Emergency trolley

موضوع: Emergency trolley الثلاثاء مارس 08, 2011 1:10 pm

Emergency trolley: Is one equipped trolley with [the essential medication and tools that need for emergency and urgent cases.

Goal of emergency trolley is:
1. Saving time.
2. Keep life of patient.
3. Saving effort of medication.

Uses of emergency trolley :
1. Ventricular fibrillation
2. Respiratory paralysis
3. Ventricular tachycardia

• Check up the trolley:
AT the beginning of each shift the in charge nurse should check the
equipment and medication if they are prepared for use in critical
situation and ensure that drug is in good statues (check the expiratory
date)as this paper & the quan***y of each medication

On the top of emergency trolley:
1. Monitor/defibrillator with patient cable and electrode attached.
2. Defibrillator paddles *2.
3. ABGs syringe.
4. Ky-gel.
5. Ambu bag-adult W/mask size: 4.5.
6. Ambu bag-pediatric W/mask size: 2.
7. Ambu mask infant size: 0A.
8. Laryngoscope with medium blade attached.
9. Laryngoscope with small blade attached.
10. Stylit for adult and pediatric
11. shuttle forceps .

The emergency trolley consist of 5 drawers:
THE FIRST DRAWER(MEDICATIONS):
1. Adrenaline 1mg /ml
2. Atropine 600mcg/ml.
3. Isorbide Dinitrate 10mg/10ml (isoket)
4. nitroglycerine 10 mg/5 ml (nitocine)
5. Lignocaine 1%, without adrenaline.
6. Lignocaine 2%, with adrenaline
7. Dopamine 200 mg/5 ml
8. Calcium Gluconate 10%
9. Digoxin 0.5/2ml (Lanoxin)
10. 10 ml potassium chloride 7.45%
11. Aminophillin 250 mg / 10 ml
12. Hydrocortisone 100mg /2 ml 1.V /1.M
13. proranolol 1 mg / 1 ml (Inderal)
14. Dexamethasone 8 mg / 2 ml (Decadron)
15. Frusemide 20mg / 2ml (Lasix) I.V /I.M
16. suprel
17. ****clopramide 10mg/ 2ml (zantac).
18. sodium bicarbonate I.V push CPR/I.V infusions
19. Tavaggle (or Avial if available)
20. Cordarone 150 m

* Adrenaline 1mg/ml (1:1000).
Classification: - Sympathomimetic drug.
Action: - Increase myocardial contraction.
Vasoconstriction.
Increase H.R.
Bronchodilator.
Dosage: - 1 mg 1.V repeated every 5 min.
Side effect: - Cardiac arrhythmias.
Pulmonary edema.
Anginal pain.
Nursing Consideration: - Monitor B.p, pulse and side effect.
Monitor for 1.V infiltration.

* Atropine 600mcg/ml.
Classification: - Anti muscarinic.
Anti cholinergic.
Action: - bronco dilator.
Depressing slivery and bronchial secretion.
Dilating the bronchi.
In habit vagal influences on the heart.
Indication: - Lessening the degree of A V node.
Restoration of cardiac rate and arterial pressure.
Relaxation of tone.
Dosage: - 0.5 mg 1.V pushed at 5 min interval
Side effect: - Nausea.
Vomiting.
Constipation.
Urinary retention.
Nursing Consideration:-Monitor ECG, Bp and HR.
Monitor for side effect as tachycardia.
Contraindicated in asthma, GI disturbance
Prepare antidote (Neustigmine).

* Isorbide Dinitrate 10mg/10ml (isoket). I.V infusion
Classification: - anti anginal drug.
Indication: - Angina pectoris.
Side effect: - headache, dizziness & weakness
Vomiting, hypotension,
Flushing, pallor.

* nitroglycerine 10 mg/5 ml (nitocine)
Classification: - anti anginal drug
Indication:- acute anginal attack
Side effect: - nausea, vomiting & incontinence
Flushing, sweating & increased perspiration
Hypotension.

