Crash Cart - Medical Procedures (PDF)

‫كليـــــــة االتحــــــــاد الدوليـــــــــة للـــعــــلوم الطـــــبية‬ Uonin collage for medical signs Intensive Care Unit Devices CRASH CART 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS,Fniv, RCP, MsRC...

‫كليـــــــة االتحــــــــاد الدوليـــــــــة للـــعــــلوم الطـــــبية‬ Uonin collage for medical signs Intensive Care Unit Devices CRASH CART 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS,Fniv, RCP, MsRC 15-Oct-24 DrMohammmed Senana 1 Crash Cart 1  Crash Cart 1. TOP & surround of crash cart : (Dr. OSID) Oxygen Tanks (cylinder). Sharps & waste container. Intravenous (I.V) stand. Defibrillator. Intravenous (I.V) stand Defibrillator shelf Writing surface Key access 5 – 6 Drawer Sharps & Waste container Tracking wheel Oxygen tank holder 2 Page  Crash Cart 2 - FIRST DRAWER (Drugs) A. Sedation and Analgesia drugs: TABLE 1 Sedative and anesthesia agent, amnesic drugs Name of drugs IV dose Onset Duration (min) Morphine 0.1 to 0.2 mg/kg 10 min 240 - 360 Fentanyl 1 to 2 µg/kg Or 0.05 to 0.4 mg/kg 1-2 min 30-40 Midozolam 0.1 to 0.2 mg/kg. 1 to 2 min 30-60 Ketamine 500mg/10ml 1 to 4.5 mg/kg. 2 to 3 min 5 to 10 Etomidate 0.2 to 0.6 mg/kg. 30 seconds 5 to 10 Propofol 1 to 2.5 mg/kg. 1 min 5 to 10 Liver diseases B. Muscle relaxant (Paralysis): For rapid sequence intubation (RSI). TABLE 2 Skeletal muscle relaxant drugs Name of drugs IV dose for facilitate intubation. Onset (min) Duration (min) Succinylcholine 0.5 to 2 mg/kg. (use 2 mg/kg for infants and 1 5–10 small children). Pancuronium 0.1mg. 2–5 40 to 60 Vecuronium 0.1 mg/kg. 3 30–35 0.25 mg/kg 1 60–120 Atracurium 0.5 mg/kg 3 25–35 3 Rocuronium 1.0 mg/kg 1–1.5 30–110 Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 1. Epinephrine 1:1000 = 1 mg.  1:1000/1ml = 1 mg (1000 μg)/ml   Take a 10 ml syringe  Draw up 9 ml NS Draw up 1 ml of epinephrine 1:10,000 IU = 0.1 mg (100 μg)/ml Take a 1 ml (0.1 mg (100 μg)/ml = 1:10,000 IU) of epinephrine  Draw up 9 ml NS 1 ml of epinephrine 1:100,000 = 0.01 mg (10 μg)/ml.  Use in PEA, Asystole, VF , pulseless VT , anaphylaxis, Asthma,  BP & bradycardia (as AV block). 4 PEA = pulseless Electric Activity; VF = ventricular fibrillation; VT = ventricular tachycardia; AV = atrioventricular; BP = blood pressure. Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 1. Epinephrine 1:1000 = 1 mg. In cardiac arrest (PEA, Asystole, VF , pulseless VT): ✓ IV/IO push: 0.01 mg/kg repeated every 3-5 min (max 1 mg). ✓ ETT: 0.1 mg flow 3 ml NS & 5 breaths (by BVM) (max dose 2.5 mg). Anaphylaxis (Severe to Moderate): ✓ IM: 0.01 mg/kg (max 0.3 mg) in upper outer thigh, repeated every 5 - 15 minutes as needed. Pediatric ✓ IV (Anaphylactic shock): 0.01 mg/kg (1:10,000) over 5 min (max 0.1 mg). Symptomatic bradycardia/shock: ✓ Continuous IV infusion 0.05 – 1 μg/kg/min. Asthma: 0.01 mg/kg SC q 0.5 h – q 4 h × 3 doses , In severe attacks may repeat q 20 min × 3 doses (max 0.3 mg). PEA = pulseless Electric Activity; VF = ventricular fibrillation; VT = ventricular tachycardia; AV = atrioventricular; BP = blood pressure; ETT = Endotracheal tube; BVM = bag-valve-mask (Ambobag ventilation). 