Wailan, Christine Roiz C.

BSN 4B

I. Contents of the Emergency cart and its use.

 Drawer 1: Drugs
 Naloxone (Narcan) 0.4 mg/ml
 Amiodarone (Cordarone) 150 mg vial
 Adenosine 6 mg vial
 Norepinephrine 1 mg/ ml in 4 ml vials
 Sodium chloride 0.9% 10-20 ml vial for drug dilution
 Magnesium sulfate, 50% 2 ml vials (1g/ml
 Epinephrine 0.1 mg/ml
 Lidocaine 0.4% (4 mg/ml) in 250 ml bag
 Dextrose 50% (dextrose 25% if treating pedia
 Lidocaine, 2% (20 mg/ml) in 5 ml prefilled syringe
 Atropine sulfate 1 mg
 Dopamine (1.6 mg/ml in 250 ml or 500 ml bag
 Calcium chloride 10% 100 mg/mL in a 10 mL prefilled syringe

 Drawer 2: Drugs
 Aspirin 81 mg tablet
 Nitroglycerin spray or 0.4 mg sublingual tablets
 Procainamide 1 g in 10 ml 100 mg/ml vial
 Diltiazem 20 mg vial
 Metoprolol 10 mg vial
 Diphenhydramine (Benadryl) 50 mg vial
 Methylprednisolone 125 mg vial

 Drawer 3: IV Supplies Fluids and Tubing, Contents

 Lactated Ringer's solution- used to treat dehydration, electrolyte imbalances, and to provide fluid
resuscitation. It's commonly used in cases of shock, trauma, burns, or surgery.
 0.9% sodium chloride- used for hydration, as a carrier solution for medications, and for flushing IV
lines. Normal saline is a go-to for fluid resuscitation and for treating low blood pressure or
dehydration.
 0.9% sodium chloride- similar to the 1000 mL version but for cases requiring lower volumes or for
patients who do not need as much fluid.
 5% dextrose- to treat hypoglycemia, provide calories in patients who are unable to take oral
nutrition, or as part of fluid resuscitation when combined with other electrolytes.
  5% dextrose- used for diabetic patients who experience low blood sugar levels or for those who are
unable to ingest food and require caloric support.
 Blood tubing- for use in blood transfusions, commonly in cases of significant blood loss
 Primary IV tubing- for administering fluids, medications, or blood products to the patient, as well
as for continuous or bolus fluid resuscitation.

 Drawer 4: Pads & Leads Box A

 Salem sump tubes- used to remove excess air and fluids from the stomach, helping relieve pressure
or bloating in cases like GI obstruction or post-surgery.
 NG tube holder- used to keep the NG or OG tube securely in place, preventing it from moving or
being accidentally dislodged.
 Lubricant- used to make inserting the tube smoother, reducing friction and discomfort during the
process.
 OG/NG syringe- used to flush, irrigate, or aspirate fluids from the tube, ensuring it stays open and
functioning properly.
 Scissors- used to trim the tube to the right length or cut other materials, like tape, during the
procedure.
 Kelly clamp- used to temporarily clamp the tube to stop the flow of fluids or air during setup or
adjustments.
 Adhesive tape- used to secure the tube in place, usually on the patient’s nose or cheek, to prevent it
from shifting.
 Waterproof tape- used to secure the tube in place when moisture is present, ensuring the tape holds
up in wet conditions.
 Benzoin caps- used to prep the skin for better tape adhesion, especially if the skin is oily or moist.

Pads & Leads, Box B

 ECG patches- used to attach to the patient’s skin to monitor heart activity (electrocardiogram or
ECG). They are essential for detecting abnormal heart rhythms or assessing the heart's electrical
activity.
 Adult & ped defib pads- used to deliver electrical shocks to the heart during a cardiac arrest. The
adult pads are for larger patients, while the pediatric pads are designed for children. They ensure
proper shock delivery during CPR when a defibrillator is needed.
 Feedback pads- used to provide real-time feedback to rescuers during CPR, often connected to a
defibrillator. They help ensure the correct depth and rate of chest compressions, guiding the rescuer
for more effective resuscitation.
 Defib recording paper- used to print out a record of the defibrillator's activity, including the shock
delivered, the heart rhythm, and other critical data. It provides documentation for medical records
or post-event analysis.
  Pulse ox sensor- used to measure the oxygen saturation (SpO₂) in the patient’s blood. It’s crucial
for assessing respiratory function, especially in emergencies involving respiratory distress or
cardiac arrest.
 Adult & child bp cuffs- used to measure blood pressure. Adult cuffs are for adult patients, while
child cuffs are smaller and used for pediatric patients. Accurate blood pressure monitoring is
critical for assessing circulatory health and shock.

