A crash cart or code cart contains medications, supplies, and equipment needed to respond to medical emergencies like cardiac arrest. It includes a defibrillator, ambu bags, oxygen, IV supplies and medications like epinephrine, atropine, lidocaine, sodium bicarbonate. The crash cart must be checked regularly, standardized, and placed in an easily accessible location. It is organized with equipment and medications grouped by function in drawers and sections for quick access during emergencies. Common arrhythmias include premature beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias which can be harmless or potentially fatal depending on their type and underlying heart condition.
2. 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
Objectives
3. A crash cart or code cart is a special mobile
unit with drawers used in health care
facilities and emergency rooms that contain
the necessary medications and equipment
to respond to a cardiopulmonary arrest.
Definition of Crash Cart
4. The purpose of the crash cart is to have a
portable life saving unit that contains all the
medications, supplies and equipment
necessary to initiate a treatment in
emergency and life threatening situations
on all health care facilities.
Purpose of Crash Cart
5. 1. Crash cart must be checked by head
nurse/staff nurse every shift and document in
checklist
2. Standarization must be maintained.
3. Defibrillator will be checked by biomed
department regularly or as necessary.
4. Crash cart items must be checked monthly for
expiry dates.
5. Each unit will have crash cart placed in and
easily place accessible location.
Policy
6. Top shelf
Defibrillator and manual
spO2 probe
ECG strips
Ultrasound jelly for DC Shock
Checklist
Right side
Adjustable iv pole
Ambu bag adult with mask
Ambu bag pedia with mask
Oxygen cylinder
Arrangement of Crash Cart
14. CIRCULATION
IV Set
IV cannula all sizes
3way stopcock
Foley catether
NGT all sizes
Blood transfusion set
Syringes all sizes
BP APP
TORNIQUET
Third Drawer
15. IV Fluids
RL
NS
D5W
D5NS ½
D5NS ¼
D5NS
D10
HUMAN PLASMA
ALBUMIN
MANNITOL
EXTRA AMBUBAGS
FRONT SIDE
CARDIAC BOARD
Lower Portion
16.
17. Adenosine
Antiarrhythmic
Conversion to sinus rhythym of paroxysmal
supraventricular tachycardia
Dose: 6mg by rapid bolus: for repeat dose, use 12mg
by IV bolus within 1-2 mins.
Epinephrine
Adrenergic agent choice for cardiac arrest,
vasopressor used in Pulseless VT/VF, Asystole and
PEA
Dose : 1mg IV every 3-5mins or more frequently. May
be given endotracheal route.
Stocked 1mg/ 10ml 1:10,000.
If used for hypersensitivity reaction 0.1- 0.25mg SC
EMERGENCY DRUGS
18. AMIODARONE (antidysrhythmics, 3rd)
-malignant Ventricular Arrythmia, V-Fib/Pulseless V-
Tach
-markedly prolongs action potential and repolarization
-300 mg IV x1 after dose of epinephrine if no initial
response to defibrillation. May repeat 150 mg IV q5-
10min. Rapid IV push if pulseless/no BP.
Not to exceed 2.2 g/day, may be diluted in N.S. or D5W
AMINOPHYLLINE (Xanthine Derivatives)
-Acute Bronchospasm
-Methylxanthines directly relaxes the smooth muscle of
the Respi Tract.
-6 to 7 mg/kg IV/PO; infuse iv over 20 mins
19. Atropine Sulfate
Parasympatholytic
Anticholinegic
Antidote for organophosphate poisoning
Agent used for symptomatic bradycardia, PEA
Dose : 0.5-1mg IV push, repeat at 3-5 mins
Intervals to max. total dose of 0.4mg/kg
May b given via endotracheal route. Stocked 1mg/
10ml
Digoxin
-(antidysrhythmics, 5th, inotropic agents)
-heart failure, A-FIB,
-0.4-0.6 mg once then may cautiously give add’tl doses
of 0.1-0.3 mg q6-8hrs until adequate.
-slow IV push over 5 mins
20. DOBUTAMINE
-inotropic agents
-low cardiac output and CHF
-0.5-1 mcg/kg/min IV initially, then 2-20 mcg/kg/min; not
to exceed 40mcg/kg/min
-infuse to large vein via infusion pump
DOPAMINE
-inotropic agents
-hypotension, cardiac output and poor perfusion of vital
organs. Mean arterial pressure in Septic shock patients
-in large vein, via infusion pump.
21. D50W (glucose-elevating agents)
-hypoglycemia
-10-25g (20-50ml 50% solution)
-high concentrations should be administered via Central Veins and
only after appropriate dilution
SODIUM BICARBONATE
-alkalinizing agent
-cardiac arrest, hyperkalemia
-1 mEq/kg/dose IV x 1
POTASSIUM CHLORIDE (Electrolytes)
-conduction of nerve impulses in the heart, contraction of cardiac,
smooth muscle
-hypokalemia
-40 to 100 mEq KCL diluted in an appropriate amount and type of
solution to be intravenously infused once at a rate not to exceed
10 to 40 mEq/hour.