5 Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 1. Epinephrine 1:1000 = 1 mg. In cardiac arrest (PEA, Asystole, VF , pulseless VT): ✓ IV/IO: 1 mg IV push every 3-5 min every 3-5 min (max dose 3 mg). ✓ ETT: 2 - 2.5 mg diluted in 5 ml NS flow by 5 breaths (by BVM). Anaphylaxis (Severe to Moderate): ✓ Inhalation Nebulized: 0.5 mg (0.5 mL) diluted in 2.5 mL N. saline. **  Inhalation also given in acute laryngeal edema, croup, epiglottitis, bronchospasm & asthma. Adults ✓ IM: 0.3–0.5 mg (0.3–0.5 mL) in upper outer thigh, repeated every 5–10 min as necessary. ✓ IV /IO bolus (Anaphylactic shock): ▪ Give 1: 10,000 (100 μg) over 5 min every 5-10 min. ▪ Give 1: 100,000 (10 μg) over 5 min every 5-10 min. ✓ Continuous IV infusion (Anaphylactic shock): at rates of 1 - 4 μg/min. why?? may be initiated in adults to prevent the need for repeat epinephrine 1: 10,000 or 1: 100,000. Symptomatic bradycardia/shock: ✓ Continuous IV infusion 2-10 μg/min (tiriate to response). Asthma: 0.3 mg (1:1,000) SC q 0.5 h – q 4 h. 6 ** But the adverse effects, such as tachycardia, arrhythmias, ischemia, and rebound swelling may limit administration. So ; May repeat once. Page Do not use again for at least 3 hrs.  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 2. Atropine 1mg/1ml Or 0.5 mg /1ml (0.02 mg/kg)  Use in bradycardia. Bradycardia with pulse: ✓ IV/IO push: 0.02 mg/kg (max dose 0.5 mg) ; May repeat once. Pediatric ✓ ETT: 0.03 mg/kg diluted in 3 ml NS flow by 5 breaths (by BVM). Atropine: Consider in infant with Succinylcholine. Bradycardia with pulse: ✓ 1st line in AV Block: IV bolus 0.5 mg/kg Repeat every 3 to 5 not Adult exceeding the maximum dose of 3 mg. 3. Adenosine 6 mg/1ml  (use in stabile PSVT/SVT). IV push fast : 1st dose 0.1 mg/kg IV rapid bolus (max 6 mg), 2nd dose 0.2 Pediatric mg/kg (max 12 mg). (max all dose 18 mg). Following by 10 mL NS. IV push fast : 1st dose IV rapid bolus 6 mg, 2nd dose 12 mg rapid bolus, Adult 3rd dose 12 mg rapid bolus (repeat within 1-2 min). (max all dose 30 mg). Following by 20 mL NS.  Adenosine used in pregnancy.  Avoid adenosine in irregular wide QRS tachycardia. 7 PSVT = paroxysmal supraventricular tachycardia; SVT = supraventricular tachycardia. Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 4. Amiodarone 150 mg / 3ml  (use in arrhythmias last drugs, For resistant pulseless VT/VF). Cardiac Arrest (pulseless VT/VF): Pediatric ✓ 5 mg/kg IV/IO (max 300 mg) bolus diluted with 20 mL dextrose, repeat twice to a max of 15 mg/kg/day. Wide complex tachycardia (stable) VT with pulse: ✓ 5 mg/kg IV over 20-60 minutes (max 300 mg), may repeat to a max of 15 mg/kg/day. Cardiac Arrest (pulseless VT/VF): 300 mg IV/IO bolus diluted in 20 mL Adult dextrose, repeat 2nd dose 150 mg diluted in 20 mL dextrose after 3-5 min. Wide complex tachycardia (stable) as VT with pulse: ✓ 1st dose 150 mg/kg IV diluted in 100 mL dextrose, give over 20-60 minutes, may repeat tree time if needed, (check BP after dose). ✓ 2nd dose 360 mg diluted in 50 mL dextrose by syringe-pomp, give over 6 h (8 mL/h). ✓ 3rd dose 540 mg diluted in 50 mL dextrose by syringe-pomp, give over last 24 h (18 h)  3 mL/h.  Max dose of Amiodarone / day 2.2 g. 8  Don’t use amiodarone in 2nd or 3rd degree AV Block. Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 5. Lidocaine 1 to 2 mg/kg (1% 1mL = 10 mg, 2% 1 mL = 20 mg) (Lidocaine = Sodium channel blockers). Lidocaine is recommended when Amiodarone is not available. Cardiac Arrest (pulseless VT/VF): ✓ 1st dose 1 mg/kg IV rapid bolus. ✓ 2nd dose half 1st dose every 5-10 min. (maximum total dose 3 mg/kg). Following by 5 mL NS (push fast). Pediatric  ETT: 2-3 mg diluted in 5 ml NS flow by 5 breaths (by BVM). Wide complex tachyarrhythmia (stable) VT with pulse: ✓ 1st dose 1 mg/kg IV bolus. ✓ 2nd infusion dose 20 – 50 mcg/kg/min (maximum total dose 100 mg). RSI : 12 mg/kg IV push over one min  if patient has  ICP. Cardiac Arrest (pulseless VT/VF): ✓ 1st dose 1-1.5 mg/kg IV/IO bolus. ✓ 2nd dose half 1st dose every 5-10 min (maximum total dose 3 mg/kg), Adult maintain dose 1-4 mg/min (0.014–0.057 mg/kg/min). Wide complex tachycardia (stable) as VT: ✓ 1st dose 0.5-1.5 mg/kg IV/IO bolus over 2–3 min. ✓ 2nd dose infusion dose 20 – 50 mcg/kg/min OR maintain dose 1-4 mg/min (up to 300 mg in any 1-h period). 