 Drawer 5: Procedures Box A

 Cricoid kit- used to perform cricothyroidotomy (emergency airway procedure) when a patient
cannot be intubated or oxygenated.
 Cordis kit- used to insert a large-bore catheter (Cordis catheter) into a large vein for rapid fluid
administration, drug delivery, or central venous access.
 Chloraprep sponge- used to disinfect the skin before a procedure, especially for central line or other
invasive procedures. It helps reduce the risk of infection by thoroughly cleaning the skin with a
broad-spectrum antiseptic.
 Tegaderm- used to cover and protect wounds or insertion sites after procedures. It’s a transparent,
sterile adhesive film that keeps the area clean, dry, and secure, helping to prevent infection and
moisture buildup.
 Gauze Sponge- used to absorb blood or fluids during a procedure, or to clean and dress wounds. It's
essential for controlling bleeding, maintaining sterile conditions, and providing comfort to the
patient.
 Sterile towels- used to maintain a sterile field during medical procedures. They’re placed around
the procedure area to keep it clean and free from contaminants.
 Scalpel- used to make incisions during surgical or emergency procedures. It’s a precise, sharp
blade that’s essential for opening airways, performing cricothyroidotomies, or other quick
interventions in life-threatening situations.

Procedures, Box B Contents:

 A-line setup- used to establish an arterial line (A-line) for continuous blood pressure monitoring
and blood sampling. This setup is crucial for patients who need constant, real-time blood pressure
readings and frequent lab tests, often in critical care or during surgery.
 Femoral a-line kit- used to insert the A-line catheter into the femoral artery (in the groin). This kit
typically includes a catheter, an introducer, and other necessary tools to gain arterial access safely
and efficiently.
 60 mL syringes- used to flush the A-line catheter or to withdraw blood samples. The large syringe
volume helps ensure the line is clear of air or clots, which is essential for accurate pressure
readings and lab results.
 Cardiac needle- sed to insert the A-line catheter into the artery. The cardiac needle is designed to
provide deeper arterial access, especially when inserting an A-line through the femoral artery. It’s
specialized for central access procedures.
  A-line cath- used to directly measure arterial blood pressure and allow for blood draws. Once
inserted into the femoral artery, this catheter is connected to a transducer that gives continuous
real-time readings of the patient's blood pressure.
 Ear mask with shield- used to protect the healthcare provider’s ears during the procedure. This
ensures they can focus on the sterile procedure without external distractions, especially in noisy
environments like an ICU or operating room.
 Caps- used to seal the catheter ports after use, keeping the system sterile and preventing infection.

 Drawer 6: Suction & O2 Equipment

 Adult resuscitator kit- used to provide emergency respiratory support, typically during resuscitation
efforts (like CPR) or when a patient is in respiratory distress.
 Suction catheters- used to clear the airway of secretions, blood, or vomit that could block airflow.
Suction catheters are essential in maintaining a clear airway, especially in patients who are unable
to clear their own airways due to sedation, injury, or illness.
 IV pressure bags- used to administer fluids or medications rapidly during emergencies. These
pressure bags allow for the inflation of the IV line, pushing fluids into the patient’s circulatory
system under pressure.
 Oxygen adapter- used to connect oxygen sources to respiratory devices, like an oxygen mask or
bag-valve mask. I
 Non-rebreather mask- used to deliver high concentrations of oxygen to a patient. The mask is fitted
with a reservoir bag that provides a higher flow of oxygen compared to a standard face mask,
making it suitable for patients with severe respiratory distress.
 Venti mask- used to deliver a precise concentration of oxygen. The venti mask has a valve that
allows the delivery of a controlled oxygen flow, making it ideal for patients with chronic
respiratory conditions like COPD, where oxygen needs to be closely regulated.
 Bougie- used to assist with intubation. The bougie is a flexible tool that can be inserted into the
trachea to guide the endotracheal tube (ET tube) during difficult or difficult-to-visualize intubation
procedures, ensuring proper placement of the tube
 Oxygen connector- used to connect oxygen supplies to various respiratory devices (e.g., mask,
cannula, or BVM). The connector ensures the oxygen flows properly from the tank to the patient’s
airway management device.

