crash cart.pptxvv

7/29/2019 Crash Cart.pptxvv

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HospitalCrash Cart - MICU

Yatska CartagenaJuan Morales


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Objectives

After this presentation the studentswill 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


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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.


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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.


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Classification

Action

Indication

Contraindication

Side effect

Nursing Consideration


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Medications included in the Crash Cart

First Line drugs

Oxygen

Epinephrine

Atropine Sulfate

Antiarrhythmic Agents

Lidocaine (Xylocaine)

Procainamide (Ponestyl)

Bretylium (Bretylol)

Verapamil (Calan) Diltiazem (Cardizem)

Adenosine (Adenocard)

Aminoradone (Cordaron)


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Miscellaneous

Magnesium Sulfate

Sodium Bicarbonate

Calcium Chloride

Calcium Gluconate Dextrose 50%

Second Line Drugs

Norepinephrine (Levophed)

Dopamine (Intropin)

Dobutamine (Dobutrex)

Isoprotenerol (Isuprel)


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Vasodilators/ Antihypertensive

Nitroglycerine (Tridil)

Anti-diuretic

Vasopressin


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Medication Classification, Mechanism of action, uses,

contraindication, side effects and nursing considerations

Epinephrine (1:10000)

Classification

Beta2 Adrenergic Agonists

Action

Stimulates beta receptors in lung.

Relaxes bronchial smooth muscle.

Increases vital capacity

Increases BP, HR, PR

Decreases airway resistance.

Indication

Asthma

Bronchitis

Emphysema

All cardiac arrest, anaphylaxis

Used for symptomatic bradycardia.

Relief of bronchospasm occurring during anesthesia

Exercised-induced bronchospasm

Side Effects/Adverse Reactions

nervousness, tremor, vertigo, pain, widened pulse

pressure, hypertension, nausea

headache

Contraindications With angle-closure glaucoma, shock (other than

anaphylactic shock), organic brain damage, cardiacdilation, arrhythmias, coronary insufficiency, orcerebral arteriosclerosis. Also contraindicated inpatient receiving general anesthesia with halogenatedhydrocarbons or cyclopropane and in patients in labor(may delay second stage)

In conjunction with local anesthesia, epinephrine iscontraindicated for use in finger, toes, ears, nose, andgenitalia.

In pregnant woman, drug is contraindicated.

In breast feeding do not use the drug or stop breastfeeding.

Nursing Management Monitor V/S. and check for cardiac dysrrhythmias

Drug increases rigidity and tremor in patients withParkinsons disease

Epinephrine therapy interferes with tests for urinarycatecholamine

Avoid IM use of parenteral suspension into buttocks.Gas gangrene may occur

Massage site after IM injection to counteract possiblevasoconstriction.

Observe patient closely for adverse reactions. Notifydoctor if adverse reaction develop

If blood pressure increases sharply, rapid-actingvasodilators such as nitrates or alpha blockers can begiven to counteract


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Atropine Sulfate (4mg/mL)

Classification Anticholinergic

Indication Pre-op meds/pre-anesthetic meds

To restore cardiac rate and arterial pressure duringanesthesia when vagal

To lessen the degree of A-V heart block

To overcome severe carotid sinus reflex

Antidote for cholinergic toxicity

Side effects CNS: restlessness, ataxia, disorientation,

hallucinations, delirium, coma, insomnia, agitation,confusion.

CV: tachycardia, angina, arrhythmias, flushing.

EENT: photophobia, blurred vision, mydriasis.

GI: dry mouth, constipation, vomiting.

GU: urine retention.

Hematologic: leukocytosis

Other: anaphylaxis

Adverse effects CNS: headache, excitement.

CV: palpitations

GI: thirst, nausea

Contraindications

Hypersensitivity

With acute angle closure glaucoma, obstructive

uropathy, obstructive disease of GI tract, paralytic

ileus, toxic megacolon, intestinal atony, unstable CV

status in acute hemorrhage, asthma, or myasthenia

gravis.

Pregnant women.

Nursing Management

Monitor VS.

Report increase HR

Monitor for constipation, oliguria.

Instruct to take 30 minutes before meals

Eat foods high in fiber and drink plenty fluids.