9 RSI : 12 mg/kg IV push over one min. Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 6. Procainamide (Sodium channel blockers): 1g/10 ml Used with Ventricular Arrhythmia, supraventricular arrhythmias. ✓ Initial dose: 20–50 mg/min IV, hypotension ensues, or the QRS complex is prolonged by 50% from its original duration (maximum dose 17 mg/kg) ✓ Maintenance infusion rate: 1–4 mg/min OR 100 mg IV every 5 min until the arrhythmia is controlled or one of the above conditions is met.  It should be avoided in patients with prolonged QT intervals, torsades de pointes, or congestive heart failure, atrial fibrillation/flutter, hepatotoxicity. 7. Mag Sulfate: 5gm/10ml or 1g/1 ml Used in cardiac arrest only with torsades de pointes or resistant VF (after lidocaine)  2 grams IV over 2 min, followed by infusion of 1–2 grams/h. Used in hypomagnesemia, acute & severe bronchial asthma, severe anaphylactic, preeclampsia. 8. Calcium gluconate: 1gm/10ml = 10% solution (20 mg/kg = 0.2 mL/kg). Used in hyperkalemia, hypocalcemia, calcium channels blocker overdose OR β- adrenergic blocker overdose, after multiple blood transfusions. Routine calcium administration is not recommended during resuscitation because of lack of proven efficacy and because of possible harmful effects. Calcium may be given 60 to 100 mg/kg (0.6 to 1.0 mL/kg of a 10% solution) via the IV. 10 Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 7. B-Blockers: as Metoprolol, Propranolol, Esmolol, Labetalol. Onset Duration IV Dose (Adult) Propranolol Oral: Oral: Indications: rate control in SVT & VT, AFib/AFlut & HTN. Vial 5 mg 1–2 h 6–12 h SVT & VT: 1–3 mg/dose IV slow; may repeat every 2–5 IV: IV: min up to a total of 5 mg. OR 0.5–1 mg over 1 min; may ≤1 min 4–6 h repeat, if necessary, up to a total maximum dose of 0.1 mg/kg. Esmolol IV: IV: Indications: SVT arrhythmias, AFib/AFlut (rate control). Vial 1g 2–10 min 10–30min SVT: Initial 250 - 500 mcg/kg IV over 1 minute; if not adequate effect followed by maintenance infusion  Pregnancy starting 50 mcg/kg/min IV over 4 min (titrated to category C therapeutic effect). If not adequate effect response, two additional 150 mcg/kg bolus doses may be given prior to increasing the infusion rate to 100 mcg/kg/min (after second bolus) and 150 mcg/kg/min (after third bolus), as required. After 4 minutes at the rate of 150 mcg/kg/min, the infusion rate may be increased to a maximum rate of 200 mcg/kg/min (without an additional bolus dose). 11 Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 7. B-Blockers: as Metoprolol, Propranolol, Esmolol, Labetalol. Onset Duration IV Dose (Adult) Metoprolol Oral: Oral: Indications: HTN, acute MI (oral), angina, rate control 5 mg inj 1–2 h 24 h in AFib/AFlut. IV: IV: Initial: 1.25–5 mg IV every 5 min up to 15 mg initial 20 min 5–8 h dose (titrate to response). Labetalol Oral: Oral: Indications: HTN. Vial 100 20 min–2 h 8–12 h IV bolus (initial): 10 - 20 mg (0.25 mg/kg for an 80- mg IV: IV: kg) IVP over 2 min; may administer 40–80 mg at 10- 2–5 min 2–18 h min intervals (maximum total cumulative dose Pregnancy 300 mg/kg). category C IV infusion (acute loading): Initial: 2 mg/min, titrate to response (maximum total cumulative dose 300 mg/kg). 12 Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 8. Calcium channel blocker: as Diltiazem, Verapamil: Verapamil 5 mg inj. Used in Angina, Arrhythmias {patients with chronic AFib} (use in Hypertension, Supraventricular tachyarrhythmias). IV Dose Diltiazem IV bolus over 2 min 0.25 mg/Kg, followed by IV infusion at 5–10 mg/h. 20 mg  Diltiazem used in pregnancy. Verapamil IV bolus over 2–3 min 0.075 to 0.15 mg/Kg; if after 15 – 30 min the 5 mg dysrhythmia persists, may with a repeat dose 5–10 mg, if necessary. ▪ Verapamil may cause hypotension that can be prevented by pretreatment with calcium chloride or gluconate (500 to 1000 mg).  