عربة الطوارئ (crash cart )
ADULT EMERGENCY DRUGS
(Based on ACLS guidelines)
ADENOSINE Antiarrhythmic in PSVT: 6 mg rapid IV push, if no response in 1-2 minutes, administer dose of 12mg, repeat 12 mg dose a second time if required
AMIODARONE Antiarrhythmic: Loading dose: 150mg Amiodarone IVP (up to 300mg IVP for cardiac arrest from VF/VT after multiple shocks) for life threatening arrhythmia. 150mg Amiodarone may be mixed in 100cc D5W and infused over 10 minutes or given IVP. Follow with IV infusion upon arrhythmia resolution
IV infusion: 450mg. Amiodarone in 250ml D5W. Initial infusion 1gm/min-x 6 hours (33ml/hr x 6 hours). Decrease infusion to maintenance dose of 0.5mg/min (17ml/hr).
ATROPINE Agent used for symptomatic bradycardia, PEA: 0.5-1 mg IV push, repeat at 3-5 min. Intervals to max. Total dose of .04 mg/kg. May be given via endotracheal route. Stocked 1 mg/10 ml.
DEXTROSE Antihypoglycemic: 10 to 25 gms. IVP. Repeat dose as required in severe cases depending on symptoms and blood glucose levels.
DOBUTAMINE Vasopressor: IV infusion: 500 mg Dobutamine in 250 ml IV solution. Usual dose 2-5mcg/kg/min. May titrate to upper dose of 20mcg/kg/min. Primarily stimulates B-1 receptors in the heart and is used for inotropic support with mild chronotropic effect. Adequate hydration of patient imperative in blood pressure support. When mixing more than 500mg. Dobutamine in IV solution, equal volume must be removed (e.g. 1gm/40ml Dobutamine, remove 40ml from IV solution).
DOPAMINE Vasopressor, IV infusion: Usual dose in code situation is 5-20mcg/kg/min. Renal perfusion dosing 2-5mcg/kg/min, increase of cardiac output 5-10mcg/kg/min and peripheral vasoconstriction 10-20mcg/kg/min. As approaching 20mcg/kg/min assess urine output. Extravasation treatment is with phentolamine. Adequate hydration of patient imperative in blood pressure support. Premix drip of 400 mg Dobutamine in 250 ml IV solution.
EPINEPHRINE Adrenergic agent of choice for cardiac arrest, vasopressor used in Pulsless VT/VF, Asystole and PEA: 1 mg IV every 3-5 min. Or more frequently. May be given endotracheal route.
Stocked 1 mg/10 ml 1:10,000. If using for hypersensitivity reaction 0.1-0.25mg SQ, SIVP.
IV infusion, mix 1 mg in 250 ml IV solution. Start at 1 mcg/min. (15 cc/hr.), each 15 cc/hr. = mcg/min.
Stocked 1 mg/1 ml in 1ml single dose ampules and 30ml multidose vials. Bristojects are 1mg/10ml.
ETOMIDATE Induction of rapid hypnosis (non-barbiturate) usual dose 0.2-0.6mg/kg IVP immediately prior or during intubation.
FLUMAZENIL Antidote for benzodiazepine: Initial dose 0.2mg administered IV over 15 seconds. If desired level of consciousness is not obtained after waiting additional 45 seconds, second dose of 0.2mg may be administered. Repeat at 60-second intervals as necessary to a maximum total dose of 1mg. Individualize the dose based on patient response.
LIDOCAINE Antiarrhythmic: Bolus: 1-1.5 mg/kg IV push initial bolus. Repeat doses of 0.5-1 mg/kg at 5-10 min. intervals if needed until total dose of 3 mg/kg for cardiac arrest from VF/VT that persists after multiple shocks. May be given via endotracheal route. Follow with IV infusion if effective in arrhythmia resolution.
IV infusion: use-premixed bag of 2 Gm in 500 cc D5W.
1-4 mg/min. (1mg/min = 15cc/hr of premix Lidocaine drip).
MAGNESIUM In cardiac arrest: 1-2 gm. (diluted in 10ml D5W or NS) IVP in torsades de pointes or when it is suspected that the arrhythmia is caused by a hypomagnesemic state.