Can cause photophobia

Instruct client not to drive a motor vehicle or

participate in activities requiring alertness. Advise to use hard candy, ice chips, etc. for dry mouth.


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Lidocaine (Xylocaine) 100 mg bolus

1 gm

Classification CV drugs: Antiarrhythmics

Anesthetic

Action Increases electrical stimulation of ventricle and His-

Purkinje system by direct action on tissues, resulting to

decrease depolarization, automaticity and excitabilityin ventricles during diastolic phase

Indication Anesthesia

Arrhythmias

Control of Status Epilepticus refractory to othertreatments

Side Effects and Adverse Reactions GI disturbances, bradycardia, hypotension, convulsion,

numbness of tongue, muscle twitching, restlessness,

nervousness, dizziness, tinnitus, blurred vision, fetalintoxication, light headedness, drowsiness,apprehension, euphoria, vomiting, sensation of heat,respiratory arrest and CV collapse

Contraindications Hypersensitivity

Heart block

Hypovolemia

Adams stroke syndromes

Infection at site of injection

Nursing Management Assess pt before and after therapy

Pts infusion must be on cardiac monitor

Monitor ECG, if QT or QRS increases by 50% or more,withhold the drug

Monitor BP, check for rebound HPN after 1-2 hrs

Assess respiratory status, oxygenation and pulsedeficits

Assess renal and liver function

Monitor CNS symptoms

Monitor blood levels


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Bretylium (Breytol) (500mg/10mL)

Classification

Antidysrhythmic

Action

Bretylol produces a prompt increase in ventricularfibrillation threshold, perhaps through postganglionicadrenergic blockade. It causes an initial release ofnorepinephrine from postganglionic nerve terminals.At present, its use is reserved for patients who fail torespond to lidocaine or other first-line

antidysrhythmics. Indication

Indicated in the prophylaxis and therapy of ventricularfibrillation.

Indicated in the treatment of life-threateningventricular arrhythmias.

Side effect/ Adverse effect

Hypotension Hypotension and postural hypotension

Nausea and vomiting

Vertigo, dizziness, light-headedness and syncope

Bradycardia, increased frequency of prematureventricular contractions, transitory hypertension,initial increase in arrhythmias, precipitation of anginalattacks, and sensation of substernal pressure.

Renal dysfunction, diarrhea, abdominal pain, hiccups,erythematous macular rash, flushing, hyperthermia,confusion, paranoid psychosis, emotional liability,lethargy, generalized tenderness, anxiety, shortness ofbreath, diaphoresis, nasal stuffiness and mildconjunctivitis.

Hyperthermia

Contraindications

There are no contraindications to use in treatment ofventricular fibrillation or life-threatening refractoryventricular arrhythmias.

Nursing Management

Assess and notify the doctor if the patient's medicalhistory include: any allergies, kidney disease, heartdisease, blocked blood vessels (aortic stenosis), lungproblems (pulmonary hypertension) because themedication is contraindicated with this conditions

To avoid dizziness and lightheadedness, the patientshould remain lying down or, if necessary, get upslowly when rising from a seated or lying position.

This medication should be avoid during pregnancyunless is clearly needed.


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

Classification

Anti-anginal

Anti-arrhythmics

Anti-hypertensive

Vascular headache suppressants

Action

Inhibits calcium transport into myocardial smoothmuscle cells

Decreases SA and AV conduction and prolongs AVnode refractory period in conduction tissue

Indication

Hypertension

Angina Pectoris

Supraventricular Arrhythmia

Atrial flutter/fibrillation

Side Effects and Adverse Reactions

CNS: abnormal dreams, anxiety, confusion,dizziness and headache

EENT: blurred vision, epistaxis and tinnitus

CV: arrhythmia, CHF, chest pain, bradycardia,hypotension and palpitations

GU: dysuria, nocturia and polyuria

GI: abnormal liver function, anorexia,constipation, diarrhea, nausea and vomiting

Contraindications

Hypersensitivity

Sick sinus syndrome

2nd or 3rd degree AV block

CHF

Cardiogenic shock

Concurrent IV beta-blocker

Nursing Management

Monitor BP and pulse before therapy, duringtitration and therapy

Monitor ECG, I&O, serum potassium and weight.