22. CALCIUM GLUCONATE
-antidote, calcium salts
-hypocalcemia (hypocalcemic tetany, hypoparathyroidism)
cardiac arrest (+ hyperkalemia, hypocalcemia,
hypermagnesemia)
-1.5-3g IV over 2-5 minutes, diluted in N.S or D5W
-rapid IV admin.: arrythmias, hypotension, M.I. or
vasodilation
CALCIUM CHLORIDE
-antidote, calcium salts
-hypocalcemia, arrythmias, hypermagnesemia
-500-1000mg IV over 5-10 mins/
-C/I in Vfib during CPR,PVT
23. DEXAMETHASONE (corticosteroid)
-hormones and synthetic substitutes
-inflammation, cerebral edema and shock
-1-6 mg/kg IV or 40 mg IV q2-6hrs PRN, diluted in D5W, N.S.
DIAZOXIDE (Glucose Elevating Agents)
-hyperinsulinemic hypoglycemia
-now in oral form.
-the injectable form used for HTN emergency is no longer available
FUROSEMIDE (loop diuretic)
-edema asso. With CHF, liver cirr. & Renal dse. HTN
-A.Pulmonary Edema, HTN crisis, ICP
- 0.5-1mg/kg (40mg) IV over 1-2 mins. Or up to 80 mg but should
not exceed 200mg
-hyperkalemia, hypermagnesemia (hpk: 40-80 mg IV; hpm: 20-
40mg iv/q3-4hrs PRN)
25. ISOPROTERENOL
-beta 1/beta2 adrenergic agonist
-V.A’s due to (AV) heart block, Adams-Stokes attacks,
cardiac arrests and shock
-IV Bolus: 0.2-0.06mg initially THEN doses of 0.01-0.2mg.
-IV Infusion: .5mcg/min, THEN doses of 2-20mcg/min. by
infusion pump in D5W
* Direct IV, IM, SC or Intracardiac inj.(EXTREME cases)
MAGNESIUM SULFATE (antidysrhythmics, V,
Electrolytes)
-hypomagnesemia, toxemia of Pregnancy and Torsades de
Pointes V-TACH
-with Pulse: 1-2g slow iv (10ml/D5W) over 5-60 mins, then
0.5-1g/hr IV
-Cardiac arrest: same as above but over 5-20 mins.
26. METHYLPREDNISOLONE (corticosteroids)
-allergic conditions, acute exacerbations of multiple sclerosis,
-dose: 10-250 mg IM/IV up to q4hr PRN
NITROGLYCERINE (nitrates)
- ANGINA, Renal Failure
-5mcg/min. if unresponsive to SL NTG
-increase by 5 mcg/min q3-5mins up to 20mcg/min.
-3ml/hr (50mg in 250ml D5W/NS)
NORADRENALINE (alpha/beta adrenergic agonist)
-acute hypotension, cardiac arrest, sepsis/septic shock
-initial: 8-12mcg/min IV Infusion. Titrate.
*extravasation: infiltrate with 10-15ml NS+5-10mg of phentolamine
mesylate.
*monitor BP
27. PROCAINAMIDE (antidysrythmics, 1a)
- arrythmia,
- IM: 0.5-1g IM q4-8hr
- IV: loading dose 15-18 mg/kg; slowly over 25-30 mins; may
repeat q5mins PRN; not to exceed 1g.
- Sol’n: 2g/250ml D5W/NS , in infusion pump
PROPRANOLOL(antidysrhythmics, II)
- beta-blockers(nonselective), antianginal
-HTN, ANGINA, Hypertropic SubAortic Stenosis,
SupraVentricular arrythmia & Portal HTN.
-SVA: 1-3mg at 1 mg/min 1st, repeat q2-5 min until 5mg. Once
achieved, no add’l dose for at least 4 hours.
28. LIDOCAINE (anesthetics pre-med agents)
- Cardiac arrythmias: 1.1-5mg/kg, slow IV over 2-3mins
(3mg/kg total)
- IV, IO/ET..Can be given IM! If, no IV and no ECG, for V.Ar
VASOPRESSIN (antidiuretics)
-Abdominal distention, Diabetes Insipidus, Gastrointestinal
Hemorrhage and vasodilatory shock.
-AD: initial: 5 units/IM, repeat q3-4hrs PRN up to 10 units.
-DI: 5-10 units IM/SC/intranasal q6-12 hrs.
-dilute to NS/D5W and via controlled infusion device.
29. Verapamil
Antianginal
Antiarrhythmic
Antihypertensive
Calcium channel blocker
Therapeutic actions:
-inhibits the movement of calcium ions across the membranes
of cardiac and arterial muscle cells
Indications: treatment of SVT, essential hypertension
Dose:
Adult- IV initial dose- 5-10mg over 2mins; may repeat dose
of 10mg 30 mins after first dose
Pedia- 1year and younger: initial dose 0.1-0.2mg/kg over 2
mins.