NALOXONE Antidote for opiate narcotics: Initial dose of 0.4mg to 2mg. IV; may repeat IV at 2 to 3 minute intervals. If no response is observed after 10mg has been administered, question the diagnosis of narcotic induced or partial narcotic induced toxicity. Can also be given IM, SQ
NOREPINEPHRINE Vasopressor, IV infusion: mix 4 mg in 250-cc IV solution (in D5W only). Usual dose 2-12 mcg/min to titrate for blood pressure control. Monitor urine output. Adequate hydration imperative in blood pressure control.
PROCAINAMIDE Antiarrhythmic: Bolus: 100 mg IV every 5 min. (or at a rate of 20mg/minute
IVSP) until one of the following observed: 1) arrhythmia suppressed; 2) hypotension ensues; 3) QRS complex is widened by 50% of its original width; 4) a total of 17 mg/kg. If effective administer IV infusion.
IV infusion: 1 gm Procainamide in 250 ml IV solution.
Stocked 1 gm/10 ml.
Range: 1-4 mg/min. (1mg/min = 15cc/hr).
SODIUM BICARBONATE Alkalinizer used in ****************bolic acidosis: Should be used, if at all, only after application of definitive and better substantiated interventions and drugs. 1 mEq/kg IV push.
Repeat doses are usually 0.5 mEq/kg, based on ABG results.
Stocked 1 mEq/1 ml 10ml and 50ml Bristojects.
VASOPRESSIN Antidiuretic hormone, vasoconstrictor: 40U as a single, one-time bolus. Alternative agent to epinephrine, vasopressin is used in persistent or recurrent VT/VF for vasoconstriction and increasing blood flow to the brain and heart during CPR. Use epinephrine to follow up in 10 minutes if there is no response to vasopressin.
VERAPAMIL Calcium channel blocker: 5 mg IV push given over 1 min.
Repeat in 30 min. if needed, increasing to 10 mg.
Stocked 5 mg/2 ml
****************************s of Meds Drawer:
ADULT CRASH CART MEDICATIONS
ADENOSINE 6mg/2ml VIAL 5
AMIODARONE 150mg/3ml AMPULE 5
DIPHENHYDRAMINE 50mg/ml VIAL 1
EPINEPHRINE 1mg/ml 30ml MDV 1
FLUMAZENIL 0.5mg/5ml VIAL 1
MAGNESIUM SULFATE 1 gm/2ml VIAL 2
METHYLPREDNISOLONE 125mg/2ml VIAL 2
NALOXONE O.4mg/ml 1ml AMPULE 4
NITROGLYCERIN 50mg/10ml VIAL 1
NITROPRUSSIDE 50mg VIAL 1
NOREPINEPHRINE 4mg/4ml AMPULE 1
PROCAINAMIDE 1 gm/10/mL VIAL 2
VASOPRESSIN 20U/ml 1ml VIAL 2
VERAPAMIL 5mg/2ml VIAL 2
SODIUM CHLORIDE 0.9% 10ml FLUSH SDV 3
DOBUTAMINE 500mg/250ml D5W PREMIX DRIP 1
DOPAMINE 400mg/250ml D5W PREMIX DRIP 1
(IF PHARMACY IS UNABLE TO OBTAIN PREMIX DRIPS WE WILL STOCK WITH:
2 X 200mg DOPAMINE VIALS (40mg/ml 5ml VIALS)
2 X 250mg DOBUTAMINE VIALS (12.5mg/ml 20ml VIALS)
LIDOCAINE 2gm/500ml PREMIX DRIP 1
BRISTOJECTS: WITH MALE LUER LOCK ADAPTERS:
ATROPINE 1mg/10ml SYRINGES 4
CALCIUM CHLORIDE 100mg/10ml SYRINGES 2
DEXTROSE 50% 50ml SYRINGE 1
EPINEPHRINE 1 mg/10ml SYRINGES 6
ETOMIDATE 2mg/ml 20 ml SYRINGE 1
LIDOCAINE 100mg/5ml SYRINGES 3
SODIUM BICARBONATE 1mEq/ml 50ml SYRINGE 2
________________________________________
****************************s of Drawer 2:
****************************s of Drawer 2:
DRAWER 2: BREATHING AND AIRWAY