PPE & Suction, Side B Contents:

 Peds resuscitator kit- used to provide respiratory support (e.g., bag-valve mask) for pediatric
patients in respiratory distress or during resuscitation.
 Gowns- used to protect healthcare providers and maintain sterile technique during procedures,
especially in emergencies.
 Suction tubing- used to connect suction devices to catheters for clearing the airway of fluids or
debris.
 1200 cc canister with lid- used to collect suctioned fluids, blood, or secretions during airway
management.
 Nitrile gloves- used to protect healthcare providers from exposure to bodily fluids and maintain
hygiene during procedures.
 Suction regulator- used to control suction pressure, ensuring it’s effective but not too strong to
avoid tissue damage.

 Cart Exterior
 Defibrillator- used to deliver electric shocks to the heart in cases of cardiac arrest or arrhythmias,
restoring a normal rhythm.
 02 tank: gas oxygen size E with regulator- used to provide supplemental oxygen to patients. The E-
size tank is portable, and the regulator controls the flow of oxygen to ensure proper delivery.
 Sharps container: sharps disposal 5.4 qt red- used to safely dispose of needles, syringes, scalpels, or
other sharp objects, reducing the risk of injury and infection.
 Pediatric intubation kit- used to secure an airway in pediatric patients by inserting a tube into the
trachea. It includes pediatric-sized endotracheal tubes, laryngoscope, and related tools for
intubation.
 Adult intubation kit- used to secure an airway in adult patients through endotracheal intubation,
including adult-sized tubes, a laryngoscope, and other necessary equipment.

II. List down emergency drugs. What are their indications and special considerations?

Drug Indication Special Considerations

Naloxone Reverses the effects of opioid  Avoid in patients with known

overdose. hypersensitivity to naloxone.

 May precipitate opioid withdrawal

syndrome.

 Administer to patients with suspected

opioid overdose whose respirations are
< 12/minute.

 Titrate to desired clinical effect by

administering a diluted preparation
(0.04 mg/mL) slow IV push.

 Dilute 0.4 mg (1 mL) ampul with 9 mL

of normal saline for a total volume of
10 mL to achieve a concentration of
 0.04 mg/mL

Amiodarone Treats acute life-threatening Avoid in patients with:

dysrhythmias, including
ventricular  Known hypersensitivity to
tachycardia/fibrillation and amiodarone, iodine, or any component
supraventricular tachycardia. of the formulation

 Severe sinus node dysfunction causing

marked sinus bradycardia

 Second- and third-degree heart block

(except in patients with a functioning
artificial pacemaker)

 Bradycardia causing syncope (except

in patients with a functioning artificial
pacemaker)

 Cardiogenic shock

 Administer undiluted over 10 minutes

for the treatment of pulseless
ventricular tachycardia/ventricular
fibrillation unresponsive to CPR,
defibrillation, and vasopressor therapy.

Adenosine Suppresses supraventricular Avoid in patients with:

tachycardia.
 Known hypersensitivity to adenosine

 Second- or third-degree AV block

(except in patients with a functioning
artificial pacemaker)

 Sinus node disease, such as sick sinus

syndrome or symptomatic bradycardia
(except in patients with a functioning
artificial pacemaker)

 If vagal maneuvers do not correct

supraventricular tachycardia,
administer 6 mg rapid IV bolus
 over a 1- to 2-second period.

 Note: Initial dose of adenosine

should be reduced to 3 mg IV bolus
if patient is currently receiving
carbamazepine or dipyridamole, has
a transplanted heart, or if adenosine
is administered via central line. If
the first dose does not result in
elimination of the SVT within 1 to
2 minutes, give 12 mg IV bolus.
Follow each dose with 20 mL
normal saline flush

Norepinephrine Increases blood pressure in  Infuse into a large vein whenever

patients with hypotension or possible to prevent infiltration of
shock who are not responsive perivascular tissue adjacent to the
to IV fluids. infusion site.

 Extravasation can cause necrosis and

sloughing of the surrounding tissue.

 Some formulations contain meta-

bisulfite, which is known to exacerbate
asthma.

