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.

 Classification Action Indication Contraindication Side effect Nursing Consideration

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)

Medications included in the Crash Cart

Miscellaneous
Magnesium Sulfate Sodium Bicarbonate Calcium Chloride Calcium Gluconate Dextrose 50%

Second Line Drugs

Norepinephrine (Levophed) Dopamine (Intropin) Dobutamine (Dobutrex) Isoprotenerol (Isuprel)

Medications included in the Crash Cart

Vasodilators/ Antihypertensive

Nitroglycerine (Tridil)

Anti-diuretic Vasopressin

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Epinephrine (1:10000) Classification

Contraindications
With angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage) In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia. In pregnant woman, drug is contraindicated. In breast feeding do not use the drug or stop breast feeding. Monitor V/S. and check for cardiac dysrrhythmias Drug increases rigidity and tremor in patients with Parkinsons disease Epinephrine therapy interferes with tests for urinary catecholamine Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur Massage site after IM injection to counteract possible vasoconstriction. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

Beta2 Adrenergic Agonists

Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Increases BP, HR, PR Decreases airway resistance. Asthma Bronchitis Emphysema All cardiac arrest, anaphylaxis Used for symptomatic bradycardia. Relief of bronchospasm occurring during anesthesia Exercised-induced bronchospasm nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension, nausea headache

Action

Indication

Nursing Management

Side Effects/Adverse Reactions

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Atropine Sulfate (4mg/mL) Classification
Anticholinergic Pre-op meds/pre-anesthetic meds To restore cardiac rate and arterial pressure during anesthesia when vagal To lessen the degree of A-V heart block To overcome severe carotid sinus reflex Antidote for cholinergic toxicity 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.

Indication

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
CNS: headache, excitement. CV: palpitations GI: thirst, nausea

Adverse effects

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Lidocaine (Xylocaine)
100 mg bolus 1 gm

Contraindications
Hypersensitivity Heart block Hypovolemia Adams stroke syndromes Infection at site of injection 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 pulse deficits Assess renal and liver function Monitor CNS symptoms Monitor blood levels

Classification
CV drugs: Antiarrhythmics Anesthetic

Action
Increases electrical stimulation of ventricle and HisPurkinje system by direct action on tissues, resulting to decrease depolarization, automaticity and excitability in ventricles during diastolic phase Anesthesia Arrhythmias Control of Status Epilepticus refractory to other treatments GI disturbances, bradycardia, hypotension, convulsion, numbness of tongue, muscle twitching, restlessness, nervousness, dizziness, tinnitus, blurred vision, fetal intoxication, light headedness, drowsiness, apprehension, euphoria, vomiting, sensation of heat, respiratory arrest and CV collapse

Nursing Management

Indication

Side Effects and Adverse Reactions

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Procainamide (Pronestyl)
1 gm

Contraindications
Heart block Heart failure Hypotension Myesthenia gravis Digoxin toxicity Lactation Assess cardiovascular status before therapy. Assess pulmonary, hepatic and thyroid. function before and during therapy. Monitor fluid and electrolytes, I&O, K, Na and Cl. Monitor ECG, BP. Assess vision.

Classification
Antiarrhythmics Blocks open Na channels and prolong the cardiac action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG Supraventricular and ventricular arrhythmias. Treatment of Wolf-Parkinson-White Syndrome Severe hypotension, ventricular fibrillation and asystole. Drug induced SLE syndrome, blood disorders, fever, myocardial depression, heart failure, agrunulocytosis, psychosis, angioedema, hepatomegaly, skin irritation, hypergammaglobulinemia, GI and CNS effects.

Action

Nursing Management

Indication

Side Effects and Adverse Reactions

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Bretylium (Breytol) (500mg/10mL) Classification Antidysrhythmic Action Bretylol produces a prompt increase in ventricular fibrillation threshold, perhaps through postganglionic adrenergic blockade. It causes an initial release of norepinephrine from postganglionic nerve terminals. At present, its use is reserved for patients who fail to respond to lidocaine or other first-line antidysrhythmics. Indication Indicated in the prophylaxis and therapy of ventricular fibrillation. Indicated in the treatment of life-threatening ventricular arrhythmias. Side effect/ Adverse effect Hypotension Hypotension and postural hypotension Nausea and vomiting Vertigo, dizziness, light-headedness and syncope Bradycardia, increased frequency of premature ventricular contractions, transitory hypertension, initial increase in arrhythmias, precipitation of anginal attacks, 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 of breath, diaphoresis, nasal stuffiness and mild conjunctivitis. Hyperthermia Contraindications There are no contraindications to use in treatment of ventricular fibrillation or life-threatening refractory ventricular arrhythmias. Nursing Management Assess and notify the doctor if the patient's medical history include: any allergies, kidney disease, heart disease, blocked blood vessels (aortic stenosis), lung problems (pulmonary hypertension) because the medication is contraindicated with this conditions To avoid dizziness and lightheadedness, the patient should remain lying down or, if necessary, get up slowly when rising from a seated or lying position. This medication should be avoid during pregnancy unless is clearly needed.

