restores buffering capacity of the body and • Nursing Management
neutralizes excess acid
– Do not take drug with milk to avoid hypercalcemia,
• Adverse Reaction abnormally high alkalinity in tissues and fluids, or
– Tetany, edema, gastric distention, belching, kidney stones.
flatulence, hypokalemia, metabolic alkalosis, – Do not give to patients with metabolic or respiratory
hypernatremia, chemical cellulites because of alkalosis, and in those with hypocalcemia in which
alkalinity, pain, irritation, tissue necrosis, alkalosis may produce tetany, hypertension, seizures,
ulceration or sloughing at the site of or heart failure.
infiltration
– Monitor for alkalosis by obtaining blood pH, PaO2,
PCO2, and electrolyte levels
• Calcium Chloride (10% 100mg/mL) • Adverse effect

– Metallic taste
• Classification
– Burning
– Electrolytes
– Heat waves
• Indication
– Bradycardia (may cause asystole)
– Hyperkalemia
– Hypotension
– Hypocalcemia
– Peripheral vasodilatation
– Hypermagnesia
– Cardiac arrhythmias
• Action – Increased digitalis toxicity
– Increase the force of cardiac contractility, by initiating
– Extravasations with necrosis, sloughing and abscess formation
myofibril
– Vasospasm in coronary and cerebral arteries.
– shortening.
– N/V
– In normally functioning hearts calcium will produce
positive inotropic
– and vasoconstrictive effects and increase systemic – Hypercalcemia
arterial blood – Digitalis toxicity
– pressure. – VF during resuscitation
– In abnormally functioning hearts calcium will produce • Nursing Management
positive – Have patient remain recumbent for a short time after IV injection.
– inotropic effects may increase or decrease systemic – Administer into ventricular cavity during cardiac resuscitation not in the
vascular myocardium
– resistance. – Teach the patient to report loss of appetite, nausea, vomiting,
– It also appears to increase ventricular automaticity. abdominal pain, constipation, dry mouth, thirst, increased voiding.
• Dextrose 50% (500mL) • Contraindications

• Classification
– Intravenous & Other Sterile Solutions
– Intracranial hemorrhage
• Indication – Increased intracranial pressure
– Hypoglycemia • Nursing Measures:
– Coma/seizure of unknown etiology
•
– Monitor infusion rate frequently; if
Action:
– A simple water soluble sugar that minimizes signs of fluid overload, turn off IV
glyconeogenesis and promotes anabolism in drip. Infusion may result in fluid
patients whose oral caloric intake is limited overload.
• Adverse Reactions
– Local pain, vein irritation, thrombophlebitis &
– Check IV site frequently and if
tissue necrosis in the event of extravasations. infiltration is noted, turn off IV drip.
– Fluid & electrolyte imbalance (eg hypokalemia, – Watch out for signs of fluid overload
hypomagnesemia & hypophosphatemia); edema
or water intoxication (distended neck veins (JVD), rapid
respirations, shallow tidal volume,
fine auscultator crackles, dyspnea,
and peripheral edema)
– Watch out for signs of infiltration
(swelling and pain around IV site).
• Norepinephrine (Levophed) (1mg/mL) • Side Effects

• Classification – CNS: Headache, anxiety, dizziness, cerebral
– Sympathomimetic hemorrhage
– Adrenergic – CV: tachycardia, hypertension
• Action – GI: Nausea, vomiting
– Cause increase contractility and heart – GU: decrease urine output
rate by acting on beta receptor in heart; – RESP: Dyspnea
also acts on alpha receptor causing – SYST: Anaphylaxis
vasoconstriction in blood vessel. • Contraindications
• Indication – Hypotensive patient with hypovolemia
– Cardiogenic shock • Nursing Management
– Neurogenic shock – ECG during administration continuously
– Inotropic support – Monitor BP and pulse q 2-3 minutes after
– Hemodinamically significant hypotension parenteral route
refractory to other sympathetic nerves – I/O ratio
• Dopamine (Intropin) • Contraindications