Verapamil used in pregnancy. 9. Digoxin: 0.5 mg/2ml. Used for rate control in atrial fibrillation (not first line), atrial flutter, congestive heart failure unrelieved by diuretics and ACE inhibitors, paroxsymal atrial tachycardia). A.fib: 0.3 to 0.5 mg initial bolus with a repeat dose in 4 hours. OR ✓ Initial: 0.25 mg IV every 2 hours up to 1.5 mg total. Repeat dosing is necessary when loading digoxin due to the prolonged distribution phase. ✓ Maintenance dosing is 0.125 to 0.375 mg daily.  Digoxin contraindicated in patients with ventricular arrhythmias, WPW syndrome (potential for ventricular fibrillation), Acute myocardial infarction, beri-beri heart 13 disease, electrolyte imbalances, sinus node disease, AV block, and Renal impairment. Digoxin used in pregnancy. Page  Crash Cart 2 - FIRST DRAWER (Drugs) C. ACLS mediations (Recesetation drugs): 9. Sodium bicarbonate: 8.4% / 50ml (1 mEq/kg) Used in prolonged resuscitation with effective ventilation, overdoses of sodium channel blocking agents (such as procainamide and tricyclic antidepressants), Sever hyperkalemia ,  not useful in hypercarbic acidosis such as cardiac arrest and CPR without intubation, diabetic ketoacidosis. Initial dose 1 mEq/kg IV/IO bolus (given only after adequate ventilation with child & neonates or premature infants), then followed by IV/IO infusion of 150 mEq NaHCO3 /L solution to maintain alkalosis  until serum pH > 7.45 (7.50-7.55 for severe overdose). Without adequate ventilation, the child cannot compensate for the release of carbon dioxide by buffering the hydrogen ions, and the adverse effects of bicarbonate therapy surpass any beneficial effects. the neonates or premature infants, dilute sodium bicarbonate 1:1 with sterile water, not saline, to reduce the hyperosmolarity of the solution. 10. Vasopressin: 40 U IV × 1  use in pediatric cardiac arrest (Instead of 2nd Epi dose) 14 Page  Crash Cart 2 - FIRST DRAWER (Drugs) D. Inotropic/Vasopressors drugs: Inotropic/Vasopressors drugs Name of drugs infusion ranges Action Dopamine 2-20 µg/kg/min α, β, and dopaminergic 200mg/5ml inj  Dose dependent ▪ < 5 µg/kg/min: DA1 , DA2. (Renal dose) ▪ 5 –10 µg/kg/min: β1. (Cardiac dose) ▪ >10 µg/kg/min: α. (B.V dose) Dobutamine 2-20 µg/kg/min β1 , some β2 and α1 in large dosages 250mg/5ml inj Norepinephrine 0.5–50 µg/min Or Primarily α1 , some β1 4mg/4ml inj 0.02–2 µg/kg/min 15 Page  Crash Cart 2 - FIRST DRAWER (Drugs) E. Antidotes drugs: 1. Sodium bicarbonate : (see more before). 2. Thiamin (vitamin B1): amp. Thiamin antidote for ethanol toxicity: ✓ Pediatric Dose: 5–10 mg IV. ✓ Adult Dose: 100 mg IV. 3. Activated charcoal : 1 gram/kg. Ingestion within the previous hour. Activated charcoal used with all patient ingestion toxic substance within the previous hour by gastric Lavage via NG tube 36 to 40F-gauge orogastric tube (22 to 24F in children) with Position the patient on the left side with the head down 20 degrees; toxic substance adsorbed by activated charcoal; may be effective when given > 60 minutes after ingestion. Administration: three time gastric Lavage: ✓ 1st time gastric Lavage with 500 mL of tap water or Normal saline (10 mL/kg in children) ; continue until returned fluid is clear. ✓ 2nd time gastric Lavage with activated charcoal 50 tab (1 gram/kg) via NG tube before removal keep in 10 - 15 minutes then aspiration all fluid with activated charcoal from gastric. ✓ 3rd time gastric Lavage with activated charcoal 50 tab in adults (1 gram/kg) via NG tube; but keep gastric without removal. 