 Dosage range varies greatly

depending on clinical situation.

 Typical dosing is between 0.5 to 4

mcg/minute continuous IV infusion

Sodium chloride 0.9% Used to dilute drugs for  Must be isotonic to avoid damaging
administration. tissues.

Provide replacement fluids in  Use hypertonic sodium chloride

the setting of dehydration or solutions with extreme caution.
hypotension.
 Must be isotonic to avoid damaging
tissues.
  Use hypertonic sodium chloride
solutions with extreme caution.

Magnesium sulfate Use for polymorphic VT  Use with caution in patients with
(with pulse) associated with existing heart blocks.
QT prolongation or
VF/pulseless VT associated  Can enhance the effect of
with torsades de pointes. neuromuscular-blocking agents.

Also used for profound IV infusion

hypomagnesemia, acute
 Dilute solutions to a concentration of <
asthma exacerbations, or
20% prior to administration.
seizures due to eclampsia.
Polymorphic VT (with pulse) associated
with QT prolongation

 1 to 2 g (diluted in 50 to 100 mL
D5W) IV over 15 minutes (range: 5 to
60 minutes).

 Can follow with a continuous IV

infusion of 0.5 to 1 g/hour.

VF/pulseless VT associated with torsades

de pointes

 1 to 2 g (diluted in 10 mL D5W)
administered as an IV or intraosseous
bolus.

Epinephrine Increases blood pressure or  Administer 1 mg IV push for:

heart rate or treats type I asystole/pulseless arrest, pulseless
allergic reactions, including ventricular fibrillation, or ventricular
anaphylaxis. tachycardia unresponsive to
defibrillation shocks.

 May also be used for allergic reactions

(intramuscularly) or profound
hypotension and shock.
Lidocaine Treats life-threatening Avoid in patients with:
arrhythmias, particularly those
that are ventricular in origin,  Hypersensitivity to local anesthetics of
such as those that occur the amide type
during acute MI.
 Stokes-Adams syndrome, Wolff-
Parkinson-White syndrome

 Severe degrees of sinoatrial,

atrioventricular, or intraventricular
block in the absence of an artificial
pacemaker

Malignant hyperthermia or
methemoglobinemia can occur in a small
subset of patients.

Administer lidocaine injection IV at a rate

of approximately 25 to 50 mg/min.

Dextrose 50% Corrects acute hypoglycemia Avoid in patients with:

 Hypersensitivity to dextrose, corn, or

corn products

 Intracranial or intraspinal hemorrhage,

delirium tremens, or dehydration, as
the hypertonic solution may exacerbate
the conditions

 Administer as a slow IV push if patient

has signs and symptoms consistent
with profound hypoglycemia and/or
measured blood glucose < 54 mg/dL.

Lidocaine Treats life-threatening Avoid in patients with:

arrhythmias, particularly those
that are ventricular in origin,  Hypersensitivity to local anesthetics of
such as those that occur the amide type
during acute MI.
 Stokes-Adams syndrome, Wolff-
Parkinson-White syndrome
  Severe degrees of sinoatrial,
atrioventricular, or intraventricular
block in the absence of an artificial
pacemaker

Malignant hyperthermia or
methemoglobinemia can occur in a small
subset of patients.

Administer lidocaine injection IV at a rate

of approximately 25 to 50 mg/min.

Atropine sulfate Increases the heart rate and is  Avoid in patients with known
an antidote for cholinergic hypersensitivity to atropine.
poisoning.
 Use with caution in patients with
myocardial ischemia, heart failure,
tachyarrhythmias (including sinus
tachycardia), and/or hypertension.

 Administer 1 mg as an IV push if
patient has symptomatic bradycardia
(< 50 beats per minute and
hypotension, altered mental status,
signs of shock or signs of acute heart
failure) or signs and symptoms of
cholinergic poisoning (titrated to an
effective dose that stops secretions).

Dopamine Improves perfusion of vital  For IV use only.

organs and/or increases
cardiac output.  Infuse into a large vein whenever
possible to prevent the infiltration of
perivascular tissue adjacent to the
infusion site.

 Extravasation can cause necrosis and

sloughing of the surrounding tissue.

 Individually titrate patients to

 desired hemodynamic and/or renal
response with dopamine.