• 400mgs/VIAL – Hypersensitivity
• 200 mg/10mL – With uncorrected tachyarrhythmia’s
• Classification – Pheochromocytoma
– Adrenergic drugs – Ventricular Fibrillation
• Action • Nursing Management
– Stimulates dopaminergic and alpha and – Most patients received less than 20 mcg/kg/min
beta receptors of the sympathetic nervous – Drugs isn’t substitute for blood or fluid volume
system resulting in positive inotropic effect deficit
and increased CO – During infusion, monitor ECG, BP, CO, PR and
• Indication color and temp of the limbs
– To treat shock and correct hemodynamic – Do not confuse dopamine to dobutamine
imbalances – Check urine output often
– To correct hypotension
– To improve perfusion of vital organs
– To increase CO
• Side Effects
– CNS: headache an anxiety
– CV: tachycardia, angina, palpitations and
vasoconstriction
– GI: nausea and vomiting
• Dobutamine (Dobutrex) • Nursing Management

• 250 mgs/20 mL – Before starting therapy, give a plasma volume
• 250mgs/VIAL expander to correct hypovolemia and a cardiac
• Classification glycoside
– Adrenergic drugs – Monitor ECG, BP, pulmonary artery wedge
pressure and CO
• Action
– Monitor electrolyte levels
– Stimulates heart beta receptors to increase
myocardial contractility and SV – Don’t confuse dobutamine to dopamine
• Indication
– To increase CO
– Treatment of cardiac decomposition
• Side Effects
– CNS: headache
– CV: HPN, tachycardia, palpitations and
vasoconstriction
– GI: nausea and vomiting
– Hypersensitivity
– Use cautiously in patients with history of HPN and
AMI
• Isoprotenerol (Isuprel) 0.2mg/mL

• Classification • Contraindications
– Sympathomimetic
• Action
– VF/VT
– Stimulates beta1- and beta2-receptors resulting in relaxation of
bronchial, GI, and uterine smooth muscle, increased heart rate
– Hypotension
–
and contractility, vasodilation of peripheral vasculature
• Indication Ischemia Heart Disease
– Hemodinamically significant bradycardia refractive to other
therapy. – Cardiac arrest
• Side Effects
– Cardiovascular: Angina, flushing, hyper-/hypotension, pallor, • Nursing Management
palpitation, paradoxical bradycardia (with tilt table testing),
premature ventricular beats, Stokes-Adams attacks,
tachyarrhythmia, ventricular arrhythmia
– Monitor ECG, heart rate,
– Central nervous system: Dizziness, headache, nervousness, respiratory rate, arterial
restlessness, Stokes-Adams seizure
– Endocrine & metabolic: Hypokalemia, serum glucose increased blood gas, arterial blood
– Gastrointestinal: Nausea, vomiting
– Neuromuscular & skeletal: Tremor, weakness pressure, CVP; serum
– Ocular: Blurred vision
– Respiratory: Dyspnea, pulmonary edema
glucose, serum potassium,
– Miscellaneous: Diaphoresis serum magnesium
• Amrinone (Inocar) • Side effects/ Adverse effect