16 Page  Crash Cart 2 - FIRST DRAWER (Drugs) E. Antidotes drugs: 4. Antiscropian amp. 5. CroFab antivenin (ANTISNAKE): CroFab antivenin antidote for Rattlesnake bite. ✓ Five vials minimum dose by infusion in normal saline; increase is rate dependent on patient’s tolerance; may cause anaphylaxis. 6. Protopam (PAM): 500 mg / 20 ml. PAM antidote for Organophosphates poisoning. ✓ Loading dose: 1-2 g IV in adults, 25-50 mg/kg in children. ✓ Adult maintenance dose: 500 mg/hr or 1-2 g q4-6h. 7. Atropine: 1mg or 0.5 mg / ml (see more before) Atropine use with Organophosphates poisoning  to titrate pulmonary secretions. ✓ In adults: 1-2 mg. ✓ In children: 0.03 mg/kg. 8. Flumazenil: Flumazenil antidote for Benzodiazepines. ✓ Pediatric Dose: 0.01 mg/kg IV. ✓ Adult Dose: 0.2 mg IV. 9. Calcium chloride: 10% / 10 ml = 3g  27.2 mg/mL elemental Ca. Calcium chloride antidote for Calcium channel antagonists toxicity. ✓ Pediatric Dose: 0.2–0.25 mL/kg IV. ✓ Adult Dose: 10 mL IV. 10. Hydroxocobalamin: Hydroxocobalamin antidote for Cyanide & Nitroprusside toxicity. 17 ✓ Adult & Pediatric Dose: 70 mg/kg IV (maximum 5 grams). Can be repeated up to 3 Page times. Administer with sodium thiosulfate.  Crash Cart 2 - FIRST DRAWER (Drugs) E. Antidotes drugs: 11. Calcium gluconate: 10%/10 ml.  9 mg/mL elemental Ca. Calcium gluconate used in Hypermagnesemia, Hypocalcemia. (see more before) ✓ Pediatric dose: 0.6–0.8 mL/kg IV. ✓ Adult dose: 10–30 mL IV. 12. Naloxone: 4 mg/1ml Naloxone antidote for respiratory and neurologic depression due to opioids intoxication unresponsive to O2 and hyperventilation post RSI or Post-operative such as Morphine, Codeine & Heroin.  Examination Findings (most common in bold): Miosis, respiratory depression, central nervous system depression, Hypothermia, bradycardia. ✓ Adults dose: ▪ Bolus: 0.04 - 2 mg IV/IO/IM/SC/IN every 2 minutes to effect. ▪ IV Infusion: 2/3 effective bolus dose. ✓ Pediatric dose: ▪ Bolus: 0.1 mg/kg IV/IO/IM/SC/IN every 2 min PRN (max 2 mg). ▪ IV Infusion: 0.002-0.16 mg/kg/hr. 13. N-acetylcysteine: N-acetylcysteine antidote for acetaminophen poisoning. ✓ Adults & pediatric dose: ▪ 1st dose: 150 mg/kg IV over 1 hour. ▪ 2nd dose: 50 mg/kg IV over 4 hours. 18 ▪ 3rd dose: 100 mg/kg IV over 16 hours. Page  Crash Cart 2 - FIRST DRAWER (Drugs) E. Antidotes drugs: 14. Dextrose (glucose): 40 %/20ml Dextrose 40/50 % antidote for hypoglycemia due to insulin/Oral hypoglycemic over dose. ✓ Pediatric Dose: 0.5 gram/kg IV. ✓ Adult Dose: 1 gram/kg IV. 15. Octreotide: 50 or 100 µg / 0.5 ml. Octreotide antidote for hypoglycemia due to Sulfonylureas (oldest class of oral antidiabetic agents) toxicity. ✓ Adults & pediatric dose: ▪ IV 5-10 µg/kg/24 hr, OR 50 µg SC q 12 h. 16. Digoxin Fab: Digoxin Fab antidote for digoxin toxicity. ✓ Pediatric Dose: 1–2 vials IV. ✓ Adult Dose: 5–10 vials. 17. Glucagon: vial  Glucagon antidote for Calcium channel blockers & β-Blockers toxicity. ✓ Pediatric Dose: 50 – 150 mcg/kg IV. ✓ Adult Dose: 3–10 mg IV. 18. Methylene blue: Methylene blue antidote for Oxidizing toxins (e.g., nitrites, benzocaine, sulfonamides). ✓ Adult & Pediatric Dose: 1–2 mg/kg IV. ✓ Neonates: 0.3–1.0 mg/kg IV. 19. Pyridoxine: Pyridoxine antidote for Isoniazid, Hydrazine & Gyromitra esculenta toxicity. ✓ Adult & Pediatric Dose: Gram for gram if amount isoniazid ingested is known. 