AMBU BAG
O2 NASAL CANNULA
O2 FLOW METER WITH ADAPTER (X-MAS TREE)
ORAL AIRWAYS: ONE EACH 10mm, 9mm, 8mm
INTUBATION TRAYS (LARYNGOSCOPE HANDLE, STRAIGHT AND
CURVED BLADE, 10cc SYRINGE, LUBRICANT)
STYLET
2 C CELL BATTERIES
2 LARYNGOSCOPE LIGHT BULBS
2 PADDED TONGUE BLADES
ROLL 1” ADHESIVE TAPE OR PRE-MADE ET TUBE HOLDER
SKIN PROP WIPES OR BENZOIN
2 PAIR EXAM GLOVES
YANKAUER SUCTION CATHETER
2 #14 SUCTION CATHETERS SALUM SUMP TEBE, 16 FRENCH
LUBRICANT
STRAIGHT CONNECTOR
TOOMEY SYRINGE
ENDOTRACHEAL TUBES, 2 EACH SIZE: 6.0, 7.0, 7.5, 8.0, 8.5, 9.0
TRACHEOSTOMY TUBES, 1 EACH SIZE: ADULT SHILEY BLUE BOX: #4, #6, #8
INNER CANNULAS, 1 SIZE EACH: ADULT SHILEY BLUE BOX #4, #6, #8
(Portex is discontinued - unless special order for a patient)
1 END-TIDAL CO2 DETECTOR
________________________________________
****************************s of Drawer 3:
DRAWER 3: CIRCULATION: I.V.SUPPLIES
ANGIOCATHS 2 EACH: 14G, 16G, 18G, 20G, 22G
2 3-WAY STOPCOCKS
BLOOD TUBES: 3SST, 1 LIGHT BLUE, 1 LAVENDER
3 STERILE WATER 10cc VIALS
2 ABG KITS, 2 HEPARINIZED ASPIRATORS IN ICU’S
NEEDLES: 6- 18G, 6- 20G, 6- 22G, 3- 25G
ALCOHOL SWABS
TAPE
BUTTERFLIES, 2 EACH: 21G, 23G
2 I.V. START KITS
SYRINGES: 2- TB, 6- 3cc, 6-5cc, 6- 10cc, 2- 20cc, 1- 50cc
****************************s of Drawer 4:
DRAWER 4: CIRCULATION: I.V. SOLUTIONS AND TUBING
1 LACTATED RINGERS 1000cc
2 NORMAL SALINE 1000cc
2 NORMAL SALINE 250cc
2 D5W 500cc
2 D5W 250cc
1 D5W 500cc WITH LIDOCAINE .4% PRE-MIXED
I.V. TUBINGS:
2 MACRODRIP
3 MICRODRIP
2 HORIZON CASSETTES
2 EXTENSION TUBING
1 BURETROL
1 BLOOD TUBING
ARMBOARDS: 1 LONG, 1 SHORT
****************************s of Drawer 5:
DRAWER 2: CARDIAC, CHEST PROCEDURES
6 EKG ELECTRODES
RESTRAINTS
STERILE GLOVES, 2 PAIR EACH SIZE: SMALL, MEDIUM, LARGE
2 MASKS WITH FACE SHIELDS OR MASKS AND EYE PROTECTION
SCALPELS WITH BLADES
DRESSINGS: 4X4 10 PACK, 2- 4X4, 2- 4X4 DRAIN SPONGE, 2- 2X2
BETADINE SOLUTION
SUTURES, 2 EACH: 000 SILK WITH NEEDLE, 0 SILK WITH NEEDLE
CARDIAC NEEDLE 20G
STERILE TOWELS
PETROLEUM GAUZE
CUTDOWN TRAY
3 - LUMEN CVP CATHETER KIT
CHEST TUBES, 1 EACH: 28 FR, 32 FR
****************************s of Drawer 6:
SPECIAL PROCEDURE TRAYS:
TRACK TUBE
CUTDOWN TRAY
3 - LUMEN CVP CATHETER K
ADULT EMERGENCY DRUGS
(Based on ACLS guidelines)
ADENOSINE Antiarrhythmic in PSVT: 6 mg rapid IV push, if no response in 1-2 minutes, administer dose of 12mg, repeat 12 mg dose a second time if required
AMIODARONE Antiarrhythmic: Loading dose: 150mg Amiodarone IVP (up to 300mg IVP for cardiac arrest from VF/VT after multiple shocks) for life threatening arrhythmia. 150mg Amiodarone may be mixed in 100cc D5W and infused over 10 minutes or given IVP. Follow with IV infusion upon arrhythmia resolution
IV infusion: 450mg. Amiodarone in 250ml D5W. Initial infusion 1gm/min-x 6 hours (33ml/hr x 6 hours). Decrease infusion to maintenance dose of 0.5mg/min (17ml/hr).