• Classification – CNS: Malaise, fatigue, dizziness, tremors, ataxia, paresthesias, lack of
– coordination
Calcium Channel Blockers
– CV: Cardiac arrhythmias, CHF, cardiac arrest, hypotension
– Cardiotonic Agents
– EENT: Corneal microdeposits (photophobia, dry eyes, halos, blurred
– Phosphodiesterase Inhibitor vision); ophthalmic abnormalities including permanent blindness
– Vasodilator Agents – Endocrine: Hypothyroidism or hyperthyroidism
• Action – GI: Nausea, vomiting, anorexia, constipation, abnormal liver function
– Increases cardiac contractility, vasodilator. Acts by tests, liver toxicity
inhibiting the breakdown of both cAMP and cGMP by the – Respiratory: Pulmonary toxicity—pneumonitis, infiltrates (shortness of
phosphodiesterase (PDE3) enzyme breath, cough, rales, wheezes)
– Other: Photosensitivity, angioedema
• Indications
– Contraindications
– Only for treatment of the following documented life- – Patients with history of hypersensitivity to the drug
threatening recurrent ventricular arrhythmias that do not
respond to other antiarrhythmics or when alternative
agents are not tolerated: Recurrent ventricular – Monitor cardiac rhythm continuously.
fibrillation, recurrent hemodynamically unstable – Monitor for an extended period when dosage adjustments are made.
ventricular tachycardia. Serious and even fatal toxicity has – Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).
been reported with this drug; use alternative agents first; – Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may
very closely monitor patient receiving this drug. need to be reduced one-third to one-half when amiodarone is started.
– Give drug with meals to decrease GI problems.
– Unlabeled uses: Treatment of refractory sustained or
– Arrange for ophthalmologic exams; reevaluate at any sign of optic
paroxysmal atrial fibrillation and paroxysmal
neuropathy.
supraventricular tachycardia; treatment of symptomatic
– Arrange for periodic chest x-ray to evaluate pulmonary status (every 3–6
atrial flutter. mo).
– Arrange for regular periodic blood tests for liver enzymes, thyroid
hormone levels.
• Nytroglycerin (Tridil) • Contraindications

• 50mg/ VIAL
• 250 mgs/ 10 mL
– Contraindicated in patients hypersensitive to nitrates
• Classification – With early MI. (S.L. form), severe anemia, increase ICP angle-
– Antianginal closure glaucoma, IV nitroglycerine is contraindicated in
– Nitrate patients with hypovolemia, hypotension, orthostatic
– Vasodilator hypotension, cardiac tamponade restrictive cardiomyopathy,
– Coronary constrictive pericarditis.
• Action • Nursing Interventions
– Relaxes the vascular smooth system
– Record characteristics and precipitating factors of anginal pain.
– Reduces myocardial oxygen consumption
– Reduces left ventricular workload
– Monitor BP and apical pulse before administration and
– Reduces arterial BP periodically after dose.
– Reduces venous return – Have client sit or lie down if taking drug for the first time.
• Indication – Client must have continuing EKG monitoring for IV
– Angina pectoris administration
– CHF associated with AMI – Cardioverter/ defibrillator must not be discharged through
– Cardiac load reducing agent paddle electrode overlying
– Hypertensive Crisis
– Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with
• Side effects
ambulating if dizzy.
– CNS: headache, throbbing, dizziness, weakness.
– GI: nausea, vomiting
– Instruct to take at first sign of anginal pain.
– Skin: Rash – May be repeated q 5 minutes to max. of 3 doses.
• Adverse Reactions – If the client doesn’t experience relief, advise to seek medical
– CV: orthostatic hypotension, flushing, fainting. assistance immediately.
– EENT: sublingual burning. – Keep in a dark colored container
– Skin: Cutaneous vasodilation, contact dermatitis (patch)
• Calcium Gluconate • Nursing Measures:

• Classification:
– Make sure prescriber specifies form of calcium
– Electrolytes
to be given; crash carts may contain both
• Indication/Dosage:
calcium gluconate and calcium chloride.
– PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic tetany
2.25 mmol via slow injection, then 58-77mL of 10% soln – Tell patient to take oral calcium 1 to 11/2
diluted and administered as a continuous IV infusion. hours after meals if GI upset occurs.
Antidote in severe hypermagnesaemia; Severe hyperkalemia
– Give I.M. injection in gluteus region in adults
10mL of 10% solution, repeat every 10 minutes if needed.
• Action: and in lateral thigh in infants. Use I.M. route
– replaces Calcium and maintains Calcium level only in emergencies when no I.V. route is
• Adverse Reactions: available because of irritation of tissue by
– GI irritation; soft-tissue calcification, skin sloughing or calcium salts.
necrosis after IM/SC inj. Hypercalcaemia characterized by – Tell patient to take oral calcium with a full
anorexia, nausea, vomiting, constipation, abdominal pain,
glass of water.
muscle weakness, mental disturbances, polydipsia, polyuria,
nephrocalcinosis, renal calculi; chalky taste, hot flushes and – Monitor calcium levels frequently.
peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias Hypercalcemia may result after large doses in
and coma.
chronic renal failure. Report abnormalities.
• Amiodarone • Nursing Measures:

