Crash Cart

Crash Cart Hatem Alsrour  Nursing College King Saud University

OUTLINE 1. 2. 3. 4. 5. 6. 7. 8.

Definition of crash cart Content of crash cart Definition of defibrillation/Cardioversion. Purposes of defibrillation. defibrillation procedure. Complication of defibrillation. Nurses responsibilities. Defibrillation vs. Cardioversion

OBJECTIVES By

the end of this lecture the student will be able to: 1. 2. 3. 4. 5. 6.

Define crash cart. List the content of crash cart. Define defibrillation/Cardioversion. List the purposes of defibrillation. Demonstrate understanding of defibrillation / Cardioversion procedure. 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 Suction

equipment Needle box Examination gloves Oxygen tank

Monitor and Paddles

Suction Apparatus

Needle Boxes

Oxygen Canister

Airway Equipment Intubation

equipment 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 To

eradicate life-threatening ventricular fibrillation or pulse less ventricular tachycardia.

To

restore 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 predispose 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