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A crash cart - is a special cart (with drawers) containing e

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wejdan ali

on 8 October 2013

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Transcript of A crash cart - is a special cart (with drawers) containing e

Outlines :
what is the crash cart ?
Contents :
The policy :


A crash cart is the trolley for storing lifesaving equipment and drugs in a hospital emergency room, intensive care unit, clinics and other areas.

The cart is characterized by being easily movable and readily accessible into all sides of the cart for quickly viewing and removing equipment and drugs during a crisis situation..

Triggers
Foods
Anaphylaxis
Insect stings
Contrast agents
Medication
Peanuts are the leading cause of food-related anaphylaxis, accounting for more than half of all cases.
Other foods known to trigger anaphylaxis include:
various types of nuts, such as walnuts, cashew nuts, almonds, brazil nuts and hazel nuts
milk
fish
seafood
eggs
some types of fruit, such as bananas, grapes and strawberries
While any insect has the potential to trigger anaphylaxis, the vast majority of cases are either caused by bee or wasp stings.
It is estimated that around one in 100 people will experience an allergic reaction after a bee or wasp sting, but only a small minority of these people will go on to develop severe anaphylaxis.
Types of medication known to trigger anaphylaxis in a small amount of people include:
antibiotics, particularly penicillin-like antibiotics
medications used to put people to sleep before they have surgery (general anaesthetic)
non-steroidal anti-inflammatory drugs (NSAIDs), a type of painkiller that includes ibuprofen and aspirin
http://www.nhs.uk/Conditions/Anaphylaxis/Pages/Causes.aspx
a serious allergic or hypersensitivity reaction that is rapid in onset and may cause death .

The Managment :
contents :

Anaphylactic kit
• 1 Page of “Drug Management Guidelines for Management of Suspected Anaphylactic shock in Children and Adults” (taped to the inside of the box lid) .

. Another page taped outside the kit shows the contents , the first expired drug , the preparing date , who prepared it and checked by who and the signature .

• 3 x 1 mL ampoules of Epinephrine (1:1000 aqueous solution)
• 1 x 1 mL vials of Diphenhydramine (50 mg/mL)
• 3 x 2.5 ml Ventolin nebulizer solution (5 mg / 2.5 ml )
• 1 x 2 ml Ranitidine injection (50 mg / 2 ml )
• 1 x Methylprednisolone Sodium Succinate injection (500ml / vial)
• 1 x Glucogon syringe ( 1 mg )
• 2x 10 ml NS for injection
• 2x 500 ml NS IV bag

• 2x IV line set

• 3 x (1 mL , 3 ml , 5 ml , 10 ml ) syringes

• 3 x Needle 18 gauge 5/8''

• 3 X filter needle 19 gauge

• 1 pocket mask

• 10 alcohol swabs

• Sphygmomanometer (optional)

• Stethoscope (optional)

• Up to date contact information for the Public Health Supervisor and Medical Officer(s) of Health.
The kits can be stored at room temperature and should be closed with an elastic to ensure the drugs are not exposed to light which can cause them to deteriorate.
Additionally, the kits require regular verification to replace drugs before the expiry date by the pharmacy department .
the net quantity of the kit contents is more than 40 , it is a huge number to place them all in a 15x25x30 cm in size kit , so it must be organized properly and efficiently to make everything clear and easy to get for the nurse . because we are talking about a life threatening situation .

Treatment is directed at limiting the absorption of
noxious material and by countering the adverse
reactions. The ABCD’s of resuscitation should be
followed while simultaneously calling 997 .
The ABCD’s refer to:
A – airway
B – breathing
C – circulation
D – drug treatment
Adult
Pediatric
Prepared by :-
Pharm.D. candidates ,
Wejdan Makki & Heba Qunq


CRASH CART AND ANAPHYLACTIC KIT
Supervised by :-
Dr. Khaled Al-shahrani

pharmacy department

*what is a crash cart ?
* the policy of using crash cart .
* the content & arrangement .





Arrangement of medicines and equipment in crash cart is different from different institutions based on their policy.
A Licensed Staff member as designated by the head of the department is responsible for checking the crash cart, oxygen cylinder levels, defibrillator, and documenting compliance on crash cart checklist.
Each emergency cart is equipped with a lock and kept locked unless in use.
If the lock is not intact, the cart is to be checked and unit personnel will replace any missing supplies.
Pediatric equipment (common pediatric drugs, intubation equipment, etc.)

