EMERGENCY TROLLEY > Is one equipped trolley with the essential medication and tools that need for emergency and urgent cases. Goal of emergency trolley is: > Saving time > Keep life of patient > Saving effort of medication Uses of emergency >Ventricular fibrillation > Respiratory paralysis >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)and the quantity of each medication.é A x Donen SHH fly = Se REPUBLIC OF NA. MIBIA / Ministry of Health and Social Services ~ ANA! ‘LACTIC SHOCK DEFINITION ‘A sudden allergic reaction due to histamine release causing the following 1 SERREE hypotension due to vasodilation and Mud leak into theinteritial space. + Laryngeal oedema + Bronchospasm ~ Memolysis with haemoglobinurea = Death CAUSES Allergy to medication administered via any reute, Any medication may cause an allergic reaction, Common medications are antibiotics, ant-serums eg, Snake bite, tetanus, - Blood transfusions Colloid intravenous solutions Insect stings eg. bee stings CLINICAL F RESENTATION Patient complains of faintness, dizziness, difficutty with beeathing and itch shortly after taking medication, = The skin may be cold and clammy and have a rash varying from ‘chicken skin: to urticarial Patient may be flushed. = Altered level 0 conscicusness varying froma anxjety to coma. = Hypotension, tachycardia. Pulse may be weak. = Difficulty with breathing. Wheezing. Brouchospasrr. = Nausea, vomiting and diarrhea + Oliguria. Dark coke coloured urine | = Flank pain. j NURSING INTERVENTION | | 1. Stop offending agent / drag | 2. Administer adrenaline intramuscular or intravonovsly of.subcutaneous, tml/IV1 slowly | ‘when symp:oms of acute shock preseat ie. no Loot pressure or pulse DOSES OF ADRENALINE = Ampoule of 1m contains 11000 (1mg/m!) "Health for All” (eee ae(000) -give 1m! of “Adrenaline Amg/ml (1 ocd pressure Srerile Wa | solution IVi every 2 minutes agai SHOULD THE PATIENT EXPERIENCE BRONCHOSPASM OR TITRATE AGAINST B.P CONTINUE (WITH FURTHER TREATMENT IN ADULTS ONLY Salbutamal Nebs: 1:1 2 Adrenacorticosteroids eg. Solucortef 200mg IVI slowly then repeat é hourly. Antihistamine eg, Phenergan 25mg/Imi IVI slowly Ranitidine 50mg iV stat (edults). GENERAL NURSING CARE 1. Maintain clear airway. 2. Give Oxygen via mask or ambubag, 3. Commence IVI infusion of Sodium Chloride 0.9% with a 16g oF 18g cannula @ 125mi/nr. or adjust flow rate against patient blood pressure. 4. Continuous monitoring of vital signs. 5. Contact doctor immediately, 6. Resuscitate if necessary. IDENTIFY THE CAUSE INFORM THE PATIENT / PARENTS ABOUT A "MEDIC ALERT” NECKLACE OR WRISTBAND 4 Prof. A.R Lichtman ICU Consultant and Anaesthetist. MBChB FFA)\ REPUBLIC OF NAMIBIA Ministry of Health and Social Services EMERGENCY TROLLEY MEDICATION POLICY ADRENALINE MG/ML (1:1000) 9). CPR Cardiac Arrest Adult: Ii repeated as needed every $ minutes IVI Paediatrics: 1:10 000 solution 0.1ml/‘g/dose 1 Anaphylaxis: Adult 0m 1:1000 $/C of IMI oF 0.05 ~0:1mg/0,5-1m (1:40 000) Org /ml {Ttvate: ite Sl Sterile Water with Adrenaline 1mg/l (1:10 000) -ive 2m of solation | Wt every 2minutes against Blood pressure. ‘= Paediatrics: 0:0imi/kg 1:1000 IMI or 0.1 mi/kg 1:10 000 VL AMIODARONE (CORDARONE) 150mg/3ml Severe arvhythanias in adults 300mg in 200ml $% dextroze over 30 minutes. Then 150mg in 200ml $3 dextrose over 1 hous every 8 hours. ATROPINE 0.5m / nl + Bradyeardia: 0.01 mg/kg V1 4 5mglV pen Ttrate for adult CALCIUM GLUCONATE ‘© Hypocaleaemla with low blood pressure {Hypocalcaemia Tetany following blood transfusion ‘+ Hyperkalaemia slow 10-40 til ECG is wormal DEXTROSESO% 20 40 ml IVI for hypoglycaemic coma FUROSEMIDE (LASIX) + Pulmonary Oedema ‘Congestive Cardiac Failure + Adults: 20~40 mg VI + Pacdistics:05~1.5 ng/ks DIHYDRALAZINE (NEPRESOL) 25mg/ampoule Ee “Health for All” “Health Tor Al”sive Emergencies Hypertens Hypertension of pregnancy Dose: 625~ 25mg IMI ‘omg/200m Saline Infusion Ttrate HvDROCORTISONE (SOLUCORTEF) + Acute Allergic Reactions + Asthma Dose: 100- 200mg VI 4 hourly LIGNOCAINE. «Ventecular Betopic Bets and Ventricular Tachycardia Dobe: tmg/lg bolus IVI can be repeated after 10 minutes 1 Follow by infusion 1me/ka/hour [NALOXONE (NARCAN) 1 of respiratory depression due to oplates ‘Adults: 04mg IV stat. Follow with very short halflife Paediatrics: 0.01ma/K ‘SODIUM BICARBONATE Metal Acidosis (03 wg (body weight) x Base Excess 42 NaBichas 0Smmol/mt Reversal sn Vt has 2 Dos: oamgintramuscular injection. Nareat Dose: = mmol NaBic {84 NaBichas mmol/l diatrics half correct and repeat blood gasses 4 Revised by: fi fe pad Ni as Date Inpaee Bi Lichtman (ICU Consultant and Anaesthetis. MBCHD FFA) Prof Al eee (ic OF 2007ISTRY OF HEALTH AND SOCIAL SERVICES. PROTOCOL FOR EMERGENCY TROLLEY ea rALoaUe |DISPOSABLE ITEMS & OTHER EQUIPMENT. [AMOUNT lorsese7 INTRAVENOUS CATHETERS (EG. CAVAFLX) : 70cm. A 716960 & : :0ci 2 2010070 SURGICAL BLADE No. 11 2 lovo2s05, PLASTER (STRAPPING) PINK (ZINC OXIDE, 1941) h lonoz0s0_ <= WHITE (ELASTOPLAST, 7544) fi lozo0s09 INFUSION SETS: BLOOD ADMINISTRATION SET 2 lov00s57 1S DROPS/AL lz loroo702 0 DROPS A ‘ozaseo2 CENTRAL VENOUS PRESSURE MONITORING SET fi IsTeAILe Gauze 1eKt loveara6 lVANKHAUER MOUTH SUCTION TUBE 2 lozize0r [SUCTION CATHETERS SIZE 12 (ADULTS) ls 717083 ie SIZE 6 (PAEDIATRICS) ls lo77029 sizes 2 070190 JORAL. AIRWAYS NO. 3 (ADULTS) 2 lozovose No 2 lozo1a07 no. (PAEDIATRICS) le lorar7so oO i lororese gon 2 "Health for AU”MINISTRY OF HEALTH PROTOCOL FOR EMER AND SOCIAL SERVICES (GENCY TROLLEY EATALOGUE DISPOSABLE ITEMS & OTHER EQUIPMENT AMOUNT OXYGEN FACEMASKS AND OXYGEN TUBING: (ADULTS) 2 *_WwaeDiaTRICs) 2 RESPIRATORY RESUSCITATOR WITH MASKS (ADULT OR PAEDIATRIC EG. AMBUBAG WITH MASKS: 1 ser ENDOTRACHAEL TUBES: NO_ 6,5 7.0 7.5 8.5 (ADULTS) lz eacn NO 2.5 3,0 3.5 4,0 4.5 (PAEDIATRICS) lz each [STERILE WATER }1 BOTTLE STERILE