Crash Cart
Hatem Alsrour Nursing College
King Saud University
OUTLINE1. Definition of crash cart2. Content of crash cart3. 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
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) Insertion Kit
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
Cardioversion is 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