• Classification: –Monitor cardiac rhythm continuously.
–Cardiac Drugs –Monitor for an extended period when dosage adjustments are made.
• Indication: –Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).
–Ventricular and supraventricular arrhythmias. –Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need
to be reduced one-third to one-half when amiodarone is started.
• Action:
–Give drug with meals to decrease GI problems.
–Blocks potassium chloride leading to prolongation of action
–Arrange for ophthalmologic exams; reevaluate at any sign of optic
potential duration.
neuropathy.
• Adverse Reactions:
–Arrange for regular periodic blood tests for liver enzymes, thyroid hormone
–Blue-grey discoloration of skin, photosensitivity, peripheral levels.
neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea, –Drug dosage will be changed in relation to response of arrhythmias; you will
vomiting, metallic taste, hypothyroidism, hyperthyroidism, need to be hospitalized during initiation of drug therapy; you will be closely
alopecia, sleep disturbances, corneal microdeposits, hot monitored when dosage is changed.
flushes, sweating. Heart block, bradycardia, sinus arrest, –Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray,
hepatoxicity, heart failure. Potentially Fatal: Pulmonary eye exam, blood tests.
toxicity including pulmonary fibrosis and interstitial –These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to
pneumonitis, hepatoxicity, thyrotoxicity. Ventricular light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of
arrhythmias, pulmonary alveolitis, exacerbation of appetite (take with meals; eat small, frequent meals); sensitivity to the sun
arrhythmias and rare serious liver injury. Generally in patients (use a sunscreen or protective clothing when outdoors); constipation (a
with high doses and having preexisting abnormalities of laxative may be ordered); tremors, twitching, dizziness, loss of coordination
diffusion capacity. (do not drive, operate dangerous machinery, or undertake tasks that require
coordination until drug effects stabilize and your body adjusts to it).
• Vasopressin
• Classification: • Indications
– Antidiuretic – Adjunct in the treatment of GI hemorrhage and esophageal
• Action varices; pulseless arrest (ventricular tachycardia
– Increases cyclic adenosine monophosphate (cAMP) [VT]/ventricular fibrillation [VF], asystole/pulseless electrical
which increases water permeability at the renal tubule activity [PEA]); vasodilatory shock ; donor management in
resulting in decreased urine volume and increased brain-dead patients .
osmolality; causes peristalsis by directly stimulating • Contraindications
the smooth muscle in the GI tract; direct
– Hypersensitivity to vasopressin or any component of the
vasoconstrictor without inotropic or chronotropic
formulation
effects
• Adverse Reactions • Nursing consideration
– Cardiovascular: Arrhythmia, asystole (>0.04 – Evaluate patient history closely for use cautions.
units/minute), blood pressure increased, cardiac – Assess potential for interactions with other pharmacological
output decreased (>0.04 units/minute), chest pain, agents patient may be taking (eg, concurrent use that will
MI, vasoconstriction (with higher doses), venous block or enhance antidiuretic response).
thrombosis – Note: Dosing and administration vary according to purpose
– Central nervous system: Pounding in head, fever, for use. I.V. requires use of infusion pump and close
vertigo monitoring to prevent extravasation (may cause severe
– Dermatologic: Ischemic skin lesions, circumoral pallor, necrosis and gangrene).
urticaria – Assess results of laboratory tests, therapeutic effectiveness,
– Gastrointestinal: Abdominal cramps, flatulence, and adverse response (eg, cardiac status, blood pressure, CNS
mesenteric ischemia, nausea, vomiting status, fluid balance, signs or symptoms of water intoxication,
– Genitourinary: Uterine contraction intranasal irritation) on a regular basis during therapy.
– Neuromuscular & skeletal: Tremor – Teach patient possible side effects/appropriate interventions
and adverse symptoms to report.
– Respiratory: Bronchial constriction
Crash Cart
*** It’s important to ensure that unless

