Crash Cart For Icu

Crash Cart and Emergency drugs
What is crash cart?

• crash cart: is a special cart (with drawers)
containing emergency drugs and equipment
needed
• Also called a “resuscitation cart” and provides an
easier access to 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
The cart is inspected for the following external
contents
• Portable suction apparatus with connecting tubing

(if not available in each unit)
• Portable defibrillator with charged batteries, multi-
function cables, multifunction pads (pediatric, adult
),pacer cable and paddles
(if available), ECG electrodes,(adult,
pediatric),defibrillation gel, monitor paper, blood
pressure cuff (adult, pediatric), SpO2 probe, ETCO2
detector, intubation kit, oxygen delivery devices,
humidifier tubes etc
cont.
• Sharp containers
• Cardiopulmonary resuscitation algorithm sheet
• Emergency crash cart check list (general)
• List of cart contents
(External & Internal in each drawer)
• Emergency drug information sheets as appropriate
for unit
NB. Each drug and equipment should be labeled

Crash cart contents have to be inspected and
refilled every morning of the working hours
Emergency crash cart drugs which are
commonly used in the ICU
Atropine Activated charcoal
Adenosine Kcl
Amiodarone Metoprolol
Adrenaline Pethidine
ASA Aminophylline
Dobutamine Quinine
Dopamine Insulin
Hydrocortisone Iv fluids
Furosemide Heparin
Sodium bicarbonate Propofol
Calcium gluconate Mannitol
Digoxine Nitroglycerine
Diazepam Thiopental
Dextrose 40% Verapamil
Hydralazine Magnesium sulphate
Ketamine
Common selected crash cart
emergency medication
1. Atropine Sulfate(1mg/ml )
• Anticholinergic/ Parasympatholytic
• Antispasmodic
• Antidote
• Ophthalmic agent
Indications
• Symptomatic bradycardia
• Asystole
• PEA
• Organophosphate poisoning
• Exercise induced bronchospastic disorders
• Pre and post operative anesthesia to restore
HR
Contraindications
•Tachycardia
•Obstructive disease of GI tract
•Unstable cardiovascular status in the
context of cardiac ischemia & hemorrhage
•Glaucoma
•Hypersensitivity
Dose (IV, IO, ETT )
•Asystole, PEA, bradycardia
- 0.5 - 1mg IV (2-3mg ETT) every 3-5
min - max - 0.04mg/kg - adult
- 0.01 - 0.03mg/kg IV, IO every 2-5 minutes
min - 0.1mg, max- 1mg - pediatric
•RSI : 0.01mg/kg, min - 0.1mg , max – 0.4mg Pedi.
0.3-0.6mg im - adult
•Organophosphate poisoning
- 2-5mg q 15-15 min until signs of atropinization
- 0.05 mg/kg q 5-15 min until symptoms
are resolved- pediatric
2. Adenosine (6mg/2ml)
Indications
•PSVT
•Symptomatic SVT
Contraindications
•2nd and 3rd degree block
•Atrial fibrillation, atrial flutter
•Hypersensitivity
Dose
Adult
• 6 mg IV rapidly over 2 seconds followed by
20 ml N/S flush
• May be repeated by increasing the dose
to 12 mg every 1-2 minutes if unsuccessful
(max -3 doses)
Pediatric
• o.05mg/kg Iv bolus, may be repeated 1-2 min
after to a maximum of 0.3mg/kg
Monitoring parameters
• ECG monitor: heart rate, blood pressure
3.Adrenaline(1mg/ml)
Indications
• Bronchial asthma/ reactive airway disease
• Acute allergic reaction e.g. Anaphylactic Shock
• Cardiac arrest
• Asystole
• Ventricular fibrillation
• Pulseless ventricular tachycardia
• PEA (Pulseless electrical activity)
• Profound symptomatic bradycardia
Contraindications
•Hypovlemic shock - correct volume deficit
•Use with caution in coronary insufficiency
•Epinephrine1:10,000 is contraindicated in
patients who do not require extensive
cardiopulmonary resuscitative efforts
17
Dose
Adult
•0.01mg/kg IV 1:10,000 - cardiac arrest, asystole
•1mg q 5 min IV 1:10,000 – bradycardia
•0.3-0.5mg im/sc - bronchial asthma, anaphylaxis
•2-10 mcg/kg/min- septic/cardiogenic shock
Pediatric
•0.1mg/kg IV/IO (0.01mg/kg of 1:10,000),
0.1mg/kg ETT(1:1000)
•0.05mcg/kg/min for continuous infusion
•0.5ml in 3ml N/S nebulization – UAO
•0.01mg/kg im 1:1000 q 5 min ,max 0.5mg-
anaphylaxis
4. Amiodarone(150mg/3ml)
Indications
• Life threatening recurrent arrhythmias
• Ventricular fibrillation
• Ventricular tachycardia
Contraindications
• Severe sinus node dysfunction
• 2nd and 3rd degree AV block
• Hypersensitivity
• Cardiogenic shock
• hypotension
Dose
• 300 mg loading dose (cardiac arrest) flush with
10 ml of saline (10mg/kg)
Stable wide complex tachycardia
• 150 mg supplemental bolus IV over 10 min.
May be repeated 150 mg Q10 min (5mg/kg)
• 360 mg slow infusion- over 6 hrs (1mg/min)
• 540 mg maintenance infusion over 18 hrs
(0.5mg/min)
Monitoring parameters
• BP, ECG-HR, Rhythm
• Serum electrolyte
• Thyroid hormone
5. Calcium (10%, 1gm/10ml,100mg/ml)
• Calcium gluconate, Calcium chloride

