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CRASH CART
FAMILIARIZATON
& ARRYTHMIAS
E.R. STAFF
 Define the term crash cart
 Understand the purpose of crash cart
 Identify the content of crash cart, their use
and th...
 A crash cart or code cart is a special mobile
unit with drawers used in health care
facilities and emergency rooms that ...
 The purpose of the crash cart is to have a
portable life saving unit that contains all the
medications, supplies and equ...
1. Crash cart must be checked by head
nurse/staff nurse every shift and document in
checklist
2. Standarization must be ma...
 Top shelf
 Defibrillator and manual
 spO2 probe
 ECG strips
 Ultrasound jelly for DC Shock
 Checklist
 Right side
...
 Top Slide
Penlight
Stylet
Scissors
Magills forcep
Extra battery
Lidocaine Gel
Curve/straight forcep
Laryngoscope...
 Chest leads
 Chest electrodes
 Conductive gel
 ECG recording paper
 Defibrillator paddles
To know the rhythm and or...
First Drawer
EMERGENCY DRUGS
 Adenosine
 Adrenaline
 Amiodarone
 Aminophylline
 Atropine
 Calcium Chloride
 Dexamet...
AIRWAY/BREATHING
Oxygen mask (Adult/Pedia)
Nasal cannula/cath
Adul/pedia neb. Kit
ETT all sizes
LAMA
Stylet
Nasopha...
CIRCULATION
 IV Set
 IV cannula all sizes
 3way stopcock
 Foley catether
 NGT all sizes
 Blood transfusion set
 Syr...
 IV Fluids
 RL
 NS
 D5W
 D5NS ½
 D5NS ¼
 D5NS
 D10
 HUMAN PLASMA
 ALBUMIN
 MANNITOL
 EXTRA AMBUBAGS
FRONT SIDE...
Adenosine
 Antiarrhythmic
 Conversion to sinus rhythym of paroxysmal
supraventricular tachycardia
 Dose: 6mg by rapid ...
AMIODARONE (antidysrhythmics, 3rd)
-malignant Ventricular Arrythmia, V-Fib/Pulseless V-
Tach
-markedly prolongs action po...
Atropine Sulfate
 Parasympatholytic
 Anticholinegic
 Antidote for organophosphate poisoning
 Agent used for symptomat...
DOBUTAMINE
-inotropic agents
-low cardiac output and CHF
-0.5-1 mcg/kg/min IV initially, then 2-20 mcg/kg/min; not
to exc...
D50W (glucose-elevating agents)
-hypoglycemia
-10-25g (20-50ml 50% solution)
-high concentrations should be administered ...
CALCIUM GLUCONATE
-antidote, calcium salts
-hypocalcemia (hypocalcemic tetany, hypoparathyroidism)
cardiac arrest (+ hype...
DEXAMETHASONE (corticosteroid)
-hormones and synthetic substitutes
-inflammation, cerebral edema and shock
-1-6 mg/kg IV ...
HYDRALAZINE (vasodilators)
-HTN crisis, CHF
-^ 10-50 mg IM, or 10-20 mg IV, repeat PRN
-may induce SLE-type syndrome
-D5W...
ISOPROTERENOL
-beta 1/beta2 adrenergic agonist
-V.A’s due to (AV) heart block, Adams-Stokes attacks,
cardiac arrests and ...
METHYLPREDNISOLONE (corticosteroids)
-allergic conditions, acute exacerbations of multiple sclerosis,
-dose: 10-250 mg IM...
PROCAINAMIDE (antidysrythmics, 1a)
- arrythmia,
- IM: 0.5-1g IM q4-8hr
- IV: loading dose 15-18 mg/kg; slowly over 25-30 ...
LIDOCAINE (anesthetics pre-med agents)
- Cardiac arrythmias: 1.1-5mg/kg, slow IV over 2-3mins
(3mg/kg total)
- IV, IO/ET....
Verapamil
 Antianginal
 Antiarrhythmic
 Antihypertensive
 Calcium channel blocker
 Therapeutic actions:
-inhibits th...
 Monitor patient carefully (BP, cardiac rythym, and
output)
 Protect IV solution from light
 Monitor patients with rena...
 Dose: IV Adult: 150mg loading dose over 10mins,
followed by 360mg over 6hr at rate of 1mg/min
 For maintenance infusion...
An arrhythmia is an irregular heartbeat - the heart may beat too
fast (tachycardia), too slowly (bradycardia), too early (...
The English word "arrhythmia" comes from the Greek word
rhymos, meaning "rhythm", the Greek suffix a (letter "a" added
to ...