ATROPINE Agent used for symptomatic bradycardia, PEA: 0.5-1 mg IV push, repeat at 3-5 min. Intervals to max. Total dose of .04 mg/kg. May be given via endotracheal route. Stocked 1 mg/10 ml.
DEXTROSE Antihypoglycemic: 10 to 25 gms. IVP. Repeat dose as required in severe cases depending on symptoms and blood glucose levels.
DOBUTAMINE Vasopressor: IV infusion: 500 mg Dobutamine in 250 ml IV solution. Usual dose 2-5mcg/kg/min. May titrate to upper dose of 20mcg/kg/min. Primarily stimulates B-1 receptors in the heart and is used for inotropic support with mild chronotropic effect. Adequate hydration of patient imperative in blood pressure support. When mixing more than 500mg. Dobutamine in IV solution, equal volume must be removed (e.g. 1gm/40ml Dobutamine, remove 40ml from IV solution).
DOPAMINE Vasopressor, IV infusion: Usual dose in code situation is 5-20mcg/kg/min. Renal perfusion dosing 2-5mcg/kg/min, increase of cardiac output 5-10mcg/kg/min and peripheral vasoconstriction 10-20mcg/kg/min. As approaching 20mcg/kg/min assess urine output. Extravasation treatment is with phentolamine. Adequate hydration of patient imperative in blood pressure support. Premix drip of 400 mg Dobutamine in 250 ml IV solution.
EPINEPHRINE Adrenergic agent of choice for cardiac arrest, vasopressor used in Pulsless VT/VF, Asystole and PEA: 1 mg IV every 3-5 min. Or more frequently. May be given endotracheal route.
Stocked 1 mg/10 ml 1:10,000. If using for hypersensitivity reaction 0.1-0.25mg SQ, SIVP.
IV infusion, mix 1 mg in 250 ml IV solution. Start at 1 mcg/min. (15 cc/hr.), each 15 cc/hr. = mcg/min.
Stocked 1 mg/1 ml in 1ml single dose ampules and 30ml multidose vials. Bristojects are 1mg/10ml.
ETOMIDATE Induction of rapid hypnosis (non-barbiturate) usual dose 0.2-0.6mg/kg IVP immediately prior or during intubation.
FLUMAZENIL Antidote for benzodiazepine: Initial dose 0.2mg administered IV over 15 seconds. If desired level of consciousness is not obtained after waiting additional 45 seconds, second dose of 0.2mg may be administered. Repeat at 60-second intervals as necessary to a maximum total dose of 1mg. Individualize the dose based on patient response.
LIDOCAINE Antiarrhythmic: Bolus: 1-1.5 mg/kg IV push initial bolus. Repeat doses of 0.5-1 mg/kg at 5-10 min. intervals if needed until total dose of 3 mg/kg for cardiac arrest from VF/VT that persists after multiple shocks. May be given via endotracheal route. Follow with IV infusion if effective in arrhythmia resolution.
IV infusion: use-premixed bag of 2 Gm in 500 cc D5W.
1-4 mg/min. (1mg/min = 15cc/hr of premix Lidocaine drip).
MAGNESIUM In cardiac arrest: 1-2 gm. (diluted in 10ml D5W or NS) IVP in torsades de pointes or when it is suspected that the arrhythmia is caused by a hypomagnesemic state.