Assess for CHF


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Diltiazem (Cardizem) (50mg/10mL)

Classification

Anti-anginals

Antiarrhythmics

Antihypertensive

Ca channel blocker

Action

Inhibits calcium transport into myocardial smoothmuscle cells

Systemic and coronary vasodilation

Indication

Hypertension

Angina Pectoris

Supraventricular Arrhythmia

Atrial flutter/fibrillation

Side Effects and Adverse and Reactions

CNS: abnormal dreams, anxiety, confusion,dizziness and headache

EENT: blurred vision, epistaxis and tinnitus

CV: arrhythmia, CHF, chest pain, bradycardia,hypotension and palpitations

GU: dysuria, nocturia and polyuria

GI: abnormal liver function, anorexia,constipation, diarrhea, nausea and vomiting

Contraindications

Hypersensitivity

Sick sinus syndrome

2nd or 3rd degree AV block

CHF

Cardiogenic shock

Concurrent IV beta-blocker

Nursing Management

Monitor BP and pulse before therapy, duringtitration and therapy

Monitor I&O and weight

Assess for CHF

Routine serum Digoxin monitoring


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Adenosine (Adenocard) (6mg/2mL)

Classification

Nucleoside

Indication

To convert paroxysmalsupraventicular tachycardia (PSVT) tosinus rhythm

Action

A naturally occurring nucleoside that

acts on the AV node to slowconduction and inhibit reentrypathways. Also useful in treatingPSVTs, including those with accessorybypass tracts (Wolff-Parkinson-Whitesyndrome)

Adverse Reaction

CNS: dizziness, lightheadedness,numbness, tingling in arms,headache.

CV: facial flushing.

GI: nausea.

Respiratory: dyspnea, shortness ofbreath, chest pressure.

Contraindication Contraindicated in patients hypersensitivity

to drugs.

Contraindicated in those with second orthird-degree heart block or sinus nodedisease (such as sick sinus syndrome andsymptomatic bradycardia), except thosewith a peacemaker.

Use cautiously in patients with asthma,emphysema, or bronchitis becausebronchoconstriction may occur.

Nursing Management ALERT: by decreasing conduction through

the AV node, drug may produce first-,second-or third-degree heart block.Patients who develop high-level heart blockafter a single dose shouldnt receiveadditional doses.

ALERT: new arrhythmias, including heartblock and transient asystole, may develop;monitor cardiac rhythm and treat asindicated.

If solution is cold, crystals may form; gentlywarm solution to room temperature. Dontuse solutions that arent clear.

Drug lacks preservatives. Discard unusedportion.
http://www.buyemp.com/tmp_image.php?item_id=11229435


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Magnesium sulfate (50%(500mg/mL))

Classification

Anticonvulsant

Indication

Treatment of hypomagnesaemia accompanied bysigns of tetany

Control of HTN

Encephalopathy & convulsions

Prevention & control of convulsions in patients w/preeclampsia or eclampsia

Prevention of hypomagnesaemia in patients receivingTPN

Action

May decrease acetylcholine released by nerveimpulses, but its anticonvulsant mechanism isunknown

Adverse Reactions

flushing, sweating, hypotension, muscularweakness, sedation & confusion

decreased deep tendon reflexes

resp. paralysis

Contraindications

Heart block or myocardial damage

Nursing Management

Monitor the following: I.V.: Rapid administration:ECG monitoring, vital signs, deep tendon reflexes;magnesium, calcium, and potassium levels; renalfunction during administration.

Obstetrics: Patient status including vital signs,oxygen saturation, deep tendon reflexes, level ofconsciousness, fetal heart rate, maternal uterineactivity.

Oral: Renal function; magnesium levels; bowelmovements.


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Sodium Bicarbonate

8.4% 50mEq/50mL

Pediatric 4.2% 50 mEql

Classification

Alkalinizers

Indication

Metabolic acidosis

Systemic or urinary alkalinization

Antacid

Cardiac arrest

Action

Restores buffering capacity of the body and

neutralizes excess acid

Adverse Reaction

Tetany, edema, gastric distention, belching,

flatulence, hypokalemia, metabolic alkalosis,

hypernatremia, chemical cellulites because of

alkalinity, pain, irritation, tissue necrosis,

ulceration or sloughing at the site of

infiltration

Contraindications

Contraindicated in patients with metabolic or

respiratory alkalosis;

Patients who are losing chlorides from vomiting or

continuous GI suction;

Patients taking diuretics known to produce

hypochloremia alkalosis; and

Patients with hypocalcemia in which alkalosis may

produce tetany, hypertension, seizures, or heart

failure.

