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Brand Name Generic Name Class of Drug Usage/ Mechanism Side Effects Nursing

of Action (at least 3) Consideration

Bronchodilator
Adrenaline Epinephrine ALPHA-ADRENERGIC Relaxes bronchial Sweating, headaches, Observe patient
1mg/1ml AGONIST smooth muscles by anxiety tachycardia closely for adverse
To start heart beat stimulating beta 2 reactions. Notify
cardiac arrest receptors and alpha prescriber if these
USES: and beta receptors changes occur
Acute Asthmatic in the sympathetic
attacks nervous system.
Hemostasis
Bronchospasm
Anaphylaxis
Allergic Reaction
Cardiac arrest
Adjust in
Anesthesia
Shock
In treatment of
bronchospasms
anaphylactic
reactions, cardiac
arrests added to
local anesthetic to
decrease syncope
Aminophylline Aminophylline BRONCHODILATOR It relaxes and opens Nausea, vomiting, Monitor vital signs;
250mg/10mls Relaxes bronchial air passages in the shock, drowsiness, measure and record
smooth muscles. lungs, making it headache, fluid intake and
easier to breathe. nervousness, output.
Used to prevent and palpitation, Dosage may need
treat wheezing, ventricular fibrillation to be increased in
shortness of breath, cigarette smokers
and difficulty and in habitual
breathing caused by marijuana
asthma, chronic smokers because
bronchitis, smoking causes
emphysema, and drug to be
other lung diseases. metabolized faster.

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Anticholinergics
Atropin Atropine Anticholinergic & Block the action of dry mouth and 1. Watch for
Sulphate Muscarinic the constipation tachycardia in cardiac
600mcg/1ml Antagonist neurotransmitter dysphagia, patients because it
Used to treat acetylcholine in the tachycardia, may lead to
bradycardia, it brain . palpitation, ventricular
reduces/suppress Inhibits arrhythmias fibrillation.
secretions during acetylcholine at
surgery. parasympathetic 2. Many adverse
neuroeffector reactions (such as dry
junction, blocking mouth and
vagal effects on SA constipation) vary
and AV nodes, with dose.
enhancing
conduction through
AV nodes and
increasing heart
rate.
Alkalinizers- Fluid and Electrolyte Replacement
Calcium FLUID AND 1.Replaces calcium Pain and burning at iv Use calcium
Chloride 10% IV ELECTROLYTIC and maintains sites, Hypotension , chloride cautiously in
push REPLACE MENT calcium levels Bradycardia, cardiac patients with cor
SOLUTION. arrhythmias ,cardiac pulmonale,
Uses: 2. For cardiac arrest respiratory
In the treatment of resuscitation acidosis, or
acute hypokalemia adrenaline to fits respiratory failure.
tetany improve myocardial
Vitamin D contractions in Monitor calcium
deficiency cardiac disturbances levels frequently.
Alkalosis of hyperkalemia Maintain
Insect bites or hypocalcaemia or calcium level of 9 to
stings calcium channel 10.4 mg/dl. Dont
blocking agent allow level to exceed
toxicity emergent 12 mg/dl.
treatment of Hypercalcemia
hypermagnesemia. may result after large
doses in chronic
renal failure. Report
abnormalities.
Calcium ELECTROLYTE AND To prevent and treat Bradycardia, Double-check that
Gluconate 10% WATER BALANCE calcium deficiencies constipation, thirst, you are giving
IV push USES: To overcome hypercalcemia the correct form of
cardiac toxicity of calcium;
hyperkalemia, for
resuscitation drug
cardiopulmonary
resuscitation
Cart may contain
(repolarisation) both calcium
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neonatal tetany gluconate
Hyperparathyroidi and calcium chloride.
sm.
Vitamin D
deficiency
Alkalosis.