NALOXONE Antidote for opiate narcotics: Initial dose of 0.4mg to 2mg. IV; may repeat IV at 2 to 3 minute intervals. If no response is observed after 10mg has been administered, question the diagnosis of narcotic induced or partial narcotic induced toxicity. Can also be given IM, SQ
NOREPINEPHRINE Vasopressor, IV infusion: mix 4 mg in 250-cc IV solution (in D5W only). Usual dose 2-12 mcg/min to titrate for blood pressure control. Monitor urine output. Adequate hydration imperative in blood pressure control.
PROCAINAMIDE Antiarrhythmic: Bolus: 100 mg IV every 5 min. (or at a rate of 20mg/minute
IVSP) until one of the following observed: 1) arrhythmia suppressed; 2) hypotension ensues; 3) QRS complex is widened by 50% of its original width; 4) a total of 17 mg/kg. If effective administer IV infusion.
IV infusion: 1 gm Procainamide in 250 ml IV solution.
Stocked 1 gm/10 ml.
Range: 1-4 mg/min. (1mg/min = 15cc/hr).
SODIUM BICARBONATE Alkalinizer used in ****************bolic acidosis: Should be used, if at all, only after application of definitive and better substantiated interventions and drugs. 1 mEq/kg IV push.
Repeat doses are usually 0.5 mEq/kg, based on ABG results.
Stocked 1 mEq/1 ml 10ml and 50ml Bristojects.
VASOPRESSIN Antidiuretic hormone, vasoconstrictor: 40U as a single, one-time bolus. Alternative agent to epinephrine, vasopressin is used in persistent or recurrent VT/VF for vasoconstriction and increasing blood flow to the brain and heart during CPR. Use epinephrine to follow up in 10 minutes if there is no response to vasopressin.
VERAPAMIL Calcium channel blocker: 5 mg IV push given over 1 min.
Repeat in 30 min. if needed, increasing to 10 mg.
Stocked 5 mg/2 ml
****************************s of Meds Drawer:
ADULT CRASH CART MEDICATIONS
ADENOSINE 6mg/2ml VIAL 5
AMIODARONE 150mg/3ml AMPULE 5
DIPHENHYDRAMINE 50mg/ml VIAL 1
EPINEPHRINE 1mg/ml 30ml MDV 1
FLUMAZENIL 0.5mg/5ml VIAL 1
MAGNESIUM SULFATE 1 gm/2ml VIAL 2
METHYLPREDNISOLONE 125mg/2ml VIAL 2
NALOXONE O.4mg/ml 1ml AMPULE 4
NITROGLYCERIN 50mg/10ml VIAL 1
NITROPRUSSIDE 50mg VIAL 1
NOREPINEPHRINE 4mg/4ml AMPULE 1
PROCAINAMIDE 1 gm/10/mL VIAL 2
VASOPRESSIN 20U/ml 1ml VIAL 2
VERAPAMIL 5mg/2ml VIAL 2
SODIUM CHLORIDE 0.9% 10ml FLUSH SDV 3
DOBUTAMINE 500mg/250ml D5W PREMIX DRIP 1
DOPAMINE 400mg/250ml D5W PREMIX DRIP 1
(IF PHARMACY IS UNABLE TO OBTAIN PREMIX DRIPS WE WILL STOCK WITH:
2 X 200mg DOPAMINE VIALS (40mg/ml 5ml VIALS)
2 X 250mg DOBUTAMINE VIALS (12.5mg/ml 20ml VIALS)
LIDOCAINE 2gm/500ml PREMIX DRIP 1
BRISTOJECTS: WITH MALE LUER LOCK ADAPTERS:
ATROPINE 1mg/10ml SYRINGES 4
