Essential Resuscitation Equipment and Drugs for In-Hospital Cardiopulmonary Arrests - Essay Sample

Introduction

In-hospital cardiopulmonary arrest requires an immediate response to improve the probability of a fruitful result. As most cardiac arrests are sudden and unexpected situations, successful CPR relies on the availability and correct functioning of essential resuscitation equipment and recommended drugs available from a well-equipped resuscitation trolley (Medical emergency trolley), as well as skilled staff. A cardiopulmonary arrest is the unexpected suspension of breathing and the insufficient flow of blood by the heart. It is a typical and treatable cause of premature death, and thus, CPR refers to the attempts to establish and maintain airway patency by supporting breathing and circulation (Rajeswaran & Ehlers, 2012). A medical emergency trolley is a waist-high or chest high wheeled cart with many drawers furnished with all the materials purposed for cardiopulmonary resuscitation (CPR) and the management of other emergencies in a health center such as defibrillators, electrodes, syringes, drugs, and easy access to electrical power (ACLS Medical Training). The medical emergency trolley, also known as a crash cart, is typically kept in an effectively open location in the resuscitation area of emergency departments and has wheels for efficient relocation when needed. It is mostly designed as a tall, five-cabinet truck with the main three drawers being generally little and of equivalent size while the fourth is bigger, and the last one is the biggest. Joined to the cart is a noticeable substance list with lapse dates.

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The Trolley Parameters

On top of the crash cart is a biphasic defibrillator with adult paddles and adult multi-purpose (defibrillation, cardioversion, and pacing) cushions. Baby paddles with cable and infant pads are placed next to the defibrillator in a transparent bag. Highly efficient crash carts also have on one side, a one new-born (250 ml) and one kid (500 ml) Ambu-sack with two size one and two face masks, and one oxygen tube connector in a transparent bag. In a separate open bag, is a one adult (1,000 ml) Ambu-sack with two size three and four face covers, and one oxygen tube connector. The other side has one compressed oxygen tank, a hard cardiopulmonary resuscitation (CPR) backboard on the rear of the cart, and a laminated length-based pediatric resuscitation tape, such as a Broselow (Jacquet et al., 2018). Inside the cart, the first two drawers of the medical emergency trolley contain essential resuscitation drugs. These drawers are isolated into compartments permitting meds to be put away independently and visibly. Also, each container is marked with the prescription name. The prescriptions in the initial two drawers are sorted out systematically. Wherein those with similar broadly useful are assembled in similar lines, those needed in crucial moments are placed in the first lines. In order to diminish medication error, prescriptions with related names ought to be marked clearly and isolated by, at any rate, one other medicine. A few of these meds require security from inordinate light introduction because of the compound responses influencing drug stability or photo-degradation (Jacquet et al., 2018).

Organization and Usage

Jacquet et al., 2018 categorizes the medical emergency trolley into five compartments. Starting from the lowest cabinet to the highest, they include:-

The fifth. This cabinet is held for more prominent instruments and supplies required for exceptional techniques. It contains materials such as the 3-7 F/single and triple lumen Central venous catheters, an intraosseous pack, a chop down plate, 3.5 and 5 Fumbilical catheterization set, size 10-42 chest tubes, a thoracostomy unit, a thoracotomy pack, stitch set, delivery set, injury tourniquets, pericardiocentesis unit, clean stapler, and a burr gap manual drill unit.

The fourth. The fourth cabinet is intended to store respiratory gear and supplies for both grown-up and young patients. The front portion of the cabinet can be separated into two separable compartments, one of which can be detached and positioned at the head of the bed during resuscitation. This is contingent upon the patient's age group. The back half will contain the remainder of the provisions, such as cricothyroidotomy kit, laryngoscope light bulbs and batteries, endotracheal tube holders, carbon dioxide identifier, xylocaine splash, and tape.

The third. This cabinet is held mainly for materials that determine peripheral intravenous (PIV) entry. These materials include gauge size 16, 18, 21, 25 needles, (1, 3, 5, 10, 20, 30 cc) syringes, long spinal needles for emergency pericardiocentesis - size 20, 22 for kids and 18 for adults, (10, 11, 15) scalpel blades, alcohol wipes, Nylon 2.0, 3.0, 4.0 and Prolene 2.0 sutures, radial and femoral arterial line catheters (children, 22, 24 G and Adults, 20 G), nasal packs and both one-sided and two-sided inflatables for severe nose bleeding, and a magnet to reset failing defibrillators. The drawer also includes gauge-sized 14, 16, 18, 20, 22, 24 angiocatheters for new decompression of strain pneumothorax.

The second. The mainline in this cabinet is prevalently loaded with meds for hypertensive crises, and diminished mental status because of hypoglycemia and narcotic overdose. The subsequent column contains intravenous and breathed in prescriptions for intense exacerbations of respiratory sicknesses (asthma, chronic obstructive aspiratory malady, and upper airway edema), just as drugs for hypersensitive responses. The third column contains antiepileptic proxies and a diuretic. Phenytoin can be put away at room temperature, and henceforth, is incorporated in the crash cart. However, fosphenytoin requires refrigeration and should be kept in an intermediary area. Naloxone is additionally held in this cabinet. The fourth column contains incidental meds, for example, thiamine to treat Wernicke-Korsakoff disorder, and glucagon to treat beta-blocker overdose.

The first. The primary line of the principal cabinet contains all the drugs utilized in heart failure, such as epinephrine, amiodarone, sodium bicarbonate, and calcium. The subsequent range includes Rapid Sequence Induction (RSI) medicines required for intubation, as well as meds for bradycardia. It is anyway imperative to take note of the specific meds utilized in RSI, for example, ketamine, which should be put away in intermediary areas. Vecuronium is one paralytic that can be placed in the resuscitation trolley since it can be stored at room temperature, in contrast to succinylcholine and rocuronium, that require refrigeration. Etomidate is the primary sedative suggested for placement in the crash cart for RSI as it has a lower potential for substance misuse contrasted with different substances (Spearpoint, 2008). Besides, RSI drugs don't need to be broad in zones where intubation is not required because of the absence of ventilation or ensuing ICU care. The third line incorporates meds transcendently utilized in tachyarrhythmias with a heartbeat. A few drugs can be exchanged with others from a similar class with practically identical qualities relying upon accessibility. For example, Metoprolol may be utilized as an agent of other beta-blockers. The fourth line has intravenous drugs required for hypotensive crises and patients with low heart yield. Hydrocortisone is incorporated for its utilization in recalcitrant hypotension and suspected adrenal emergency.

CPR outcomes heavily rely on the availability and efficacy of these emergency trolleys and its equipments. Failing to check the kits regularly and missing emergency fluids, drugs, and defibrillators may lead to fatal delays, leading to adverse outcomes. It is, therefore, imperative to routinely inspect all the trolley equipments and always restock its accessories promptly.

References

ACLS Medical Training: Crash Carts. Retrieved on 23rd May, 2020, from https://www.aclsmedicaltraining.com/crash-carts/

Jacquet, A.G., et al., (2018): The Emergency Department Crash Cart: A systematic review and suggested contents. World J Emerg Med. Vol 9, Iss 2. pp 93- 98.

Rajeswaran, L. & Ehlers, V.J., (2012): Audits of emergency trolleys' contents in selected hospitals in Botswana. Health SA Gesondheid. Vol 17, Iss 1. Art. Pp 1-7.

Spearpoint, K., (2008): Resuscitating patients who have a cardiac arrest in hospital. Nursing Standard. Vol 23, Iss 14. pp 48–57.