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Verapamil (Calan, Isoptin) (5mg/2mL) Classification Anti-anginal Anti-arrhythmics Anti-hypertensive Vascular headache suppressants Action Inhibits calcium transport into myocardial smooth muscle cells Decreases SA and AV conduction and prolongs AV node 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, during titration and therapy Monitor ECG, I&O, serum potassium and weight. Assess for CHF

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Diltiazem (Cardizem) (50mg/10mL) Classification Anti-anginals Antiarrhythmics Antihypertensive Ca channel blocker Action Inhibits calcium transport into myocardial smooth muscle 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, during titration and therapy Monitor I&O and weight Assess for CHF Routine serum Digoxin monitoring

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Adenosine (Adenocard) (6mg/2mL) Classification Nucleoside Indication To convert paroxysmal supraventicular tachycardia (PSVT) to sinus rhythm Action A naturally occurring nucleoside that acts on the AV node to slow conduction and inhibit reentry pathways. Also useful in treating PSVTs, including those with accessory bypass tracts (Wolff-Parkinson-White syndrome) Adverse Reaction CNS: dizziness, light- headedness, numbness, tingling in arms, headache. CV: facial flushing. GI: nausea. Respiratory: dyspnea, shortness of breath, chest pressure.

Contraindication

Contraindicated in patients hypersensitivity to drugs. Contraindicated in those with second or third-degree heart block or sinus node disease (such as sick sinus syndrome and symptomatic bradycardia), except those with a peacemaker. Use cautiously in patients with asthma, emphysema, or bronchitis because bronchoconstriction may occur. ALERT: by decreasing conduction through the AV node, drug may produce first-, second-or third-degree heart block. Patients who develop high-level heart block after a single dose shouldnt receive additional doses. ALERT: new arrhythmias, including heart block and transient asystole, may develop; monitor cardiac rhythm and treat as indicated. If solution is cold, crystals may form; gently warm solution to room temperature. Dont use solutions that arent clear. Drug lacks preservatives. Discard unused portion.

Nursing Management

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Magnesium sulfate (50%(500mg/mL)) Classification Anticonvulsant Indication Treatment of hypomagnesaemia accompanied by signs of tetany Control of HTN Encephalopathy & convulsions Prevention & control of convulsions in patients w/ preeclampsia or eclampsia Prevention of hypomagnesaemia in patients receiving TPN Action May decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown Adverse Reactions flushing, sweating, hypotension, muscular weakness, 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; renal function during administration. Obstetrics: Patient status including vital signs, oxygen saturation, deep tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity. Oral: Renal function; magnesium levels; bowel movements.

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Sodium Bicarbonate 8.4% 50mEq/50mL 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. Do not take drug with milk to avoid hypercalcemia, abnormally high alkalinity in tissues and fluids, or kidney 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

Classification Action

Pediatric 4.2% 50 mEql

Alkalinizers Metabolic acidosis Systemic or urinary alkalinization Antacid Cardiac arrest Restores buffering capacity of the body and neutralizes excess acid 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

Indication

Nursing Management

Adverse Reaction

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Calcium Chloride (10% 100mg/mL) Classification
Electrolytes Hyperkalemia Hypocalcemia Hypermagnesia Increase the force of cardiac contractility, by initiating 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 Hypercalcemia Digitalis toxicity VF during resuscitation 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.

Indication

Action

Contraindications

Nursing Management

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Dextrose 50% (500mL) Classification Intravenous & Other Sterile Solutions Indication Hypoglycemia Coma/seizure of unknown etiology Action: A simple water soluble sugar that minimizes glyconeogenesis 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; if signs of fluid overload, turn off IV drip. Infusion may result in fluid overload. Check IV site frequently and if infiltration is noted, turn off IV drip. Watch out for signs of fluid overload (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).

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
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 causing vasoconstriction 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

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Dopamine (Intropin) 400mgs/VIAL 200 mg/10mL Classification Adrenergic drugs Action Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system 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 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 volume deficit During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs Do not confuse dopamine to dobutamine Check urine output often

Side Effects
CNS: headache an anxiety CV: tachycardia, angina, palpitations and vasoconstriction GI: nausea and vomiting

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
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

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Isoprotenerol (Isuprel) 0.2mg/mL Classification
Sympathomimetic Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature Hemodinamically significant bradycardia refractive to other therapy. Cardiovascular: Angina, flushing, hyper-/hypotension, pallor, palpitation, paradoxical bradycardia (with tilt table testing), premature ventricular beats, StokesAdams attacks, tachyarrhythmia, ventricular arrhythmia 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 Monitor ECG, heart rate, respiratory rate, arterial blood gas, arterial blood pressure, CVP; serum glucose, serum potassium, serum magnesium

Action

Nursing Management

Indication

Side Effects

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
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 the phosphodiesterase (PDE3) enzyme Indications Only for treatment of the following documented lifethreatening 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 including permanent blindness Endocrine: Hypothyroidism or hyperthyroidism GI: Nausea, vomiting, anorexia, constipation, abnormal liver function 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 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 of optic neuropathy. Arrange for periodic chest x-ray to evaluate pulmonary status (every 36 mo). Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels.