KIDNEY DISH a mouTHGAG 1 LARYNGOSCOPE WITH BLADES jt + 3 eLaDes MAGILL'S FORCEPS (ADULT SIZE OR PAEDIATRIC SIZE) ARTERY FORCEPS ~ TONGUE DEPRESSOR (METAL) 1 ENDOTRACHEAL TUBE INTRODUCER, (METAL/PROPYLENE) ADULT OR PAEDIATRIC SIZE scissors OXYGEN CYLINDER WITH FLOWMETER CONNECTED, |SUGTION APPARATUS JBAUMANOMETER, Page 3 otAT WORE aa OSHARATOSMINISTRY OF HEALTH AND SOCIA L SERVICES. PROTOCOL FOR EMERGENCY TROLLEY : [cxtALOGUE sPosAGLE ews & OTHER EOUIPHENT ramoONT AMPOULE FILES a loraoos0 SYRINGES a ls lora0001 : a S ie : Sree ; lora0.09 : 20m, > o739618 lnceoes = BLACK NO. 22 a loza9s45 : ____=_GREENNO.21 4 jozssasa : PINK NO. 18, A azaao0s LUMBAR PUNCTURE NEEDLES -70 x 074K lz lorasoaa | 40x07 2 INTRAVENOUS GANHULAS: E.G. JELCO'S) lorva022 ADULT WARD) = PINKNO, 20 ls } < 10712973 ~ GREEN NO. 18 a orsa01s += GREYNO. Is arisx2 PAEDIATRIC WARDS)” PINK NO.20 2 ors2076 += BLUENO.22 s lorsze17 ~ YELLOW NO.24 ls oz00975_ laurrenrLy No.23__ 5VAMIBIA Ministry of Health and Social Services EMERCENCY TROLLEY MEDICATION POLICY ADRENALINE IMG/ML (1:1000) CPR Cardiac Arrest: Adult: 1nil repeated as needed every 5 minutes VI. ‘Paediatrics: 1:10 000 solution 0.1mi/g/dose IVI Anaphylaxis: "Adult 05a! 1:1000 $/C or IM o 0.05 ~0-1mg/0. 5-1ml (1:10.000) 01mg /ml + Ttrate: Dilute ml Sterile Water with Adrenaline Lmg/ml (1:10 000) -give ml of solution IVI every 2minutes against Blood pressure. + Paediatrics: .01mi/kg 1:1000 IMI or 0.1 ml/kg 1:10 000 VL AMIODARONE (CURDARONE) 150mg/3m! + Severe arrhythmias in adults + 300%ng in 200m! 596 dextraze over 30 minutes. Then 150mg in 200ml 5% dextrose over 1 houe every 8 hours. ATROPINE 0.5mg / ral “© Bradycardia: 0.01 mg/kg IVI + 0.5mg IV prn Titrate for adult ‘CALCIUM GLUCONATE + Hypocaleaemla with low blood pressure + Hypocalcaemia Tetany following blood trarsfsion ‘© Hyperkalasmia slow 10 - 40 till ECG is normal DEXTROSE 50% 20 - 40 ml IVI for hypoglycaemic coma FUROSEMIDE (LASIX) + Pulmonary Oedema + Congestive Cardiac Fatlure © Adults:20- 40 ig 1V1 «© Paediatics: 05 ~1.5 ng/kg DIHYDRALAZINE (NEPRESOL) 25mg/ampoule "Health for All”+ Hypertensive Emergencies + Hypertension of pregnancy + Dose: 625 - 25mg IMI + somg/200mi Saline Infusion Titrate HYDROCORTISONE (SOLUCORTEF) + Acute Allergic Reactions = Asthma © Dose: 100- 200mg IVI + hourly : LIGNOCAINE 1 Ventiular Eetple Beats and Ventriclar Tachycardia + pene dmg/eg bolus IV canbe repested after 10 minutes 1) Fallow by infuston 1ma/ke/nour NALOXONE (NARCAN) Reversal of respiratory depression dueto opiates dul: €AmgVI stat Follow with 0AmgintramuscuarIn/eclon Narean IVE has Dose: very short half life Paediatrics: 0.01mE/ Ks ‘SODIUM BICARBONATE Metalic Addosis Dose: ‘oa xk (body weight) x Base Excess = mmol NaBle 42. NaBic has 0Smmol/eal 4.4 NaBichas 1mmol/l tn paediatrics half correct and repeat blood gasses Revised by: prof AR Lichtman (CU Consultant and Anaesthetist. MBCHb FFA) Date