SKILLS LAB E-CART/CRASH CART Emergency Trolley It is a multi drawer cabinet with the essential medication and tools

needed for emergency cases Goal: each cart to begin addressing the emergency conditions while waiting the emergency team to arrive: o Compromised airway o Respiratory distress/respiratory arrest o Cardiac arrest o Drug overdose o Hypoglycemia o Anaphylactic reaction

*dexamethasone corticosteroid; treatment of shock *diazepam (valium) indicated if the seizure is more than 2 minutes; anxiolytic; for cardioversion *digoxin inotropic, contractility/contraction; heart failure, paroxysmal SVT, atrial fibrillation, atrial flutter *furosemide edema; heart failure *noradrenaline (levophed) for cardiac arrest and unstable, profound hypotension; peripheral vasoconstrictor; inotropic stimulator of the heart and dilator of coronary arteries *morphine acute pulmonary edema *magnesium sulfate neurochemical transmission and muscular excitability; for convulsions *nicardipine blocker hypertension, angina; calcium channel

Note: at the beginning of each shift the nurse should check the equipment and medication to ensure if they are prepared for use in critical situation The Emergency Trolley Contents: IDEAL -(A) oxygen supply, defibrillator with monitor, portable monitor, defibrillator unit, portable suction apparatus, laryngoscope, shuttle forceps, sphygmomanometer, stethoscope, emergency crash cart check sheet, e drug info sheet, checklist of cart content *Adenosine anti arrhythmic for patients with arrhythmias; supraventricular tachycardia *aminophylline bronchodilator; works in the airways by relaxing muscles, opening air passages *amiodarone broad spectrum anti-arrythmic; multiple complex effects on the electrical activity of the heart which is responsible for the heart s rhythm (ma am lasala) *atropine sulfate muscarinic receptor antagonist; inhibits the effects of excessive vagal activation on the heart; can temporarily revert sinus bradycardia to normal sinus rhythm and reverse AV nodal blocks by removing vagal influences

*lidocaine HCl antiarrythmic; ventricular arrhythmias (for acute myocardial infarction), digitalis poisoning, cardioversion, cardiac catheterization *epinephrine (20 epi in a crash cart) adrenaline; cardiac arrest, cardiac dysrhythmias, anaphylaxis, superficial bleeding *heparin anticoagulant; for acute coronary syndrome, NSTEMI, atrial fibrillation, DVT, pulmonary embolism (low molecular weight = inoxaparin) *esmolol HCl antiarrhythmic; acute supravenmtricular tachycardia *dopamine pressure for increasing the heart rate and blood

*calcium gluconate given only by MD under strict cardiac consultation ; cardioprotective agent in hyperkalemia; reduces the excitability of cardiomyocytes thus lowering the likelihood pof developing cardiac arrhythmias *Phenobarbital Na anticonvulsant, status epilepticus *Vitamin K preventing certain bleeding *phenytoin (dilantin) anticonvulsant; epilepsy

*terbutaline sulfate bronchodilator for asthma *verapamil calcium channel blocker; hypertension, angina pectoris, cardiac arrhythmias *isosorbide (isoket) angina pectoris nitrate vasodilator, treatment for

M- Morphine: 2.5 mg IV every 5 mins; max is 15mg; binds to opiate receptors in the CNS altering pain perception and response O Oxygen: 4LPM; maintain O2 sat > 90%; increases myocardial O2 supply N Nitroglycerin: 1 tab repeat dose every 5 mins; max is 3 doses; causes relaxation of vascular smooth muscles inducing vasodilatadion A Aspirin: 160-325mg tab p.o.; inhibits platelet aggregation Management for Sinus Bradycardia

*Glyceryl trinitrate antianginal, antihypertensive, vasodilator; angina pectoris *hydrocortisone (solucortef) increasing blood sugar through glucogenesis, suppressing the immune system; aids in fat, protein, and carbohydrate metabolism *clonidine (catapres) calcium channel blocker, in micrograms; for high blood pressure *aspirin prophylaxis of cardiovascular events *nitroglycerin systemic effect; for angina *sodium chloride severe hyponatremia *potassium chloride treat and prevent hypokalemia, lowering high blood pressure *sodium bicarbonate indicated for respiratory acidosis, CPR; 50cc syringe and gauge 19 needles are needed EMERGENCY DRUGS Indications: y y y y y y y y y y Cardiac Arrest Anaphylaxis Arrhythmias Stroke Acute Coronary Syndrome (MI) Acute exacerbation of COPD Hypoglycemia Convulsive Status Opiod Induced Respiratory Depression Drug Overdose

Atropine: 0.5mg IV every 3-5 minutes; Max of 3 doses; competitively blocks the muscarinic receptors in peripheral tissues Dopamine Infusion: (px is hypotensive, needs a vasoconstrictor) 2-10mcg/kg/minute; stimulates both dopaminergic and B-adrenergic receptors producing cardiac stimulation and renal vasodilatation Computation for Dopamine Dosage: Mcg/kg/min = cc/hr x concentration wt. in kg Flow Rate:

Dopamine 1 vial = 200mg

Dose 200 400 800

Concentration 13.33 26.66 53.32

Dobutamine 1 vial =

Dose

Concentration

Management MONA -for chest pain, MI or acute coronary syndrome

Note: Maximum dose for both 20 mcg/kg/min. *Beyond this dose, it will only have the same therapeutic effect.

Stuff about Levoped with formulas and info Levoped Concentration: Dosage: Mcg/kg/min = flow rate x concentration wt. in kg x 60/min/hr Flow Rate:

Initial dose: two 50ml (44.6 to 100 mEq) Repeat dose: 50 ml every 5-10 mins (if necessary) *increases plasma bicarbonate, buffers excess hydrogen ion concentration For Hypoglycemia Glucagon: 1mg/IV; 0.5 mg for patients <25 kg; promotes hepatic glycogenolysis and gluconeogenesis Glucose: 50% 20-50ml IV at 3ml/min; given after 10 mins of no response to Glucagon; chief source of energy for call cellular activities; slow IV push

Management for Coding Epinephrine: 1mg/ml IV given every 3-5 mins; direct acting sympathomimetic drug that acts as an agonist at alpha and beta adrenergic receptors Vasopressin: 40U IV; alternate with 1st or 2nd dose of Epinephrine; constricts the peripheral blood vessels, causes the smooth muscle of the intestine, gallbladder and urinary bladder to contract. Causes of Cardiac Arrest 6Hs y y y y y y 5Ts y y y y y Toxins Tamponade, cardiac Tension pneumothorax Thrombosis Trauma Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/hyperkalemia Hypothermia Hypoglycemia

Management for Cardiac Arrest Sodium Bicarbonate (acidosis)