Oral sodium bicarbonate is contraindicated in patients

with acute ingestion of strong mineral acids.

Nursing Management

Do not take drug with milk to avoid hypercalcemia,

abnormally high alkalinity in tissues and fluids, orkidney stones.

Do not give to patients with metabolic or respiratory

alkalosis, and in those with hypocalcemia in which

alkalosis may produce tetany, hypertension, seizures,

or heart failure.

Monitor for alkalosis by obtaining blood pH, PaO2,

PCO2, and electrolyte levels


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Calcium Chloride (10% 100mg/mL)

Classification

Electrolytes

Indication

Hyperkalemia

Hypocalcemia

Hypermagnesia

Action

Increase the force of cardiac contractility, byinitiating myofibril

shortening.

In normally functioning hearts calcium will

produce positive inotropic

and vasoconstrictive effects and increase

systemic arterial blood

pressure.

In abnormally functioning hearts calcium will

produce positive

inotropic effects may increase or decrease

systemic vascular

resistance.

It also appears to increase ventricular

automaticity.

Adverse effect

Metallic taste

Burning

Heat waves

Bradycardia (may cause asystole)

Hypotension

Peripheral vasodilatation

Cardiac arrhythmias

Increased digitalis toxicity

Extravasations with necrosis, sloughing and abscess

formation

Vasospasm in coronary and cerebral arteries.

N/V

Contraindications

Hypercalcemia

Digitalis toxicity

VF during resuscitation

Nursing Management Have patient remain recumbent for a short time after IV

injection.

Administer into ventricular cavity during cardiac

resuscitation not in the myocardium

Teach the patient to report loss of appetite, nausea,

vomiting, abdominal pain, constipation, dry mouth, thirst,

increased voiding.


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Dextrose 50% (500mL)

Classification

Intravenous & Other Sterile Solutions

Indication

Hypoglycemia

Coma/seizure of unknown etiology

Action:

A simple water soluble sugar that minimizesglyconeogenesis and promotes anabolism in

patients whose oral caloric intake is limited

Adverse Reactions

Local pain, vein irritation, thrombophlebitis &

tissue necrosis in the event of extravasations.

Fluid & electrolyte imbalance (eg hypokalemia,

hypomagnesemia & hypophosphatemia); edema

or water intoxication

Contraindications

Intracranial hemorrhage

Increased intracranial pressure

Nursing Measures:

Monitor infusion rate frequently; ifsigns of fluid overload, turn off IV

drip. Infusion may result in fluidoverload.

Check IV site frequently and ifinfiltration is noted, turn off IV drip.

Watch out for signs of fluid overload(distended neck veins (JVD), rapidrespirations, shallow tidal volume,

fine auscultator crackles, dyspnea,and peripheral edema)

Watch out for signs of infiltration(swelling and pain around IV site).


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Norepinephrine (Levophed) (1mg/mL)

Classification

Sympathomimetic

Adrenergic

Action

Cause increase contractility and heart

rate by acting on beta receptor in heart;

also acts on alpha receptor causingvasoconstriction in blood vessel.

Indication

Cardiogenic shock

Neurogenic shock

Inotropic support

Hemodinamically significant hypotension

refractory to other sympathetic nerves

Side Effects

CNS: Headache, anxiety, dizziness, cerebral

hemorrhage

CV: tachycardia, hypertension

GI: Nausea, vomiting

GU: decrease urine output

RESP: Dyspnea

SYST: Anaphylaxis Contraindications

Hypotensive patient with hypovolemia

Nursing Management

ECG during administration continuously

Monitor BP and pulse q 2-3 minutes after

parenteral route

I/O ratio


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Dopamine (Intropin)

