• Document: Crash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University
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Crash Cart Drugs Drugs used in CPR Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Introduction • A list of the drugs kept in the crash carts. • This list has been approved by the Pharmacy and Therapeutic Committee. • The most important indications, contraindications and dosage and administration of these drugs are reviewed as a reminder for the physicians, nurses and pharmacists who serve on cardiac arrest (code) teams or who are involved in other emergency situations. Crash Cart Definition Crash Cart • A crash cart - is a special cart (with drawers) containing emergency drugs and equipment needed when a cardiac- pulmonary arrest occurs. • It provides an easier access to the emergency drugs and equipment. Purpose • To have the crash cart and Defibrillator constantly ready for use in case of life threatening condition such as cardiopulmonary arrest. • To establish standard practice, which is required to maintain and utilize the crash cart and the defibrillator. Crash Cart Procedure: 1. The cart is inspected for the following External contents: • 1.1. Portable suction apparatus with connecting tubing if not available in each patient’s room. • 1.2. Portable monitor/defibrillator unit with charged batteries, multi-function cable, multifunction pads (pedi, adult or both as appropriate), pacer cable (if pacer capable machine), ECG electrodes, appropriate sized paddles (adult, pediatric), defibrillation gel, monitor paper, blood pressure cuff (adult carts), SpO2 probe. Crash Cart Procedure: • 1.3. Sharps container. • 1.4. Cardiopulmonary Resuscitation records • 1.5. Emergency Crash Cart Check Sheet. • 1.6. List of cart contents. • 1.7. Emergency drug information sheets as appropriate for unit Crash Cart Drugs Intraosseous (IO) Access In older children and adults: • Distal radius and ulna • Proximal tibia. Transtracheal Administration TT 1. Lipid-soluble drugs such as lidocaine, epinephrine, atropine, and naloxone ("LEAN") can be given via the endotracheal tube. 2. Flush with a minimum of 5 mL normal saline followed by 5 assisted manual ventilations. Medications 1. Adenosine 6mg/2ml 5 amp. For symptomatic SVT 6 mg over 1-3 sec. Monitor ECG If no response within 1-2 min Repeat: 12 mg, Rapid IV/IO bolus Remarks: Rapid IV push Max dose 12 mg Medications 1.Adenosine • AV nodal conduction block and interrupts reentry circuits. • Wide safety margin because of its short half-life. • Adenosine may also be given by IO route. Medications 150 mg/3ml 2. Amiodarone 6 vial For refractory pulseless VT/VF 5 mg/Kg rapid 300 mg IV/IO; over 3 min. (dilute in 20-30ml). Monitor ECG and BP For perfusing tachycardia Loading 5 mg/kg over 20-60 min Max 15 mg/kg/day IV Medications 2. Amiodarone • Slows AV conduction, prolongs QT interval, and slows ventricular conduction (widens the QRS). • Amiodarone causes hypotension. The severity of the hypotension is related to the infusion rate and is less common with the aqueous form of amiodarone: 1. It should be administered slowly to a patient with pulse. 2. May be given rapidly to a patient with cardiac arrest or ventricular fibrillation (VF). Medications 2. Amiodarone • Monitor the ECG because complications may include: 1. Bradycardia, 2. Heart block, 3. Torsades de pointes ventricular tachycardia (VT). • Use extreme caution when administering with another drug causing QT prolongation, such as procainamide. • Adverse effects may be long lasting because the half- life is up to 40 days. Medications Atropine 1mg/ml single 3. Atropine Sulfate dose vial (5 amp) 0.02 mg/kg Atropine 10ml .1mg/ml Sulfate 18g Safety 1 mg IV, IO, TT Syringe Injector Total dose of 3 mg. • Parasympatholytic drug that accelerate sinus or atrial pacemakers and increases AV conduction. • Small doses of atropine (<0.1 mg) may produce paradoxical bradycardia (block of presynaptic M1 receptors). • Avoid large dose in coronary patients as excessive tachycardia may aggravate ischemia and/or cause ventricular arrhythmia. Medications Calcium 10% 10ml 100mg/ml 4. Calcium Chloride single dose vial (2) (10%, 1 g/10 mL) Calcium Chloride 10% 1.36mEq/ml

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