Sodium FLUID AND For cardiac arrest Belching, Gastric Monitor changes in
bicarbonate ELECTROLYTE and metabolic distention, urine with respect to
8.4% BALANCE acidosis flatulence, pH
Antacid Alkalinizer
restores buffering SE: tetany, edema,
capacity & flatulence,
neutralizes excess hypokalemia,
acid. hypernatremia

Antidysrhymics
Xylocaine Lidocaine 2% LOCAL ANESTHETIC; Has and Seizures, heart-block, Monitor drug level.
ANTI-ARRHYTHYMIC antiarrhythmic tinnitus, rash, Monitor patient for
Uses: Treatment of action thus respiratory toxicity.
arrhythmias (V-fib decreases depression.
and V-tach) ventricular
Local anesthetic depolarization,
automaticity and
excitability in the
bundle of HIS
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Purkinje system

Cardiac Glycoside/ inotropic/Antidysrhymics

Digoxin CARDIAC GLYCOSIDE; Inhibit the sodium Nausea, vomiting, Excessively slow
Lanoxin INOTROPIC
0.5mg/2ml pump causing the Dizziness, and pulse rate
Corrects increase in diarrhea, (60 beats/minute or
tachycardia and availability of dysrhythmias, less) may be a sign of
slow, steady and intracellular calcium blurred vision, digitalis toxicity.
strengthen heart in the myocardium abdominal pain Withhold drug and
muscle and conduction (Withold if pulse is notify
Uses: Heart failure system resulting less than 60 bpm) prescriber.
atrial fibrillation, increased In children, cardiac
atrial tachycardia, contractility of the arrhythmias,
cardiogenic shock heart muscle. including
sinus bradycardia,
are usually early
signs of toxicity.

Anticonvulsant/Anti-anxiety
Valium Diazepam Anti-convulsant, 1. A benzodiazepine Nausea , Dry mouth Monitor elderly
10mgs/2ml Anxiolytic, that probably headaches , rash patients for dizziness,
Sedative potentiates tachycardia, ataxia, mental status
Uses: the effects of GABA, respiratory changes. Patients are
Management of depresses the distression, ecg at an increased risk
anxiety CNS, and suppresses changes. for falls.
Before the spread of Use of drug may
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endoscopic seizure lead to abuse and
procedures activity. addiction. Dont
Cardioversion 2. Acts at the limbic withdraw drug
Acute alcohol , thalamic, and abruptly
withdrawal hypothalamic after long-term use;
Preoperative regions of the CNS withdrawal
sedation and produces CNS symptoms
Status epilepticus depression resulting may occur.
in sedation,
hypnosis and causes
skeletal muscle
relaxation, it works
as a anticonvulsant
depending on the
dosage.

Luminal Phenobarbitone ANTICONVULSANT The effects of the drowsiness, nausea, Therapeutic level is
200mg/1ml Uses: Long term drug interferes with vomiting, respiratory 15 to 40 mcg/ml.
management of the impulse depression, Elderly patients are
tonic- clonic transmission of bradycardia, apnea, more sensitive to
partial seizures cerebral cortex by drugs effects; drug
status epilepticus inhibition of the may produce
eclampsia reticular activating paradoxical
febrile convulsion system. Thus excitement.
in young children limiting the spread Dont stop drug
neonatal seizures of seizure activityby abruptly because this
febrile seizures increasing the may worsen seizures.
threshold for motor Call prescriber
cortex stimulation immediately
if adverse reactions
develop.
Dilantin Phenytoin Management of Anticonvulsant Headache, nausea, Monitor for reduce
250ml/5ml generalized tonic action elevates the vomiting, seizure electrical
clonic simple seizure threshold constipation activity if treating
partial and limiting the spread arrhythmias. Look for
complex partial of seizure discharge. the effectiveness of
seizures Prevention the QT prolongation
of seizure following Phenytoin is
head trauma/ accompanied by
neurosurgery, reduced voltage
ventricular digitalis frequency and
intoxication spread of electrical
prolonged Q-T discharges within
interval and the motor cortex
surgical repair of
congenital heart
disease in children.
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Adrenergic ( Sympathomimetics)
Dobutrex Dobutamine ADRENERGIC Stimulates beta 1 Headaches, fatigue, Monitor ECG, blood
Hydrochloride AGONIST: receptors in the SOB, Mild tremors , pressure
250mcg/5ml VASSOPRESSOR heart increasing nervousness Cardiac output, and
IV route USES: short term contractility and urine output.
treatment of adults cardiac output. Because drug
with cardiac increases AV node
decompensation conduction, patients
due to depressed with atrial fibrillation
myocardial may develop a rapid
contractility ventricular heart
resulting from rate.
either organic
heart disease or
from cardiac
surgery.