19 ▪ Pediatric Dose: 70 mg/kg IV (maximum 5 grams). ▪ Adult Dose: 5 grams IV. Page  Crash Cart 2 - FIRST DRAWER (Drugs) F. Other drugs: 1. Streptokinase (original) 1.500000 u vials, Use thrombolysis in: Acute myocardial infarction with ST segment elevation myocardial infarction (STEMI): Streptokinase 1.500000 u with 50 cc Isotonic NS by Syringe-pump infusion  during one hour with monitoring BP & HR/10 minutes if there is no contraindication. Pulmonary embolism: 1.500000 u with 50 cc Isotonic NS by Syringe-pump infusion start infusion 250,000 u over 30 minutes (8.3 mL/h) , then 100000 u every 1 hour for up to 24 hour (3.3 mL/h), duration is adjusted according to condition with monitoring of clotting parameters. Thick & located empyema pleural effusions post chest tube: injected by thoracic surgeon, pulmonologist, or interventional radiologist into the pleural space in an attempt to dissolve adhesions and allow fluid to drain freely. 2. KCL: 20 mEq/5ml. 3. Heparin: 25000 IU. 4. Enoxaparine (Enclex): 40 mg or 60 mg 5. Transexamic acid: 500 mg 6. Vit K (Phytonadione): 1 mg/0.5 mL or 10 mg/1 mL 7. Dicynone: 250 mg/2 mL 8. Dexamethasone: 8mg/1ml. 9. Diphenhydramin AMP (Anti allergic) 10. Lasix: 20mg 11. Nitroglycerine: (Nitroprusside) 50mg/10ml. 20 12. Phenylephrin: AMP Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 1. Airway adjuncts: multiple size. ▪ Oropharyngeal airways (OPA). ▪ Nasopharyngeal airways (NPA). NPA are called "trumpets’’ Oropharyngeal airways (OPA) Nasopharyngeal airways(NPA) ▪ Characteristic of OPA : ▪ Characteristic of NPA : 1. Rigid & soft tube. 1. It's “soft rubber or silicone”. 2. Has a channel from the lips 2. Has a channel to allow for to the posterior pharynx patient to take breath. through the middle or along the sides to allow for patient to take breath and suctioning of oral secretions. 21 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: Nasopharyngeal airways(NPA) 1. Airway adjuncts: multiple size. Indication of NPA: ▪ Oropharyngeal airways (OPA). 1. Unresponsive or semiconscious ▪ Nasopharyngeal airways (NPA). patients with gag reflex. 2. Patients who will not tolerate to Oropharyngeal airways (OPA) OPA. Indication of OPA: 1. Unresponsive or semiconscious  Some doctors use a NPA to dilate the patients without cough or gag nasal passages for 20 to 30 minutes reflex. Why??? before nasotracheal intubation. 2. Unconscious patient with difficult bag/mask seal. Contraindications of NPA: Patient with 3. Patient with seizure. Why??? 1. Nasal bleeding. 4. Intubated Patient with teeth. 2. Past history of fractured nasal Why??? bone  Resistance of insertion. 5. Intubated Patient with severe 3. Coagulation disturbance. secretion from mouth. 4. Suspected basilar skull fractures. Contraindications of OPA: 5. Nasal trauma (facial trauma). 1. Conscious patients OR any patient 6. Nasal deformity (patient with nasal has gag reflex or cough. polyp)  Resistance of insertion. 22 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 2. Suction catheters: multiple size (6 Fr., 8 Fr., 10 Fr, 14 Fr) Rigid pharyngeal suction tips Fixed Portable Hand-operated Non-rigid plastic catheters Apply Suctioning if there is no contraindications such as: ▪ From nose: Basal skull fracture, Epistaxis, Bleeding disturbance. ▪ From oral: Severe laryngospasm, Epiglottis. 60 – 120 mm Hg 5 – 15 Sec.  20 5 Power of suctioning Time of suctioning 23 Infants (60-80), children (80-100) & adult (100-120) Infants (5), children (10) & adult (15) Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 3. Magill forceps: For removal foreign body (FB). 4. Tongue blades (tongue depressor). 5. Stethoscope. 