400mgs/VIAL

200 mg/10mL

Classification

Adrenergic drugs

Action

Stimulates dopaminergic and alpha and

beta receptors of the sympathetic nervoussystem resulting in positive inotropic effect

and increased CO

Indication

To treat shock and correct hemodynamic

imbalances

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

Contraindications

Hypersensitivity

With uncorrected tachyarrhythmias

Pheochromocytoma

Ventricular Fibrillation

Nursing Management

Most patients received less than 20 mcg/kg/min

Drugs isnt substitute for blood or fluid volumedeficit

During infusion, monitor ECG, BP, CO, PR and

color and temp of the limbs

Do not confuse dopamine to dobutamine

Check urine output often


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Dobutamine (Dobutrex)

250 mgs/20 mL

250mgs/VIAL

Classification

Adrenergic drugs

Action

Stimulates heart beta receptors to increase

myocardial contractility and SV Indication

To increase CO

Treatment of cardiac decomposition

Side Effects

CNS: headache

CV: HPN, tachycardia, palpitations and

vasoconstriction

GI: nausea and vomiting

Contraindications

Hypersensitivity

Use cautiously in patients with history of HPN and

AMI

Nursing Management

Before starting therapy, give a plasma volume

expander to correct hypovolemia and a cardiac

glycoside

Monitor ECG, BP, pulmonary artery wedge

pressure and CO

Monitor electrolyte levels

Dont confuse dobutamine to dopamine


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Isoprotenerol (Isuprel)0.2mg/mL

Classification Sympathomimetic

Action Stimulates beta1- and beta2-receptors resulting in

relaxation of bronchial, GI, and uterine smoothmuscle, increased heart rate and contractility,vasodilation of peripheral vasculature

Indication

Hemodinamically significant bradycardia refractive toother therapy.

Side Effects Cardiovascular: Angina, flushing, hyper-/hypotension,

pallor, palpitation, paradoxical bradycardia (with tilttable testing), premature ventricular beats, Stokes-Adams attacks, tachyarrhythmia, ventriculararrhythmia

Central nervous system: Dizziness, headache,nervousness, restlessness, Stokes-Adams seizure

Endocrine & metabolic: Hypokalemia, serum glucose

increased Gastrointestinal: Nausea, vomiting

Neuromuscular & skeletal: Tremor, weakness

Ocular: Blurred vision

Respiratory: Dyspnea, pulmonary edema

Miscellaneous: Diaphoresis

Contraindications VF/VT

Hypotension

Ischemia Heart Disease

Cardiac arrest

Nursing Management Monitor ECG, heart rate, respiratory rate, arterial

blood gas, arterial blood pressure, CVP; serum glucose,serum potassium, serum magnesium


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Amrinone (Inocar)

Classification

Calcium Channel Blockers

Cardiotonic Agents

Phosphodiesterase Inhibitor

Vasodilator Agents

Action

Increases cardiac contractility, vasodilator. Acts by

inhibiting the breakdown of both cAMP and cGMP by thephosphodiesterase (PDE3) enzyme

Indications

Only for treatment of the following documented life-

threatening recurrent ventricular arrhythmias that do not

respond to other antiarrhythmics or when alternative

agents are not tolerated: Recurrent ventricular

fibrillation, recurrent hemodynamically unstable

ventricular tachycardia. Serious and even fatal toxicity

has been reported with this drug; use alternative agents

first; very closely monitor patient receiving this drug.

Unlabeled uses: Treatment of refractory sustained or

paroxysmal atrial fibrillation and paroxysmal

supraventricular tachycardia; treatment of symptomatic

atrial flutter.

Side effects/ Adverse effect CNS: Malaise, fatigue, dizziness, tremors, ataxia,

paresthesias, lack of coordination

CV: Cardiac arrhythmias, CHF, cardiac arrest, hypotension

EENT:Corneal microdeposits (photophobia, dry eyes, halos,blurred vision); ophthalmic abnormalities includingpermanent blindness

Endocrine:Hypothyroidism or hyperthyroidism

GI: Nausea, vomiting, anorexia, constipation, abnormal liverfunction tests,liver toxicity

Respiratory: Pulmonary toxicitypneumonitis, infiltrates

(shortness of breath, cough, rales, wheezes) Other: Photosensitivity, angioedema

Contraindications

Patients with history of hypersensitivity to the drug

Nursing Management Monitor cardiac rhythm continuously.

Monitor for an extended period when dosage adjustmentsare made.