Intropin Dopamine ALPHA AND BETA Direct action the N&V, Hypertension, Higher doses
Hydrochloride ADRENERGIC alpha and beta angina pain, can stimulate alpha
200mg/5ml AGONIST INOTROPIC adrenergic receptors palpitation, receptors,
USES: To correct and on specific headache. constricting
hemodynamic dopaminergic blood vessels and
imbalance in shock receptors in increasing blood
syndrome due to mesenteric and pressure.
MI (cardiogenic renal vascular beds. During infusion,
shock), trauma, 2. Positive inotropic
endotoxic frequently monitor
effect on
septicemia (septic ECG,
myocardium
shock) , open heart blood pressure,
increase cardiac
surgery, and CHF. cardiac output,
output with increase
central
in systolic and pulse
venous pressure,
pressure.
, pulse rate, urine
Very low pulse
output, and color
when the systolic is
and temperature.
<90 mmHg then
administer.

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Lasix Furosemide LOOP DIURETICS- Rapid acting of the Nocturia, Dizziness, Monitor for signs of
20mg/2ml Inhibits sodium and potent sulfonamide and nausea, edema, and
chloride loop diuretic. diarrhoea , intravascular volume
reabsorption Inhibits constipation, which lows blood
at the proximal and reabsorption of abdominal cramping, pressure.
distal tubules and sodium and chloride anorexia.
the primarily in loop of
Ascending loop of henle and also in
Henle. loop of Henle and
Uses: Treatment of also in proximal
edema associates distal renal tubules.
for CHF
Cirrhosis of liver,
Kidney disease and
Nephrotic
syndrome .
Is used in the
management of
hypertension.

Corticosteroids
Decadron Dexamethasone ANTI- Decreases Nausea and Vomiting Monitor patients
4mg/1ml INFLAMMATORY / inflammation, hypertension, weight, blood
CORTICOSTEROID mainly by stabilizing heachaches, heart pressure,
leukocytes failure and electrolyte levels
lysosomal Watch for
membranes depression or
psychotic
episodes, especially
in high-dose therapy.
Diabetic patient
may need increased
insulin; monitor
glucose levels.
(Causing
Hypoglcemia)
Hydrocort Hydrocortisone CORTICOSTEROIDS Decreases Fluid & Electrolyte Watch for
100mg/vial HORMONE inflammation, disturbances, depression or
Uses: mainly by stabilizing impaired wound psychotic
Severe leukocyte healing, IOP & episodes, especially
inflammation and lysosomal ICP, during high-dose
adrenal membranes; therapy.
insufficency suppresses immune
Endocrine, response; stimulates Diabetic patient
hematologic, GI, bone marrow; and may need increased
respiratory , influences protein, insulin; monitor

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Rheumatic & fat, and glucose level.
collagen disorder, carbohydrate
edematous states metabolism

SOLU- Methylprednisol Therapeutic class: Blocks inflammation Anxiety , dizziness, Monitor


MEDROL one (1mg/1vial) CORTICOSTEROID Primary anti- headache, blurred electrolyte level,
Pharmacologic inflammatory of vision, and irritability and sleep patterns.
class: GLUCOCORTICOID immunosuppressant
Uses: inflammatory agent in the
diseases both treatment of a
chronic and acute variety of diseases
Management of including those
Acute bronchial hematologic,
asthma, prevention allergic,
of fat embolism in inflammatory,
patients with long neoplastic, and auto
bone fracture immune origin.
Prevention and
treatment of graft
v.s host disease
following allogenic
bone marrow
transplantation.
Isuprel Isoproterenol BETA- ADRENERGIC Relaxes vascular N&V, dizziness, Monitor patient for
hydrochloride AGONIST; smooth muscles headache, weakness adverse reactions.
2mg/ml BRONCHODILATOR with vasodilation. ,sweating, Correct volume
Fridge CARDIAC deficit before giving
STIMULATOR
vasopressors.
Uses: in treatment
If heart rate
of shock
exceeds 110 beats/
CARDIOGENIC
minute during I.V.
SHOCK
infusion, notify
BACTEREMIC
prescriber.
SHOCK
Doses that increase
Used for cardiac
the heart rate
stimulation eg.
to more than 130
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Bradycardia beats/minute may
Relaxation of induce
bronchial smooth ventricular
muscles arrhythmias.
Peripheral
vasodilation
Opioid Antagonist
Narcan Nalaxone NARCOTIC OPIOID A potent narcotic SOB, sweating, Patients who
Hydrochloride ANTAGONIST antagonist reversing severe N&V, severe receive drug to
4mg/2ml Uses: the effects of headache, agitation, reverse
Acute opioid over opiates. anxiety. opioid-induced
dosage respiratory
Narcotic depression may
overdosage exhibit tachypnea.
complete and Monitor respiratory
partial depth and rate.
Provide oxygen,
ventilation, and other
resuscitation
measures.