6. Endotracheal tube (ETT): Types of Endotracheal tube : A. Disposable ETT: ▪ Endotracheal tube cuffed & un-cuffed. ▪ High volume Low pressure cuff. ▪ Endotracheal tube without cuff. B. Reusable ETT : cuffed & un-cuffed. ▪ With cuff Low volume High pressure cuff. 24 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 7. Laryngoscope handle with multiple size blades: curved (Macintosh): 0 – 4 ; straight (Millar): 0 – 4 , and Laryngoscope handle multiple size ; spare bulbs & batteries for Laryngoscope. Spare bulbs 25 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 8. Stylet & Bougie (gum elastic bougie): 9. ETT tube holder. 26 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 10. Pulse oximeter : with pediatric and adult probes. ▪ Indications for Pulse Oximetry: 1. Should be routine vital sign for measurement of oxygen satiation. 2. Monitoring oxygen therapy. ▪ Sensors for Pulse Oximeters and according to location: A. Re-usable sensor for adults only, attached to a finger. B. Single-use adult sensor, attached to a finger. Or bridge of nose C. Re-usable for adults and pediatric, attached to earlobe. D. Single-use pediatric sensor, attached to a toe. 11. End-tidal CO2 monitoring device. 27 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 12. Non-visualized advanced airways (supraglottic device): ▪ Laryngeal Mask Airway (LMA) multiple size according to body weight. ▪ Combitube: multiple size. There's only size for adults > 14 years old (Or ≥ 4 foot tall). 28 Size 37 for 4– 5,5 feet tall & Size 41 for > 5,5 feet tall. Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) A. Airwa management equipment's: 13. Cricothyrotomy devices: 1. Needle cricothyrotomy. 2. Surgical cricothyrotomy  Traditional & Melker Cricothyrotomy 14. Tracheostomy tube multiple size. 29 Page  Crash Cart 2 - SECOND DRAWER (Airwa management equipment's ) 9. Oxygen therapy devices: T-piece BVM A. Bag-valve-mask (BVM): multiple size. B. Non-rebreathing mask: multiple size. C. O2 Nasal cannula. D. Simple face masks: multiple size. E. T-piece. F. Tracheostomy mask: multiple size. Tracheostomy mask 30 Page  Crash Cart The FiO2 depend on: 1. The flow rate of oxygen. 2. The patient’s respiratory flow rate and tidal volume. ▪ Lowe flow O2 devices: all Clear, multiple size for infant, child, and adult. 1. Rebreathing Mask. 2. Nasal cannulas. 3. Simple oxygen masks. ▪ Flow rate: 6–10 L/min. ▪ Partial rebreather 6 -10 L/m FIO2 35–60% ▪ Flow rate: 1–4 L/min. ▪ 6 – 10 L/minute FIO2 35% - 60%  FiO2 ▪ Rebreather 6 -10 L/m FIO2 40% to 70%. ▪ 6 L/minute FIO2 44%  FiO2 increases for each ≈ 6% ▪ Need tight seal. increases 4% for each L/min. ▪ 10 – 15 L/minute that is not ensures oxygen constant. ▪ 10 - 15 L 70% to 80%. ▪ Doesn’t need tight seal.  Use: Mild or no respiratory 31  Use: Mild-moderate respiratory distress or distress or oxygenation problem. oxygenation problem. Page  Crash Cart 32 Page  Crash Cart ▪ High flow O2 devices: all Clear ,multiple size for infant, child, and adult. 1. Bag valve mask (BVM). BVM 2. Non-Rebreathing Mask. Bag-mask device (manual 3. Venturi mask with Venturi Barrels. resuscitator), self-inflating 4. Tracheostomy Masks. (infant size: 250mL , child ▪ 10 - 15 L / min FIO2 100%. size: 450 mL and adult size: 5. T-piece. 1000 mL(. ▪ 4–10 L/min FIO2 80%. ▪ Flow rate: 8–15 L/min. ▪ It is can be adjusted to 24%, 28%, 31%, 35% & 40% using a flow rate of 4 - 8 L/min & providing FIO2 24% to 40%. While flow rate 8 – 15 L/min FIO2 40% - 60%) ▪ 9 L/minute FIO2 80%. ▪ blue jet provides 24% FIO2 when 4 L/min is delivered from the oxygen source, and ▪ 10 - 15 L / min 85%. from the white jet providing 28% FIO2 at 4 L/min, until the green jet providing FIO2 ▪ Use: Moderate-severe 60% at 15 L/min. respiratory distress or ▪ Use: Patients at risk of hypercapnic respiratory failure or paraquat poisoning. oxygenation problem. T-piece Requires tight fitting mask ▪ 4–10 L/min FIO2 24% -100% 33 Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 1. Intravenous (IV) Line multiple size. 34 Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 2. Central Venous Line multiple size (4.0F– 7.0F). 