Monitor for safe and effective serum levels (0.52.5mcg/mL).

Doses of digoxin, quinidine, procainamide, phenytoin, and

warfarin may need to be reduced one-third to one-halfwhen amiodarone is started.

Give drug with meals to decrease GI problems.

Arrange for ophthalmologic exams; reevaluate at any sign ofoptic neuropathy.

Arrange for periodic chest x-ray to evaluate pulmonarystatus (every 36 mo).

Arrange for regular periodic blood tests for liver enzymes,thyroid hormone levels.


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Nytroglycerin (Tridil) 50mg/ VIAL

250 mgs/ 10 mL

Classification Antianginal

Nitrate

Vasodilator

Coronary

Action Relaxes the vascular smooth system

Reduces myocardial oxygen consumption Reduces left ventricular workload

Reduces arterial BP

Reduces venous return

Indication Angina pectoris

CHF associated with AMI

Cardiac load reducing agent

Hypertensive Crisis

Side effects CNS: headache, throbbing, dizziness, weakness.

GI: nausea, vomiting

Skin: Rash

Adverse Reactions CV: orthostatic hypotension, flushing, fainting.

EENT: sublingual burning.

Skin: Cutaneous vasodilation, contact dermatitis(patch)

Contraindications Contraindicated in patients hypersensitive to nitrates

With early MI. (S.L. form), severe anemia, increase ICPangle-closure glaucoma, IV nitroglycerine is contraindicatedin patients with hypovolemia, hypotension, orthostatichypotension, cardiac tamponade restrictivecardiomyopathy, constrictive pericarditis.

Nursing Interventions Record characteristics and precipitating factors of anginal

pain.

Monitor BP and apical pulse before administration and

periodically after dose. Have client sit or lie down if taking drug for the first time.

Client must have continuing EKG monitoring for IVadministration

Cardioverter/ defibrillator must not be discharged throughpaddle electrode overlying

Nitro-Bid ointment or the Transderm-Nitro Patch. Assistwith ambulating if dizzy.

Instruct to take at first sign of anginal pain.

May be repeated q 5 minutes to max. of 3 doses.

If the client doesnt experience relief, advise to seek medicalassistance immediately.

Keep in a dark colored container


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Calcium Gluconate

Classification:

Electrolytes

Indication/Dosage:

PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic

tetany 2.25 mmol via slow injection, then 58-77mL of

10% soln diluted and administered as a continuous IV

infusion. Antidote in severe hypermagnesaemia;

Severe hyperkalemia 10mL of 10% solution, repeat

every 10 minutes if needed.

Action:

replaces Calcium and maintains Calcium level

Adverse Reactions:

GI irritation; soft-tissue calcification, skin sloughing or

necrosis after IM/SC inj. Hypercalcaemia characterized

by anorexia, nausea, vomiting, constipation,

abdominal pain, muscle weakness, mentaldisturbances, polydipsia, polyuria, nephrocalcinosis,

renal calculi; chalky taste, hot flushes and peripheral

vasodilation. Potentially Fatal: Cardiac arrhythmias

and coma.

Nursing Measures:

Make sure prescriber specifies form of calcium to be

given; crash carts may contain both calcium gluconate

and calcium chloride.

Tell patient to take oral calcium 1 to 11/2 hours after

meals if GI upset occurs.

Give I.M. injection in gluteus region in adults and in

lateral thigh in infants. Use I.M. route only in

emergencies when no I.V. route is available because ofirritation of tissue by calcium salts.

Tell patient to take oral calcium with a full glass of

water.

Monitor calcium levels frequently. Hypercalcemia may

result after large doses in chronic renal failure. Report

abnormalities.


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Amiodarone

Classification:

Cardiac Drugs

Indication:

Ventricular and supraventricular arrhythmias.

Action:

Blocks potassium chloride leading to

prolongation of action potential duration.

Adverse Reactions:

Blue-grey discoloration of skin,

photosensitivity, peripheral neuropathy,

paraesthesia, myopathy, ataxia, tremor,

nausea, vomiting, metallic taste,

hypothyroidism, hyperthyroidism, alopecia,

sleep disturbances, corneal microdeposits, hot

flushes, sweating. Heart block, bradycardia,

sinus arrest, hepatoxicity, heart failure.