Nursing Management

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Nytroglycerin (Tridil)
50mg/ VIAL 250 mgs/ 10 mL

Contraindications
Contraindicated in patients hypersensitive to nitrates With early MI. (S.L. form), severe anemia, increase ICP angle-closure glaucoma, IV nitroglycerine is contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis. 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 IV administration Cardioverter/ defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with 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 medical assistance immediately. Keep in a dark colored container

Classification
Antianginal Nitrate Vasodilator Coronary Relaxes the vascular smooth system Reduces myocardial oxygen consumption Reduces left ventricular workload Reduces arterial BP Reduces venous return Angina pectoris CHF associated with AMI Cardiac load reducing agent Hypertensive Crisis CNS: headache, throbbing, dizziness, weakness. GI: nausea, vomiting Skin: Rash CV: orthostatic hypotension, flushing, fainting. EENT: sublingual burning. Skin: Cutaneous vasodilation, contact dermatitis (patch)

Nursing Interventions

Action

Indication

Side effects

Adverse Reactions

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
Calcium Gluconate Classification:

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 of irritation 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.

Electrolytes
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. replaces Calcium and maintains Calcium level GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterized by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias and coma.

Indication/Dosage:

Action:

Adverse Reactions:

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
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 including pulmonary 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 of optic 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).

Medication Classification, Mechanism of action, uses, contraindication, side effects and nursing considerations
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 (ventricular tachycardia [VT]/ventricular fibrillation [VF], asystole/pulseless electrical activity [PEA]); vasodilatory shock ; donor management in brain-dead patients . Hypersensitivity to vasopressin or any component of the formulation Evaluate patient history closely for use cautions. Assess potential for interactions with other pharmacological agents patient may be taking (eg, concurrent use that will block or enhance antidiuretic response). Note: Dosing and administration vary according to purpose for use. I.V. requires use of infusion pump and close monitoring to prevent extravasation (may cause severe necrosis and gangrene). Assess results of laboratory tests, therapeutic effectiveness, and adverse response (eg, cardiac status, blood pressure, CNS status, fluid balance, signs or symptoms of water intoxication, intranasal irritation) on a regular basis during therapy. Teach patient possible side effects/appropriate interventions and adverse symptoms to report.

Contraindications

Nursing consideration

Crash Cart

*** Its 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

1st Drawer on top of the crash cart

Equipment on Crash Cart 1st Drawer Medications

Epinephrine 1:10,000, (0.1 mg/mL)
5 IV JECT 2 IV JECT 4 VIALS 1 IV JECT

Dextrose 50 %

Vasopressin 20 units/AMP Atropine Sulfate 0.4 mg/ Ml Calcium Gluconate 10 %

5 VIALS
200 mg/10 Ml - 5 VIALS 2 IV JECT 250 mgs/20 mL - 3 VIALS 2 AMP

Dopamine Adenosine 6mg/2mL Dobutamine

Verapamil 5mg/ 2mL

2nd Drawer

Equipment on Crash Cart 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

Equipment on Crash Cart 3rd Drawer - Medications

Dextrose 50 %
4 IV JECT 2 AMPS 10 IV JECT 5 IV JECT 100 mg Bolus - 5 IV JECT 1 GM 3 VIAL 15 IV JECT 5 VIALS 3 IV JECT 5 VIALS 50 mg - 4 VIALS 50 mg/ 10mL 6 VIALS 3 AMP

Vasopressin 20 units/AMP Sodium Bicarbonate 8.4 % 50 mEq Sodium Bicarbonate Pediatric 4.2 % 50 mEq Lidocaine (Xylocaine) Epinephrine 1:10,000, (0.1 mg/mL) Adenosine 6mg/2mL Calcium Chloride10% Calcium Gluconate 10 % Diltiazem, refrigerated Amioradone HCL 150 mg/ 3mL

Equipment on Crash Cart 3rd Drawer Medications

Atropine Sulfate 0.4 mg/mL
10 AMP 10 VIALS 5 VIALS 3 AMP 4 IV JECT 3 AMP 250 mgs/ VIAL 5 VIALS 200 mg/10 Ml - 4 VIALS 400mgs/VIAL 5 VIALS 250mgs/ 10 Ml 2 VIALS 50 mg/ VIAL 2 VIALS

Verapamil 5mg/ 2mL Magnesium Sulfate 50% Norepinephrine Bitartrate 1mg/ml Dobutamine Dopamine Nitroglycerine Bretylium 500 mg/ 10mL

5 AMP
5 AMP 2 VIALS

Isoproterenol 0.2 mgmL Pronestyl 1GM

4th Drawer IV Solutions and Tubing

Equipment on Crash Cart 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

5th Drawer

Equipment on Crash Cart 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 3.0 ET tubes without cuff 3.5 ET tubes without cuff 4.0 ET tubes without cuff

Other equipment Oxygen and EKG machine

On the side At the top