is being used, this cart need to have a
security seal.
Equipment on top of
the crash cart
• Portable monitor/defibrillator
• AMBU-SPUR
• Laryngoscope set
• Adult Pro-pads radiolucent electrodes
• Pacer cable
• Drip stand
• 2 - #11 blade
• Laryngoscope
Adult laryngoscope with blade
Pediatric laryngoscope with blade
Equipment basket on
top of the crash cart
• 5- tongue depressor
• 2 – Sterile gauze
• 2 – Berman Airways
• 2- Sterilization Pouch
• 2 – Septra 360 Electro Gel
• 1- Intubation Stylet
• 5 – Endotracheal tubes holder with releasable
cable tie.
• 1 – Nasal Cannula tube
• 1 – Medical Recording Chart
Equipment on side
of the crash cart
• Oxygen:
• Pressure reducing valve
• Pressure gauge
• Nipple adaptor
• Oxygen tubing connected to the flow
meter
• 5 package - EKG Conductive Adhesive
Equipment on side
of the crash cart
• Endotracheal tubes
• Adult: 6.5, 7, 7.5, 8
1 Drawer on top of the crash cart
st
Equipment on Crash Cart
1st Drawer – Medications
• Epinephrine 1:10,000, (0.1 mg/mL)
 5 IV JECT
• Dextrose 50 %
 2 IV JECT
• Vasopressin 20 units/AMP
 4 VIALS
• Atropine Sulfate 0.4 mg/ Ml
 1 IV JECT
• Calcium Gluconate 10 %
 5 VIALS
• Dopamine
 200 mg/10 Ml - 5 VIALS
• Adenosine 6mg/2mL
 2 IV JECT
• Dobutamine
 250 mgs/20 mL - 3 VIALS
• Verapamil 5mg/ 2mL
 2 AMP
2 Drawer
nd
2nd Drawer - IV & Blood Draw Supply
• 15 - Angiocath Needles
 Sizes:
 18G
 20G
 22G
 1 and 1.5 in
• 6 - Butterflies
 Sizes:
 18G
 20G
 22G
• 10 – Vacutainers
• 6 - non sterile glove
• 4 – Sterile Gauze 10 x 10
• 20 – Syringes:
 3mL
 5mL
 10mL
 20mL
• Lab specimen tube
• Alcohol
• 4 – Tourniquet
Needles and Syringes
3rd Drawer
Medications
3rd Drawer - Medications
• Dextrose 50 %
 4 IV JECT
• Vasopressin 20 units/AMP
 2 AMPS
• Sodium Bicarbonate 8.4 % 50 mEq
 10 IV JECT
• Sodium Bicarbonate Pediatric 4.2 % 50 mEq
 5 IV JECT
• Lidocaine (Xylocaine)
 100 mg Bolus - 5 IV JECT
 1 GM – 3 VIAL
• Epinephrine 1:10,000, (0.1 mg/mL)
 15 IV JECT
• Adenosine 6mg/2mL
 5 VIALS
• Calcium Chloride10%
 3 IV JECT
• Calcium Gluconate 10 %
 5 VIALS
• Diltiazem, refrigerated
 50 mg - 4 VIALS
 50 mg/ 10mL – 6 VIALS
• Amioradone HCL 150 mg/ 3mL
 3 AMP
3rd Drawer – Medications
• Atropine Sulfate 0.4 mg/mL
 10 AMP
 10 VIALS
• Verapamil 5mg/ 2mL
 5 VIALS
 3 AMP
• Magnesium Sulfate 50%
 4 IV JECT
• Norepinephrine Bitartrate 1mg/ml
 3 AMP
• Dobutamine
 250 mgs/ VIAL – 5 VIALS
• Dopamine
 200 mg/10 Ml - 4 VIALS
 400mgs/VIAL – 5 VIALS
• Nitroglycerine
 250mgs/ 10 Ml – 2 VIALS
 50 mg/ VIAL – 2 VIALS
• Bretylium 500 mg/ 10mL
 5 AMP
• Isoproterenol 0.2 mgmL
 5 AMP
• Pronestyl 1GM
 2 VIALS
4th Drawer
IV Solutions and Tubing
4th Drawer – IV solutions and Tubing
• 2 - IV care set
• 2 - Micro-drip IV tubing
• 2 - Macro-drip IV tubing
• 2 - Secondary line IV tubing
• 2 – Nitroglycerine IV set
• 4 – 0.45 SS/50mL
• 2 – D/W 250mL
• 2 – D/W 500mL
• 1 - N/S 9% 500mL
• 1 - 0.45 SS/500mL
• D/W 250mL Glass Bottle
5 Drawer
th
5th Drawer – Miscellaneous
• 2- 0.9% Sodium Chloride Irrigation
• 2- Irrigation Tray
• 1- Adult Ambu bag with O2 connection
• 1- Pediatric Ambu bag with O2 connection
• 1 – Nasal cannula
• 1- Sterile Water
• 3 – Suction tubing
• 1 – Suction tubing tip
• 2 – Sterile Gloves
• 2 - Surgical gown
• 2 – Restraints
• 2 – Double lumen Catheters
• Endotracheal tubes:
 Adult: 6.5, 7, 7.5, 8
 Pediatrics:
 2.0 ET tubes without cuff
Other equipment
Oxygen and EKG machine
• On the side… • At the top…