Potentially Fatal: Pulmonary toxicity includingpulmonary fibrosis and interstitial

pneumonitis, hepatoxicity, thyrotoxicity.

Ventricular arrhythmias, pulmonary alveolitis,

exacerbation of arrhythmias and rare serious

liver injury. Generally in patients with high

doses and having preexisting abnormalities of

diffusion capacity.

Nursing Measures:

Monitor cardiac rhythm continuously.

Monitor for an extended period when dosage adjustments are

made.

Monitor for safe and effective serum levels (0.52.5 mcg/mL).

Doses of digoxin, quinidine, procainamide, phenytoin, and

warfarin may need to be reduced one-third to one-half when

amiodarone is started.

Give drug with meals to decrease GI problems.

Arrange for ophthalmologic exams; reevaluate at any sign ofoptic neuropathy.

Arrange for regular periodic blood tests for liver enzymes,

thyroid hormone levels.

Drug dosage will be changed in relation to response of

arrhythmias; you will need to be hospitalized during initiation

of drug therapy; you will be closely monitored when dosage is

changed.

Have regular medical follow-up, monitoring of cardiac rhythm,

chest x-ray, eye exam, blood tests.

These side effects may occur: Changes in vision (halos, dry

eyes, sensitivity to light; wear sunglasses, monitor light

exposure); nausea, vomiting, loss of appetite (take with meals;

eat small, frequent meals); sensitivity to the sun (use a

sunscreen or protective clothing when outdoors); constipation

(a laxative may be ordered); tremors, twitching, dizziness, loss

of coordination (do not drive, operate dangerous machinery,

or undertake tasks that require coordination until drug effects

stabilize and your body adjusts to it).


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Vasopressin

Classification:

Antidiuretic

Action

Increases cyclic adenosine monophosphate (cAMP)

which increases water permeability at the renal tubule

resulting in decreased urine volume and increased

osmolality; causes peristalsis by directly stimulating

the smooth muscle in the GI tract; direct

vasoconstrictor without inotropic or chronotropic

effects

Adverse Reactions

Cardiovascular: Arrhythmia, asystole (>0.04

units/minute), blood pressure increased, cardiac

output decreased (>0.04 units/minute), chest pain, MI,

vasoconstriction (with higher doses), venous

thrombosis

Central nervous system: Pounding in head, fever,

vertigo

Dermatologic: Ischemic skin lesions, circumoral pallor,

urticaria

Gastrointestinal: Abdominal cramps, flatulence,

mesenteric ischemia, nausea, vomiting

Genitourinary: Uterine contraction

Neuromuscular & skeletal: Tremor

Respiratory: Bronchial constriction

Indications Adjunct in the treatment of GI hemorrhage and

esophageal varices; pulseless arrest (ventriculartachycardia [VT]/ventricular fibrillation [VF],asystole/pulseless electrical activity [PEA]);vasodilatory shock ; donor management in brain-deadpatients .

Contraindications Hypersensitivity to vasopressin or any component of

the formulation

Nursing consideration

Evaluate patient history closely for use cautions.

Assess potential for interactions with otherpharmacological agents patient may be taking (eg,concurrent use that will block or enhance antidiureticresponse).

Note: Dosing and administration vary according topurpose for use. I.V. requires use of infusion pump andclose monitoring to prevent extravasation (may causesevere necrosis and gangrene).

Assess results of laboratory tests, therapeutic

effectiveness, and adverse response (eg, cardiacstatus, blood pressure, CNS status, fluid balance, signsor symptoms of water intoxication, intranasalirritation) on a regular basis during therapy.

Teach patient possible side effects/appropriateinterventions and adverse symptoms to report.


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Crash Cart

*** Its important to ensure that unless

is being used, this cart need to have a

security seal.


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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


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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


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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


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Equipment on side

of the crash cart

Endotracheal tubes

Adult: 6.5, 7, 7.5, 8


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1st Drawer on top of the crash cart


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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


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2nd Drawer


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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


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Needles and Syringes


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3rd Drawer

Medications


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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


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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

h


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4th Drawer

IV Solutions and Tubing


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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


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5th Drawer

h


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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




h i


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Other equipment

Oxygen and EKG machine

On the side At the top

crash cart.pptxvv

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