Diprivan Propofol GENERAL Slows the activity of Headaches, Monitor for


200mg/20ml ANESTHETICS your brain and Dizziness, twitching, minimal excitation
nervous system. myoclonic during induction of
Fridge Uses: Diprivan is movements cough anesthesia
Stored at 22c used to help you
relax before and SE: pain, swelling,
during general blisters, or skin
anesthesia for changes where the
surgery or other medicine was
medical injected, seizure
procedures. (convulsions);Tachyp
nea or Dyspnea ,
Bradycardia.

Beta Blockers/ Adrenergic Beta Blockers

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Inderal Propranolol BETA BLOCKER Propranolol is used Weight gain, fever, Monitor for
Hydrochloride Uses: to treat tremors, respiratory distress, decrease cardiac
10mg,40mg,80m Angina pectoris, angina (chest pain), light headedness output and
g MI,HTN, Essential hypertension (high hypertension
tremor, migraine blood pressure),
heart rhythm
disorders, and other
heart or circulatory
conditions.

Amidarone Cordarone ADRENERGIC Acts directly on all N & V and diarrhea, Give loading doses
150mg/3ml BLOCKERS cardiac anorexia and in a hospital setting
Uses: Treatment tissues by flatulence and with continuous
of life-threatening prolonging duration ECG monitoring
ventricular of action potential because of the slow
arrhythmias and refractory onset
and period. Slows of antiarrhythmic
supraventricular conduction time effect and the risk of
arrhythmias, through the AV life-threatening
particularly with node and can arrhythmias.
atrial interrupt
fibrillation. the reentry
Severe tachycardia pathways through
the AV node
Anectine Succinylcholine DEPOLARIZING Relaxing muscles Prolonged Muscle Monitor for flaccid
Fridge Chloride SKELETAL MUSCLE during surgery or relaxation, muscle muscle. Skeletal
20mg/ml RELAXANT when using a pain, bradycardia muscle paralysis in
(ultra short-acting breathing machine tachycardia muscle membranes
depolarizing-type) (ventilator). It is also hypertension
Uses: used to induce ostoperative pain,
To relax skeletal anesthesia or when jaw rigidity, excessive
muscles for surgery a tube must be salivation, rash,
& orthopedic inserted in the hypotension
manipulation. windpipe

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Barbiturates- Sedatives and Hypnotic Drugs
Thiopentone Thiopental BARBITURATE 1. Depresses the Respiratory Quality for signs of
Sodium GENERAL CNS depression, respiratory
1mg/vial ANESTHETIC thereby causing myocardial depression
CONVULSANT anticonvulsant depression, cardiac in debilitated patient
Uses: effect and arrhythmias, or one with a history
1. Main use is for producing sedation of respiratory
induction of and hypnosis. disease.
anesthesia . 2. Thiopental may Monitor patients
2. For ICU patients reduce ICP by neurologic status
with head injuries increasing cerebral every
to control surges in vascular resistance, hour, or as ordered,
intracranial which in patient with
pressure decreases cerebral increased ICP.
3.As it possess blood flow and
potent anti volume.
convulsant activity,
it may be given to
treat epileptic
seizures that do
not respond to
other therapy

Fifth Drawer
5% Dextrose in Crystalloids A form of glucose SE: fever, stomach Used as a mixing
1000mls (sugar) pain, redness, or solution for meds
Used to treat low cloudy drained fluid, contains 50 g of
blood sugar flu symptoms, chest glucose, it is used to
(hypoglycemia), pain, high blood suppy water and
insulin shock, or ,severe skin reaction calories to the body.
dehydration (fluid Dextrose serves as a
loss). major energy source.