1-15 years: initial dose 0.1-0.3mg/kg over 2mins. Do not exceed
5mg. Repeat above dose 30mins after initial dose if response is
not adequate. Repeat dose should not exceed 10mg.
30. Monitor patient carefully (BP, cardiac rythym, and
output)
Protect IV solution from light
Monitor patients with renal or hepatic impairment
carefully for possible drug accumulation and
adverse reactions
Nursing Considerations
31. Dose: IV Adult: 150mg loading dose over 10mins,
followed by 360mg over 6hr at rate of 1mg/min
For maintenance infusion 540mg at 0.5mg/min over
18hr
Remember Amiodarone should be diluted with D5W
32. An arrhythmia is an irregular heartbeat - the heart may beat too
fast (tachycardia), too slowly (bradycardia), too early (premature
contraction) or too irregularly (fibrillation). Arrhythmias are heart-
rhythm problems - they occur when the electrical impulses to the
heart that coordinate heartbeats are not working properly, making
the heart beat too fast/slow or inconsistently.
Many heart arrhythmias are harmless. We all occasionally
experience irregular heartbeats, which may feel like a racing heart
or fluttering. Some arrhythmias, however, especially if they veer too
far from a normal heartbeat or result from a weak or damaged
heart, may cause troublesome and even potentially fatal
symptomsRapid arrhythmias are called tachycardias, while slow
ones are called bradycardias. Irregular arrhythmias - when the
heartbeat is irregular - are called fibrillations, as in atrial or
ventricular fibrillation. When a single heartbeat occurs earlier than
it should it is called premature contraction.
ARRHYTHMIAS
33. The English word "arrhythmia" comes from the Greek word
rhymos, meaning "rhythm", the Greek suffix a (letter "a" added
to the beginning of a word) means "loss" - put together they
mean "loss of rhythm".
4 MAIN TYPES
1. Premature (extra) beats
2. Supraventricular arrhythmias
3. Ventricular arrhythmias
4. Bradyarrhythmias
PREMATURE (EXTRA) BEATS
- Most common type. They are harmless most of the time and
often don’t cause any symptoms. Premature beats that occur in
the atria (the heart’s upper chambers) are called premature
atrial contractions, or PACs. Premature beats that occur in the
ventricles (the heart’s lower chambers) are called premature
ventricular contractions or PVCs.
34. SUPRAVENTRICULAR
ARRHYTHMIAS
-are tachycardias (fast heart rates) that starts in the
atria or atrioventricular (AV) node. The AV node is
a group of cells located between the atria and the
ventricles.
Types of SV Arrhythmias
Atrial Fibrillation (AF)
Atrial Flutter
PSVT
Wolff-Parkinson-White
35. VENTRICULAR ARRHYTHMIA
-Starts at the heart’s lower chambers, the ventricles.
They can be very dangerous and usually require
medical care right away.
Includes:
Ventricular Tachycardia
is a fast, regular beating of the ventricles that may
last for only a few seconds or much longer.
Ventricular Fibrillation
is disorganized electrical signals make the
ventricles quiver instead of pump normally. Without
the ventricles pumping blood to the body, sudden
cardiac arrest and death can occur within a few
minutes.
36. BRADYARRHYTHMIAS
-Occur if the heart rate is slower than normal. If the heart rate is
too slow, not enough blood reaches the brain. This can cause
you to pass out.
-in adults, a heart rate is slower than 60 beats per minute is
considered bradyarrhythmia. Some people normally have
slower heart rates, especially people who are very physically fit.
For them, a heart beat slower than 60 beats per minute isn’t
dangerous and doesn’t cause symptoms. But in other people,
serious diseases or other conditions may cause
bradyarrhythmias.
-can cause
Heart attacks
Conditions that harm or change the heart’s electrical activity,
such as an underactive thyroid gland or aging
An imbalance chemicals or other substances in the blood,
such as potassium
Medicines such as beta blockers, calcium channel blockers,
some antiarrhythmia medicines, and digoxin
37. Arrhythmia in children
Children’s heart rates normally decreases as they get older. A newborn’s
heart beats between 95-160 times a minute. A 1 year old heart beats
between 90- 150 times a minute, and a 6 to 8 year old heart beats
between 60 to 110 times a minute.
A baby or child's heart can beat fast or slow for many reasons. Like
adults, when children are active, their hearts will beat faster. When
they're sleeping, their hearts will beat slower. Their heart rates can speed
up and slow down as they breathe in and out. All of these changes are
normal.
Some children are born with heart defects that cause arrhythmias. In
other children, arrhythmias can develop later in childhood. Doctors use
the same tests to diagnose arrhythmias in children and adults.
Treatments for children who have arrhythmias include medicines,
defibrillation (electric shock), surgically implanted devices that control
the heartbeat, and other procedures that fix abnormal electrical signals
in the heart.