 Begin infusion with 2 to 5

mcg/kg/minute IV and increase
dose gradually, using 5 to 10
mcg/kg/minute increments.

 Dose rates should not exceed 50

mcg/kg/minute.

Sodium bicarbonate Corrects low blood pH due to  Infuse into a large vein whenever
metabolic acidosis. possible to prevent the infiltration of
perivascular tissue adjacent to the
Also used to treat acute infusion site.
symptomatic hypokalemia
and tricyclic antidepressant  Extravasation may cause necrosis and
overdose. sloughing of the surrounding tissue.

 Avoid administration with

catecholamines in same IV catheter or
tubing; inactivation of catecholamines
will result.

 For cardiac arrest with acidosis,

administer a rapid IV dose of 200 to
300 mEq of bicarbonate, given as a
7.5% or 8.4% solution.

Calcium chloride Use when epinephrine fails to  For IV use only.

improve weak or ineffective
myocardial contractions.  Irritates veins.

 Do not use scalp vein or small hand or

foot veins for IV administration;
central-line administration is preferred.

 Do not inject into tissues because

severe necrosis and sloughing can
occur.
  Overdosage or rapid IV administration
can result in serious cardiac effects,
including bradycardia, arrhythmia, and
ventricular fibrillation.

 Administer at a rate not to exceed 1

mL per minute.

 Administer through a small needle into

a large vein to minimize venous
irritation and to avoid undesirable
reactions.

Aspirin Reduces platelet aggregation  Avoid in patients with known

during myocardial infarction. salicylate allergy, risk of bleeding, and
in children with viral infections.
Dramatically reduces  Chew and swallow two tablets
morbidity and mortality in
patients with active
myocardial infarction.

Nitroglycerin Improves cardiac blood flow  Avoid in patients with known

and reduces symptoms of hypersensitivity to nitroglycerin,
angina. circulatory failure (shock), or
increased intracranial pressure.

 Risk of hypotension increases with

concurrent use of phosphodiesterase
type 5 (PDE5) inhibitor.

 Administer sublingually if the patient

has signs and symptoms consistent
with angina or myocardial infarction.

Procainamide Effective and recommended Avoid in patients with known:

treatment alternative for
hemodynamically stable  Procainamide or ester-type local
monomorphic ventricular anesthetic hypersensitivity
tachycardia in adults with
 Prolonged QT interval
preserved left ventricular
function.  Administer 100 mg IV every 5 minutes
 until arrhythmia is controlled,
hypotension occurs, or QRS complex
widens by 50% of its original width.

Diltiazem Treats symptoms (e.g.,  Avoid in patients who are taking a beta
palpitations) associated with blocker or who have heart failure with
non-sustained ventricular reduced ejection fraction (due to its
tachycardia or ventricular negative inotropic and chronotropic
premature beats. effects).

Used for acute management  Avoid in patients with sinus node

of supraventricular dysfunction or second- or third-degree
tachycardia. atrioventricular block (unless a
functioning pacemaker has been
placed).

 Administer 20 mg IV if vagal
maneuvers or adenosine are ineffective
for supraventricular tachycardia.

 Can also be used to treat hypertensive

emergencies.

Metoprolol Lowers blood pressure Avoid in patients with known:

 Hypersensitivity to metoprolol or
severe sinus bradycardia (heart rate
less than 45 bpm)

 Second- and third-degree heart block

 Significant first-degree heart block (PR

interval at least 0.24 seconds)

 Systolic blood pressure less than 100

mm Hg

 Moderate to severe cardiac failure

 Administer 5 mg and titrate to desired

heart rate and blood pressure in
hemodynamically stable acute MI to
 reduce cardiovascular mortality.

 Generally administered in addition to

amiodarone for acute ventricular
arrhythmias.

Diphenhydramine Blunts the effect of excess  Avoid in patients with known

histamine hypersensitivity to diphenhydramine.

 Administer 25-50 mg as an adjunct

to epinephrine in patients with type
I allergic reactions.

 Can be used for drug-induced

extrapyramidal reactions (dystonic
reactions) at 25-50 mg.

Methylprednisolone Reduces inflammation

Avoid in patients with known hypersensitivity to any
component of the formulation (including those with milk

Off-label therapy for a variety of issues.

Reduces cerebral edema or acute respiratory distress

syndrome (1 mg/kg).

Improves outcomes post myocardial infarction.