50% Dextrose Crystalloids Treatment of insulin SE: severe allergic


50mls in 1000mls hypoglycemia to reactions, dyspnea,
restore blood swelling of mouth,
glucose levels face, lips, or tongue).

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5% Dextrose with Crystalloids As stated before to Patients with
0.2% Normal provide fluid and diminished renal
Saline in electrolytes function
1000mls replacements administration of
such solution may
result in sodium
retention.
0.9% Sodium Crystalloids To supply water & Used for maintaining
Chloride in salt to the body electrolyte balance
1000mls dehydration and
hypovolemia.

Ringers Lactated Crystalloids Used during surgery Contains multiple


in 1000mls or in the initial electrolytes used to
management of the treat hypovolemia.
injured or wounded Burns, diarrhea, mild
to provide ions for metabolic acidosis
fluid and electrolyte
imbalance
Used to supply
water & electrolytes
(eg. K+, Na+, Cl) to
the body
Water for Diluent As a vehicle or
Injection diluent for parental
administration of
some drugs

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Emergency Trolley

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

PURPOSES:

1. To enhance the Code Blue teams response to patients with emergency medical situations by
providing immediate access to supplies and medications.

2. An emergency cart or crash cart is a cart that facilitates coordination of emergency equipment.

3. A specific crash cart type facilitates staff familiarity with equipment

4. It is help to ensure a properly stocked emergency cart will be readily available

5. It also ensures a properly functioning defibrillator will be readily available.

6. It helps to save the valuable time at the time of emergency.

CONTENTS

The contents of a crash cart vary from hospital to hospital, but typically contain the tools and drugs
needed to treat a person in or near cardiac arrest. These include but are not limited to:

Monitor/defibrillators and suction devices

Advanced Cardiac Life Support (ACLS) drugs such as Epinephrine, Atropine, Amiodarone,
Lidocaine, Sodium bicarbonate, Dopamine, and Vasopressin

First line drugs for treatment of common problems such as: Adenosine, Dextrose, Diazepam or
Midazolam, Epinephrine, Naloxone, Nitroglycerin, and others

Drugs for rapid sequence intubation: Succinylcholine or other paralytic agents like Pancoronoum
, a sedative drugs such as Etomidate or Midazolam; endotracheal tubes and other intubating
equipment

Vascular access devices Intra Venous(IV) Cannulae, Drip sets [Micro and Macro], IV fluids
[Normal Saline(NS), Lactated Ringer(RL), Hydroxy ethyl starch

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Other drugs and equipment as chosen by the facility.

TYPES OF CRASH CART:-

BASED ON AGE OR DEVELOPMENTAL VARIATIONS

Adult Emergency Crash Cart

Pediatric Emergency Crash Cart

Newborn Intensive Care Crash Cart

GENERAL INFORMATION:

1. A Licensed Staff member as designated by the head of the department is responsible for
checking the crash cart, oxygen cylinder levels, defibrillator, and documenting compliance on
crash cart checklist.

2. Each emergency cart is equipped with a lock and kept locked unless in use.

3. If the lock is not intact, the cart is to be checked and unit personnel will replace any missing
supplies.

4. Crash cart is checked every shift and recorded.

5. Defibrillator load checks will be performed every shift with the defibrillator plugged in and
unplugged.

6. All carts will be opened and checked for contents once monthly and following each use. Sterile
items will be checked for package integrity and expiration date. Items with expiration dates
expiring within the month will be replaced. The medication drawer will not be opened if it is
sealed and intact.
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7. Laryngoscopes will be checked prior to placement on the cart and monthly.