35 Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 3. CVP measurement. 3-way I.V. solution bottle stopcock Manometer 36 Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 4. Intraosseous needles or device. Bone injection gun (BIG) Sur-Fast needle EZ-IO FAST1- IO Infusion System ▪ IO sytems used for securing emergency vascular access via bone medullary cavities: FAST1-IO used in approximately 1.5 cm below the sternal notch only. 37 BIG-IO & EZ-IO are most widely used in the proximal tibia. Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 4. Intraosseous needles or device. 38 Page  Crash Cart 3 - THIRD DRAWER for Circulation (IV supplies) 5. Infusion Bag Pressure. Pressure Bag 6. Alcohol swabs. 7. Blood sets, IV fluid sets & tree way. 8. Blood sampling tubes. 9. Syringes multiple size. 10. Bedside Glucometer with strips. Pressure Bag 11. Thermometers. 12. Blood Pressure Device (Sphygmomanometer) with appropriate cuffs for neonatal, infant, child and adult. 39 Page  Crash Cart 4 - FOURTH DRAWER for Circulation IV solutions 1. Ringers Lactated 500 ml 4 liters. 2. Normal saline 500 ml 4 liters. 3. D5W or DNS 500 ml 2 liters. 40 Page  Crash Cart 5 - FIFTH DRAWER for Cardiac, Chest Procedures 1. Defibrillator Electrodes. 2. Lubricant (gel). 3. Shaver. 4. Portable pacemaker (temporary pacemaker) with Bipolar lead wire & Sheath Catheters. 41 Page  Crash Cart 5 - FIFTH DRAWER for Cardiac, Chest Procedures 5. Chest Tube multiple size with Under-water seal OR with Heimlech Valve & Chest Drainage Bag. Underwater seal Heimlech Valve 42 Chest Drainage Bag Page  Crash Cart 5 - FIFTH DRAWER for Cardiac, Chest Procedures 6. Occlusive dressing. Occlusive dressing (A Square gauze taped on only 3 sides can be applied while preparing for chest tube insertion.) To prevent tension pneumothorax. 7. Needle decompression sheath. 8. Towel for control flail Chest. Asherman chest seal 43 Page  Crash Cart 5 - SIXTH DRAWER for Dressings & body substance isolation 1. Personal protective equipment. 44 Page  Crash Cart 5 - SIXTH DRAWER for Dressings & body substance isolation 2. Drainage Sheet, Emesis Basin (kidney dish), Tourniquet, sterile gloves, Antiseptic solution, Battery-powered cautery, irrigating syringe with splash protector, 45 Page  Crash Cart 5 - SIXTH DRAWER for Dressings & body substance isolation 3. Dressing set : Needle holder, Scissors, Clamp Forceps (Tissue forceps/Hemostatic Forceps/Towel Forceps) & scalpel (Knife). 46 ▪ The size of instruments must be proportionate to the tissue. Page  Crash Cart 5 - SIXTH DRAWER for Dressings & body substance isolation 4. SUTURES Materials. ▪ Non-absorbable: Less infection Used with tissue characterized by prolong healing  Skin, Tendon. More infection ▪ Absorbable: Used with tissue characterized by fast healing  Peritoneal, Liver, Intestinal, Rounding Cutting Muscles, urinary bladder. ▪ 3,2,1,0: Used in fascia & Skin of palm, sole & back. ▪ -1,-2,-3: Most common at other parts of skin. ▪ -4,-5: Used in face commonly & can be used in ear & nose. 47 ▪ -6,-7: B.V. ▪ Page -8,-9,-10: Ophthalmology.  Crash Cart 5 - SIXTH DRAWER for Dressings & body substance isolation 5. Dressing Wound equipment: Bandage, adhesive dressing, palster, sterile gauze 4 X 4, Vaseline gauze, packing gauze.. 48 Page Crash Cart Crash Cart  Thank you for attention ,,, 15-Oct-24 DrMohammmed Senana 2  Have a great day DrMohammmed Senana 15-Oct-24 3