Bag Valve Masks (BVMs)
of different sizes

Monitor/defibrillators



TYPES OF CRASH CART :-

BASED ON AGE OR DEVELOPMENTAL VARIATION

Adult Emergency Crash Cart
Pediatric Emergency Crash Cart
Newborn Intensive Care Crash Cart


Advanced Cardiac Life Support (ACLS) drugs such as epinephrine, atropine, amiodarone, lidocaine, sodium bicarbonate, dopamine, and vasopressin
Drugs used for the treatment of common problems such as: adenosine, dextrose, diazepam or midazolam, epinephrine for IM use, naloxone, nitroglycerin, heparin, Frusemide , vecuronium , Lorazepam etc.) and others
Drugs for rapid sequence intubation: Succinylcholine or another paralytic, and a sedative such as etomidate or midazolam; endotracheal tubes and other intubating equipment
Drugs for peripheral and central venous access

Crash cart is a specially designed trolley, used for transporting and dispensing medicines and equipments at the emergency site for participating in life saving measures. Crash carts are located in areas of patient care in case of a life-threatening occurrence.
Physicians, nurses, pharmacists, and respiratory therapists must become familiar with the contents of this cart. It contains necessary equipments to handle an emergency situation. A crash cart is enabling healthcare providers to manage medical emergencies easily and confidently.

conclusion :

• Respiratory: Dyspnea, chest tighness, wheezing, cough, stridor
• Skin: Urticaria, angioedema, generalized itch, flushing
• Eye/Nasal: runny nose, red eyes, congestion, sneezing
• Vascular: Hypotension, chest discomfort, dizziness, syncope, headache.

• Other: Difficulty swallowing, abdominal pain, nausea, emesis, diarrhea, diaphoresis, apprehension
crash cart /anaphylactic kit documents , in-patients pharmacy detp. , NGH.
https://www.google.com.sa/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CDAQFjAA&url=http%3A%2F%2Fwww.gov.mb.ca%2Fhealth%2Fpublichealth%2Fcdc%2Fprotocol%2Fanaphylactic.pdf&ei=CAZBUoaNJ8jbtAaJiICgAQ&usg=AFQjCNFqCq62SiFY5tu1uG2aRCP4li8sQg
http://ar.scribd.com/doc/132235513/Crash-Cart-pptxvv
http://www.slideworld.com/slideshow.aspx/crash-cart-Items-in-Hospital-2773054
http://medical-dictionary.thefreedictionary.com/crash+cart
http://www.mrcrashcart.com/products.php?cat=7
crash cart contents
Crash cart www.wikipedia.com
UC Davis Health System standard crash cart www.ucdmc.ucdavis.edu

References :
the end

2000 deaths/per
When the anaphylaxis is suspected ?
the death from the allergy to medication is the most common cause
Rx/dose
date.
sig
The outlines :
Introduction to the anaphylaxis
When the anaphylaxis is suspected ?
The management
the contents of the anaphylaxis kit
Crash cart is checked every shift and recorded.
Defibrillator load checks will be performed every shift with the defibrillator plugged in and unplugged .
All carts will be opened and checked for contents once monthly and following each use. Sterile items will be checked for package integrity and expiration date. Items with expiration dates expiring within the month will be replaced. The medication drawer will not be opened if it is sealed and intact.

Laryngoscopes will be checked prior to placement on the cart and monthly.

Oxygen cylinders are replaced when the tank has emptied.

Drawers of crash carts are to be clearly labeled to identify contents.

Special procedure trays are kept on the bottom shelf.


Different types of arrangements are following:
1). based on the airway, breathing, circulation and
2.) based on the need and necessity of medicines and equipment

#Drawer 1- Medications- Adenosine, Amiodarone, Epinephrin, Magnesium Sulfate, Atropin…etc
#Drawer 2 - Breathing and Airway-
Ambu bag O2 Nasal cannulae, Oral airways, Intubation tray, suction catheters, Endotracheal tubes, Tracheostomy tubes, Inner cannulae,….etc
#Drawer 3 – Circulation:
IV supplies,3-Way, Blood set, ABG kits, heparinized aspirators, Needles, Alcohol swabs, Syringes….etc
#Drawer 4-Circulation: IV solutions and tubing-
RL, NS, D5W, IV Tubing, Macro & Micro drip, Extension tubing, Blood pump tubing, Arm boards: long & short…etc
#Drawer 5- Cardiac, Chest Procedures-
ECG electrodes, Restraints, Sterile gloves, Masks with face shields or masks and eye protection, Scalpels with blades, Dressings, drain sponge, Betadine solution, Sutures, silk with needle, Cardiac needle, Sterile towels,3 - lumen Central Venous Pressure catheter kit, Chest tubes….etc

BASED ON AIRWAY, BREATHING AND CIRCULATION
1. Medicines
It is again classified based on the priority-first, Second and Third priority medicines.
2. Equipments
3. IV fluids
4. Open tray on the top-Disposable syringes, IV cannulae, Needles, Defibrillator
5. Bottom of crash cart-Plastic apron, Intubation tray, Intubation pillow,

Commonly on the top of the Crash Cart we can place Defibrillator, Inventory Checklist/ Code Blue sheets. On the side of the Crash Cart we can find an Oxygen Cylinder and al so we can find a Cardiac Board.

BASED ON THE NEED AND NECESSITY OF MEDICINES AND EQUIPMENTS
Now a day’s different types of crash kits are also available it contain different emergency drugs, oxygen system, Ambu disposable resuscitator and manual suction unit. This types of crash kits help us to deliver ACLS measures outside the hospital settings also.



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