CALCIUM CHLORIDE 100mg/10ml SYRINGES 2
DEXTROSE 50% 50ml SYRINGE 1
EPINEPHRINE 1 mg/10ml SYRINGES 6
ETOMIDATE 2mg/ml 20 ml SYRINGE 1
LIDOCAINE 100mg/5ml SYRINGES 3
SODIUM BICARBONATE 1mEq/ml 50ml SYRINGE 2
________________________________________
****************************s of Drawer 2:
****************************s of Drawer 2:
DRAWER 2: BREATHING AND AIRWAY
AMBU BAG
O2 NASAL CANNULA
O2 FLOW METER WITH ADAPTER (X-MAS TREE)
ORAL AIRWAYS: ONE EACH 10mm, 9mm, 8mm
INTUBATION TRAYS (LARYNGOSCOPE HANDLE, STRAIGHT AND
CURVED BLADE, 10cc SYRINGE, LUBRICANT)
STYLET
2 C CELL BATTERIES
2 LARYNGOSCOPE LIGHT BULBS
2 PADDED TONGUE BLADES
ROLL 1” ADHESIVE TAPE OR PRE-MADE ET TUBE HOLDER
SKIN PROP WIPES OR BENZOIN
2 PAIR EXAM GLOVES
YANKAUER SUCTION CATHETER
2 #14 SUCTION CATHETERS SALUM SUMP TEBE, 16 FRENCH
LUBRICANT
STRAIGHT CONNECTOR
TOOMEY SYRINGE
ENDOTRACHEAL TUBES, 2 EACH SIZE: 6.0, 7.0, 7.5, 8.0, 8.5, 9.0
TRACHEOSTOMY TUBES, 1 EACH SIZE: ADULT SHILEY BLUE BOX: #4, #6, #8
INNER CANNULAS, 1 SIZE EACH: ADULT SHILEY BLUE BOX #4, #6, #8
(Portex is discontinued - unless special order for a patient)
1 END-TIDAL CO2 DETECTOR
________________________________________
****************************s of Drawer 3:
DRAWER 3: CIRCULATION: I.V.SUPPLIES
ANGIOCATHS 2 EACH: 14G, 16G, 18G, 20G, 22G
2 3-WAY STOPCOCKS
BLOOD TUBES: 3SST, 1 LIGHT BLUE, 1 LAVENDER
3 STERILE WATER 10cc VIALS
2 ABG KITS, 2 HEPARINIZED ASPIRATORS IN ICU’S
NEEDLES: 6- 18G, 6- 20G, 6- 22G, 3- 25G
ALCOHOL SWABS
TAPE
BUTTERFLIES, 2 EACH: 21G, 23G
2 I.V. START KITS
SYRINGES: 2- TB, 6- 3cc, 6-5cc, 6- 10cc, 2- 20cc, 1- 50cc
****************************s of Drawer 4:
DRAWER 4: CIRCULATION: I.V. SOLUTIONS AND TUBING
1 LACTATED RINGERS 1000cc
2 NORMAL SALINE 1000cc
2 NORMAL SALINE 250cc
2 D5W 500cc
2 D5W 250cc
1 D5W 500cc WITH LIDOCAINE .4% PRE-MIXED
I.V. TUBINGS:
2 MACRODRIP
3 MICRODRIP
2 HORIZON CASSETTES
2 EXTENSION TUBING
1 BURETROL
1 BLOOD TUBING
ARMBOARDS: 1 LONG, 1 SHORT
****************************s of Drawer 5:
DRAWER 2: CARDIAC, CHEST PROCEDURES
6 EKG ELECTRODES
RESTRAINTS
STERILE GLOVES, 2 PAIR EACH SIZE: SMALL, MEDIUM, LARGE
2 MASKS WITH FACE SHIELDS OR MASKS AND EYE PROTECTION
SCALPELS WITH BLADES
DRESSINGS: 4X4 10 PACK, 2- 4X4, 2- 4X4 DRAIN SPONGE, 2- 2X2
BETADINE SOLUTION
SUTURES, 2 EACH: 000 SILK WITH NEEDLE, 0 SILK WITH NEEDLE
CARDIAC NEEDLE 20G
STERILE TOWELS
PETROLEUM GAUZE
CUTDOWN TRAY
3 - LUMEN CVP CATHETER KIT
CHEST TUBES, 1 EACH: 28 FR, 32 FR
****************************s of Drawer 6:
SPECIAL PROCEDURE TRAYS:
TRACK TUBE
CUTDOWN TRAY
3 - LUMEN CVP CATHETER K