8. Oxygen cylinders are replaced when the tank has emptied.

9. Drawers of crash carts are to be clearly labeled to identify contents.

10. Special procedure trays are kept on the bottom shelf.

THE FRONT LINE DRUGS ARE:

Adrenaline
Aminophylline
Atropine
Lidocaine
Dexamethasone
Sodium Bicarbonate
Calcium Gluconate
Magnesium Sulphate
Dextrose 50%

In case of a low blood pressure in cardiac arrest we use Atropine

Layout of the Crash Cart


Top of trolley:

Monitor/defibrillator
Suction machine
Blood Pressure Apparatus
SPO2 Probe
ECG strips with ECG machine at side of crash cart
Stethoscope

First Drawer:

Adrenaline 1mg/ml
Aminophylline 250mg/10ml

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Atropine 600mcg/ml
Calcium Gluconate 10%
Dexamethasone
Diazepam 10mg/2ml
Digoxin 0.5mg/vial
Dilantin/ Phenytoin
Dopamine HCL 200mg/5ml
Furosemide 20mg/2ml
Lidocaine Inj Bp 2%
Methylprednisolone Sodium Succinate 1g
Naloxone 40 mcg/2ml
Phenobarbitone
Phenytoin 250mg/5ml
Sodium Bicarbonate Inj, USP 8.4%
Thiopentone 1g
50% w/v glucose Inj
Water for injection

Second Drawer:

Alcohol prepads
Angiocatheters
Biohazard bags
Blood bottles (various)
Crepe bandages (all sizes)
Guedel airway (all sizes)
Lancets
Needles (18G, 21G, 22G, 26G)
Plastic adhesive bandages
Scissors
Sickness bag
Sterile guaze
Stomach tube
Surgical blades (varies)
Syringes (1ml, 3ml, 10ml, 20ml, 60ml)
Tongue depressors
Transpore tape

Third Drawer:

Blood collection set

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Defibrillator pad
Drip set
ECG Electrodes
Endotracheal tube
Emerald fiberoptic blade (Macintosh 4)
I.V lines
I.V tags
Kidney dish
Laryngoscope
Latex Gloves
O2 facemask and nasal cannula
Smallbore extension set
Stylet
Suction catheter (all sizes)
Surgical gloves
Tracheostomy tube

Fourth Drawer:

Ambu bag-adult with mask size: 4.5


Ambu bag- paediatric with mask size: 2
Ambu bag- infant size: 0A
Dextrose 50%
Dextrose 5%- 1L
Dextrose 5%/Sodium Chloride 0.2%- 1L
Lactated Ringers
Sodium chloride
Sterile polygeline solution

Fridge:

Isoproterenol HCL 0.2mg/ml


Propofol 200mg/20ml
Succinylcholine Chloride 20mg/ml

*Oxygen cylinder should be attached to the crash cart or in close proximity to the crash cart.

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Crash Cart: 1st Draw

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Crash Cart: 2nd Draw

Crash Cart: 3rd Draw

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Crash Cart: 4th Draw

EMERGENCY TROLLEY

1. Adrenaline 1 mg/1ml
2. Aminophylline 250mg/10ml
3. Atropine 600mcg/ 1ml
4. Calcium Gluconate 10%
5. Dexamethasone 4mg/ml
6. Dextrose 50%
7. Digoxin 0.5mg/2ml
8. Dopamine HCL 200mg/5ml
9. Furosemide Lasix 20mg/ 2ml
10. Isoprel 0.2mg/1 ml
11. Lidocaine 2%
12. Methypredisolone 1 g

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13. Naxolone 10 mcq/ 2ml
14. Phenytoin 250mg/ 5ml
15. Propofol ( Dipravin )200mg/20mls (FRIDGE)
16. Sodium bicarbonate 8.4%
17. Succinyl Choline (Anectine)
18. Water for Injection
19. Dextrose 5% 1000ml
20. Dextrose 10% in 1000ml
21. Dextrose 5.9% /sodium chloride
22. 5.2% Dextrose/ Na CL 1000ml
23. Lactated Ringers 1000ml
24. 0.9% Na Cl 1000ml
25. Thiopental 1 g
26. Diazepam ( Valium) 10mg/ 2mls
27. Phenobarb 200mg/1ml
28. Hammer
29. Torch Light
30. Defibrillator Plugged in
31. Laryngoscope
32. Adenosine
33. Intubation Tray
34. Bag Valve mask (AMBUBag)
35. Amidarone (Coradone) 150mg/3ml

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