* Lignocaine 1%, without adrenaline. I.V / I.M
Classification: - Anti arrhythmic.
Indication: - Anti arrhythmic (For arrhythmia heart beat)
Local anesthetics
Side effect: - Dizziness, drowsiness, Fatigue
Twitching, mouth numbness.
Slurred speech, vision changes.

* Lignocaine 2%, with adrenaline. I.V / I.M / S.C
Classification: - Anti arrhythmic drug
Indication: - For bleeding
For arrhythmia in heart beat
Local anesthetics.
Side effect: - dizziness, drowsiness, fatigue
Twitching, mouth numbness
Slurred speech, vision changes.

* Isorbide Dinitrate 5 mg (Isordil). Sublingual
Classification: - Anti anginal drug
Indication: - Angina pectoris.
Side effect: - Headache, dizziness and weakness
Vomiting, hypotension.

* Calcium Gluconate 10% I.V/ I.M.
Classification: - Electrolyte, Anti Acid.
Indication: - Treat of hypertension.
Supply dietary  when decrease Ca or inadequate.
Side effect: - decrease slow H.R, sever necrosis
Local irritation.

Nursing consideration: - intake B.p & H.R & ECG.
Avoid give direct.
Avoid mixing with carbonate or Phosphate.

* Dopamine 200 mg/5 ml I.V Infusion
Classification: - Dopamenergic drug.
Indication: - correction & hemodynamic imbalance.
Side effect: - surfeiting, tremor, headache &palpitation.
Nursing consideration: - observe the side effect, vital sing.
Chick dysrhythmia.
administers medication effect meals.

* Digoxin 0.5/2ml (Lanoxin) I.V/I.M
Classification: - Cardiac glycosides
Indication: - CHF.
Atrial Flatter
Atrial Fibrillation.
Atrial tachycardia.
Side effect: - Vomiting, nausea
Nursing consideration: - Monitor C.O.P & Bp
Monitor fluid.

* 10 ml potassium chloride 7.45% (I.V Diluted not less than 500 ml)
Classification: - Electrolyte.
Indication: - Prevent & treat cardiac arrhythmia. (PVC).decrease K or increase K
Side effect: - Hyperkalemia.
Vomiting,
Diarrhea,
Nausea.

* Aminophillin 250 mg / 10 ml. I.V Infusion
Classification: - Xanthenes bronchodilator
Indication: - Prevention of bronchial asthma and Reversal of bronco spasm associated with COPD.
Side effect: - Flushing, irritability, nauseas.

* Dexamethasone 8 mg / 2 ml (Decadron)
Classification: - Glucorticoids.
Indication: - Relieve comfort.
Give the body a chance to heal from the effect of inflammation.

* proranolol 1 mg / 1 ml (Inderal)
Classification: - Anti hypertension
Indication: - increase Bp.
Anginal pectoris.
Arrhythmia.
Side effect: - Brady cardiac
Congestive heart failure
Cardiac Arrhythmia
Nursing consideration: - monitor B p.
Not to be given in asthma

* Hydrocortisone 100mg /2 ml 1.V /1.M
Classification: - Adrenal corticosteroid
Indication: - inflammation
Blood disorder
Organ transplant rejection.
Side effect: - Depression
Peptic ulcer
Menstrual disorder

* Frusemide 20mg / 2ml (Lasix) I.V /I.M
Classification: - Loop diuretic
Indication: - Hypertension and pulmonary edema
Edema with C H F.
Renal Failure.
Side effect: - Polyuria.
Constipation.
Vomiting and nausea.
Nursing consideration: - Monitor Fluid changes
Monitor body weight

* ****clopramide 10mg/ 2ml (clopram).
Indication: Antemetic to prevent nausea and vomiting.

* sodium bicarbonate I.V push CPR/I.V infusions
Classification: - Electrolyte, antacid.
Indication: - ****bolic acidosis.
Sever diarrhea associated with hyper acidity.
Drug intoxicant.
Side effect: Systemic alkalosis.
Hypokalemia.
Gastric rupture.
Nursing consideration: Monitor arterial blood gases.
Avoid mixture with ca++ in potential solution.