Hospital "Crash Cart" - MICU: Yatska Cartagena Juan Morales

Uploaded by

Copyright:

Available Formats

Hospital "Crash Cart" - MICU: Yatska Cartagena Juan Morales

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Hospital "Crash Cart" - MICU: Yatska Cartagena Juan Morales

Uploaded by

Copyright:

Available Formats

Hospital

“Crash Cart” - MICU

First Line drugs Antiarrhythmic Agents

Miscellaneous Second Line Drugs

Vasodilators/ Antihypertensive Anti-diuretic

• Epinephrine (1:10000) • Contraindications

• Atropine Sulfate (4mg/mL) • Contraindications

• Lidocaine (Xylocaine) • Contraindications

• Procainamide (Pronestyl) • Contraindications

• Bretylium (Breytol) (500mg/10mL) • Contraindications

• Verapamil (Calan, Isoptin) (5mg/2mL)

• Diltiazem (Cardizem) (50mg/10mL)

• Adenosine (Adenocard) (6mg/2mL) • Contraindication

• Magnesium sulfate (50%(500mg/mL)) • Adverse Reactions

• Sodium Bicarbonate • Contraindications

• Calcium Chloride (10% 100mg/mL) • Adverse effect

• Dextrose 50% (500mL) • Contraindications

• Norepinephrine (Levophed) (1mg/mL) • Side Effects

• Dopamine (Intropin) • Contraindications

• Dobutamine (Dobutrex) • Nursing Management

• Isoprotenerol (Isuprel) 0.2mg/mL

• Amrinone (Inocar) • Side effects/ Adverse effect

• Nytroglycerin (Tridil) • Contraindications

• Calcium Gluconate • Nursing Measures:

• Amiodarone • Nursing Measures:

*** It’s important to ensure that unless

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.