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