* Niffedipine 10mg ( adalat)
Classification:- calcium channel blockers
Indication:- Headache and fatigue
Nausea and hypotension

* Tavaggle (or Avial if available)
Classification: - Non-sroidal anti inflammatory drug.
* Cordarone 150 mg
Classification: - Adrenergic blockers
Indication: - Used as antiarrhthmies.
Adverse effect: - Nausea, vomiting and diarrhea
Anorexia and Flatulence.

** Second drawer:
1. I.V cannula different size (G18, G20, G22).
2. Spinal needle size G20.
3. Triple lumen cavafix cath 30 cms size 7F.
4. Scalp vein I.V set size G21.
5. Needle size (G20, G21, G23).
6. 3 way stopcock.
7. Injectable cannula covers (yellow).
8. Cannula covers (Red).
9. Oxygen connector (with nipple adapter).
10. Disposable razor.
11. Scalpel blades .
12. Transpore tape (1 inch) size 2.5cm.
13. Micropore tape (Scalp vein I.V set size G21.
14. Needle size (G20, G21, G23).
15. I.V cannula dressing (IV300).
16. I.V set IVAC 590 (vented).
17. Suture, silk write code (size: 3.0).
18. Pressure tubes/extension set 15cm.
19. I.V set IVAC 560 (with filter).
20. Annie pump set.
21. Annie syringe set.
22. Syringe 50cc w/leur lock.
23. Suture, silk write code (size: 2.0).
24. Soluset, Abbott 150/60 (micro).
25. Suture, silk write code (size: 2.0).
26. Suture, silk write code (size: 3.0).

*** Third drawer
2. Air way
3. N.G.tube
4. T-connection
5. Surgical blade
6. Adult face mask
7. ECG electrodes
8. Urine bag
9. Sterile gauze
10. Endotrachial tube
11. Suction tube

**** Fourth drawer
2. Latex gloves
3. I.V tag
4. Drip set
5. Surgical gloves

***** Fifth drawer(solutions)
1. 0.9% sodium chloride (500ml). "Isotonic"
Uses: Extra cellular fluid deficits in patient with low serum level of sodium or chloride and ****bolic alkalosis.

2. 5% dextrose (500ml). "Hypotonic"
Uses:
1. Replace deficit of total body water.
2. Not use alone to expand extra cellular fluid (ECF) volume because dilution of electrolytes can occur.

3. 5% dextrose and N/S (500ml)."Hypertonic"
Uses:
1. Extra cellular fluid deficit in patient with low serum level of Na or Cl with ****bolic alkalosis.
2. provides modest calories (170 Kcal).
4. Hase-steril 6% (500ml).
Uses: Massive bleeding.

5. Ringer lactate (500ml). "Isotonic"
Uses:
Electro cellular fluid deficit, such as fluid loss with burins and bleeding and dehydration from loss of bile or diarrhea.

1* 10% dextrose (500ml).
Uses: Hypoglycemia and hypertension.

1* 4.3% dextrose 1/5 N/S (500ml).
Uses:
1. Hypotension no D.M.
2. Hypoglycemia no HTN.
3. Abdominal pain.
4. Post operative.

Cardiopulmonary resuscitation (CPR)
Definition:
Basic emergence procedure for life support consisting of artificial respiration and manual external cardiac compression.
Purposes:
• To establish effective circulation and respiration.
• To provide oxygen to the vital organs.
• To prevent irreversible cerebral anoxic damage.

• Indication:
For all patients with:
• Cardiac arrest:
1. Ventricular fibrillation.
2. Ventricular tachycardia; a systole.
3. Electromechanical dissociation.
4. Respiratory arrest:
5. Foreign body airway obstruction.
6. Suffocation.
7. Smoke inhalation.
8. Coma.
• In presence of the following sing and symptoms:
1. Absence of pulse in large arteries (carotid and femoral).
2. Absence of breath sound or air movement through nose or mouth.
3. Paleness and cyanosis.
4. Dilated pupils that is unresponsive to light
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