 SUPRAVENTRICULAR
ARRHYTHMIAS
 -are tachycardias (fast heart rates) that starts in the
atria or atrioventricular (AV) no...
 VENTRICULAR ARRHYTHMIA
-Starts at the heart’s lower chambers, the ventricles.
They can be very dangerous and usually req...
 BRADYARRHYTHMIAS
-Occur if the heart rate is slower than normal. If the heart rate is
too slow, not enough blood reaches...
 Arrhythmia in children
 Children’s heart rates normally decreases as they get older. A newborn’s
heart beats between 95...
ARRHYTHMIAS
NON SHOCKABLE
PEA (Pulseless Electrical Activity)
Asystole (Silent Heart)
SHOCKABLE
VF (Ventricular Fibrillati...
Thank you!!!
Crash cart familiarizaton with Arrythmias
Crash cart familiarizaton with Arrythmias
Crash cart familiarizaton with Arrythmias
Crash cart familiarizaton with Arrythmias
Crash cart familiarizaton with Arrythmias
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familiarization of er's or any dept crash cart

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Crash cart familiarizaton with Arrythmias

  1. 1. CRASH CART FAMILIARIZATON & ARRYTHMIAS E.R. STAFF
  2. 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. 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. 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. 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. 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
  7. 7.  Top Slide Penlight Stylet Scissors Magills forcep Extra battery Lidocaine Gel Curve/straight forcep Laryngoscope Disposable razors Airway different sizes
  8. 8.  Chest leads  Chest electrodes  Conductive gel  ECG recording paper  Defibrillator paddles To know the rhythm and or delivering shock defibrillator
  9. 9. First Drawer EMERGENCY DRUGS  Adenosine  Adrenaline  Amiodarone  Aminophylline  Atropine  Calcium Chloride  Dexamethasone  Diazoxide  Digoxin  Dopamine  Sodium bicarbonate  Procainamide  Dextrose 50%  Dobutamine  Isoproterenol  Magnesium Sulfate  Methylprednisolone  Noradrenaline  Hydrocortisone  Furosemide  Calcium chloride  Potassium chloride  Propranolol  Verapamil  Vasopressin  Lidocaine 1% and 2%  Hydralazine
  10. 10. AIRWAY/BREATHING Oxygen mask (Adult/Pedia) Nasal cannula/cath Adul/pedia neb. Kit ETT all sizes LAMA Stylet Nasopharyngeal tubes Second Drawer
  11. 11. 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
  12. 12.  IV Fluids  RL  NS  D5W  D5NS ½  D5NS ¼  D5NS  D10  HUMAN PLASMA  ALBUMIN  MANNITOL  EXTRA AMBUBAGS FRONT SIDE  CARDIAC BOARD Lower Portion
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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.
  17. 17. 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.
  18. 18. 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
  19. 19. 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)
  20. 20. HYDRALAZINE (vasodilators) -HTN crisis, CHF -^ 10-50 mg IM, or 10-20 mg IV, repeat PRN -may induce SLE-type syndrome -D5W HYDROCORTISONE (corticosteroids) -status asmaticus, anti-inflammatory & immunosuppressive -Initial dose: 100mg -500mg PRN, may repeat q2, 4, 6hrs PRN
  21. 21. 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.
  22. 22. 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
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.
  26. 26.  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
  27. 27.  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
  28. 28. 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
  29. 29. 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.
  30. 30.  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
  31. 31.  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.
  32. 32.  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
  33. 33.  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.
  34. 34. ARRHYTHMIAS NON SHOCKABLE PEA (Pulseless Electrical Activity) Asystole (Silent Heart) SHOCKABLE VF (Ventricular Fibrillation) VT(Ventricular Tach Pulseless) TORSADES de Pointes Perfusing Rhythms (non-arrest rhythms) BRADYCARDIA Sinus Bradycardia Junctional rhythym Idioventricular Rhythym Artioventricular Block: 1st degree 2nd degree: Mobitz Type I Mobitz Type II 3rd degree (Complete Heart Block) TACHYCARDIAS: NARROW QRS Regular Rhythym: Sinus tacycardia Atrial flutter Supraventricular Tachycardia Junctional Tachycardia Irreguar Rhythyms: Atrial flutter Atrial Fibrillation Multifocal Atrial Tachycardia TACHYCARDIAS : WIDE QRS Regular Rhythym: Ventricular tachycardia: monomorphic Irregular Rhythym: Ventricular Tachycardia: polymorphic Torsades de Pointes
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