Crash Cart

Hatem Alsrour
 Nursing College
King Saud University
 OUTLINE
1. Definition of crash cart
2. Content of crash cart
3. Definition of defibrillation/Cardioversion.
4. Purposes of defibrillation.
5. defibrillation procedure.
6. Complication of defibrillation.
7. Nurses responsibilities.
8. Defibrillation vs. Cardioversion
 OBJECTIVES
By the end of this lecture the student will be
able to:
1. Define crash cart.
2. List the content of crash cart.
3. Define defibrillation/Cardioversion.
4. List the purposes of defibrillation.
5. Demonstrate understanding of defibrillation /
Cardioversion procedure.
6. List the complications of defibrillation.
 crash cart
A crash cart or code cart is a set of
trays on a wheeled cart that is used in
hospital wards and emergency rooms.
It contains all the basic equipment
necessary to follow ACLS protocols
and potentially save someone's life.
CRASH CART
Top drawer - medications
2nd drawer – adult
intubation supplies
 3rd drawer – peds
intubation supplies
 4th drawer – peds
miscellaneous supplies
5th drawer – IV and blood
draw supplies
 6th drawer – IV
solution and tubing
7th drawer – procedure trays
and miscellaneous supplies
Outside of the Cart
Monitor and paddles
• Defibrillation
• Evaluate heart rate
Suctionequipment
Needle box
Examination gloves
Oxygen tank
Monitor and Paddles
Suction Apparatus
Needle Boxes
Oxygen Canister
Airway Equipment
Intubationequipment
Endotracheal tubes
• If cuffed can use with ventilator
CO2 detector
• To make sure tube is in airway
Intubation Equipment
Endotracheal Tubes &
Airway
CO2 Detector
Breathing Equipment
Face mask
Manual resuscitator
Oxygen equipment for monitoring
and delivery
Face Mask
Adult Manual Resuscitator
Oxygen Flowmeter
Nasal Oxygen Cannula
Circulation Equipment
To insert a central line
To start peripheral lines
To test blood
• Venous
• ABGs (put on ice and deliver to lab STAT)
Central Venous Catheter (CVC)
IV Bags and Tubing
Tegaderm Transparent
Dressing
ABG Kit
Butterfly
Blood Collection Vials
Syringes and Alcohol
Swabs
Safety Needles
Personal Equipment
„ Face mask
„ Cover gown
„ Gloves
• Sterile
• Examination
Face Mask
Sterile Gloves
Miscellaneous Equipment
Scissors
Hemostat
Irrigation equipment
Sponges
Extension cord
Bandage Scissors
Hemostat
NS and Irrigation Syringe
Sponges
Extension Cord
 Defibrillators
Defibrillators are devices that apply sharp
electrical shocks to the heart when its beating
becomes dangerously rapidly or chaotic. The
shocks can restore normal heart rhythms before
the malfunctioning heart suffers sudden cardiac
arrest, a seizure than can lead to death within
minutes.
PURPOSE OF DEFIBRILLATION
Toeradicate life-threatening
ventricular fibrillation or pulse less
ventricular tachycardia.

Torestore cardiac output lost due to

dysrhythmias and reestablish tissue
perfusion and oxygenation.
 PROCEDURE
 Defibrillation is an emergency procedure; and hence no time
should be lost to carry it out. The main principle is to “ACT
QUICKLY”
1. Verify the V-fib or V-tach by ECG and correlate with clinical state. Assess
to determine absence of pulse. Call for help and perform CPR until
defibrillator and crash cart arrives.
2. Bring defibrillator to the bedside.
3. Turn power “ON” the defibrillator, make sure the synchronized selection
switch is “OFF”.
4. Squeeze generous amount of jelly on to the defibrillator paddles. The jelly
conducts electricity and at the same time reduces the risk of electrical
burns. Coat entire surface of the paddle with jelly by rubbing the paddles
together. Gel pads are available instead of jelly.
5. Select the correct electrical charge on the defibrillator. Average charge for
an adult is 200 to 300 joules.
6. Press the charge button to charge the capacitor. When it
displays the required energy level place the defibrillator
paddles on the patient’s chest. Put one paddle (sternum) to
the right of the sternum between the second and third
intercostals space and the other (APEX) at the fifth
intercostals space on the left side of the chest near the apex
of the heart.
7. Make sure that the paddles rest flat against the patients body,
if not it may cause burns in the patients and the shock will
not be effective.
8. Before delivering the shock tell everyone to stand clear off
the patient and his bed.
9. If the patient is getting oxygen it should be turned off.
10.Make sure that the operator is not standing on a wet surface
or leaning against the bed of the patient.
11. Check rhythm immediately before discharge.
12. Deliver the shock by pressing the discharge button on
the paddle simultaneously.
13. Observe the post defibrillator rhythm to see whether
defibrillation has altered cardiac rhythm the arrhythmia
and restored the normal the rhythm. If the desired
cardiac rhythm is not restored, defibrillation is repeated
with a higher energy level immediately.
14. Give a third shock at 360 joules if required and proceed
with advance cardiac life support recommendation.
15. If an organized rhythm results from defibrillation,
check the pulse and obtain ECG.
 COMPLICATION OF
DEFIBRILLATION
 Skin irritation, redness or burns may result if an
inadequate conduction medium is used or if there are
multiple counter shocks.
 Formation of short circuit between paddles due to
excessive amount of conduction jelly applied on the
paddles.
 Arcing of the current may occurs if the defibrillation
jelly spread across the chest bar.
 Direct or indirect contact with the patient during
defibrillation may result in V-F or skin burns to
bystanders.
 Damage to myocardium due to repeated high energy
electrical counter shocks.
 Cardioversion
Cardioversionis the process of converting
abnormal atrial and ventricular rhythms
back to normal sinus rhythm. This can be
accomplished by drugs known as
“chemical cardioverison” or by delivering
an electrical charge known as “electrical
cardio version”.
 INDICATIONS
Common indications for synchronized
Electrocardioversion include:
Atrial fibrillation
Atrial flutter
Atrial tachycardia
Supraventricular tachycardias.
Stable ventricular tachycardia
 RESPONSIBILITIES OF THE
NURSE
 ECG readings are taken prior to the procedure to identify
the type of arrhythmia present in the patient.
 Explain the procedure to the patient and obtain consent.
 Record base line vital signs.
 Establish an IV line and keep it patent for emergency
purposes.
 Keep ready all articles necessary for the immediate
resuscitation of the patient, if any emergency arise.
 The patient may develop a lethal arrhythmia such as VF,
when shocked.
 Stop digitalis prior to the procedure, as digitalis may pre-
dispose the patient to develop ventricular arrhythmia.
Defibrillation vs. Cardioversion
What's the difference?
• Defib- patient must be pulseless
• Cardioversion- designed to be
synchronized with the “R” wave (during
the absolute refractory period)
• Cardioversion is used to control
tachydysrhymia’s