Indications
• Hypocalcemia
• Hyperkalemia
• Ca channel overdose
• Magnesium intoxication
Dose
Adult
• Calcium chloride/calcium gluconate
- 1gm Iv slowly over 10 min
- 1gm in 100ml 5% D/W IV over 30-60
min – Hyperkalemia/ Mg intoxication
Pediatric
-10-20mg/kg IV ,may be repeated after 6hrs
.Hyperkalemia/Hypocalcemia
6. Magnesium sulphate (50%/20ml,1gm/2ml)
Indications
• Tachycardia
• Bronchoconstriction
• Post infarction Ventricular arrhythmias
• Recurrent VF
Dose
Adult
• 1-2g over 30-60 min, maintenance 0.5-1g/hr
continuous infusion
• Pre eclampsia 4gm iv initially over 10min,then
2g/hr
Pediatric
• 25-50mg/kg IV slowly q 6hrs for 3 doses
Contraindications
• Shock
• Renal failure
• Hypocalcaemia
• 3rd degree AVB
7. Dopamine( 200mg/5ml, 40mg/ml,5ml)
Indications
• Hemodynamically significant hypotension
• Cardiogenic /septic shock
• Bradycardia
Contraindications
• Tachydysrhythmias ,cardiomyopathy
• VF
• Hypertension
Dose
• Renal dose:2-4mcg/kg/min
• Cardiac dose:5-10 mcg/kg/min
• Vasopressor dose: >10mcg/kg/min
• Bradycardia: 2-20mcg/kg/min
26
8. Glucose (10%, 40%,50%) D/W
Indications
•Hyperkalemia
•Hypoglycemia
Dose
•Hyperkalemia
- 25-50gm dextrose 40%/50% with 10u RI IV-
adult
- 0.3u RI with 10ml 10% dextrose (0.3unit/gm
dextrose, 0.3u/2.5ml 40% dextrose, 0.3u/2ml 50%
dextrose) - pediatric
• Hypoglycemia
Adult
• Standard dosage in hypoglycemia is 25 g (50 ml of
a 50% solution) IVP
Pediatrics
- > 8 years, 2 ml/kg of 50% solution
- 1 – 8 years, 2 ml/kg of 25% solution
- Infants under 2months
- 4 ml/kg of 12.5% solution
9. Sodium Bicarbonate ( 7.5%/50ml,
8.4%/50ml )
Indications
• Used late in cardiac arrest
• Asystole/PEA with medical control approval
• Tricyclic antidepressants overdose
Dose
• 1 meq/kg IV
Contraindications
• Metabolic alkalosis
• Pulmonary edema
• Hypernatremia
10. Lidocain Hydrochloride (1%/50ml,
2%/50ml)
Indications
• VF/VT
• Local anesthesia
Dose (adult & pediatric)
• 1 - 1.5mg/kg IV, followed by 0.1-1mg/kg
q 5-10min to a total of 3mg/kg, 1-4mg/min -
maintenance
• 3-5mg/kg - surgical procedures
Contraindications
• Heart block( Mobitz type II ,3rd degree)
• PVC with bradycardia (treat bradycardia first)
• Liver failure
Thank you!

Crash Cart For Icu

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Crash Cart and Emergency drugs

What is crash cart?

• Portable suction apparatus with connecting tubing

NB. Each drug and equipment should be labeled

• Calcium gluconate, Calcium chloride

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