RESUSCITATION TROLLEY

1. General Information
The Resuscitation Trolley is for the purpose of cardio-pulmonary resuscitation and management of other
emergencies in the Health Centre. Resuscitation Trolley’s should be easily accessible in the Emergency
Room, and able to be moved to any area within the Health Centre if required.
The Emergency Outreach Drug Box stored in the Resuscitation Trolley is designed to provide a
reasonable cover of emergency drugs to meet most emergencies encountered by remote health centre
staff both within and outside the HC. To avoid unnecessary duplication of stock, one drug kit is to be held
in the Resuscitation trolley in each Health Centre to fulfil both functions
There is a wide range of trolley types used throughout. While the contents of the trolley are to be stocked
consistently across all health centres, the configuration may have to change according to trolley type.
Configurations for 2 and 3 drawer trolleys are provided below. For trolleys with different numbers of
drawers, the list can be reformatted to suit, providing a basic Airway / Breathing / Circulation
configuration is followed. Consult with a Professional Practice Nurse if assistance is needed in
developing a customised format. The use of a trolley that cannot adequately house the standard contents
list should not be used and an adequate trolley may be requisitioned.
A purpose built Resuscitation Trolley / Emergency Cart would be the preferred standard equipment
throughout the Branch but is not affordable within routine budgets. However the purchase of such
equipment is flagged as a possibility if a suitable funding opportunity arises.

3. Responsibilities of All Health care Staff

Are required to be familiar with the location, contents and operation of equipment and supplies on the
Resuscitation Trolley
Will participate in checking the contents of the Resuscitation Trolley, ensuring weekly checks are
routinely attended, or following use
Responsible for restocking after use, as soon as practicable

AIRWAY & BREATHING first drawer

Basic airway tray Advanced airway tray
• oropharyngeal airways sizes 2, 3 & 4 laryngoscope size 3 standard blade
• nasopharyngeal airways 6 & 7 tracheal tube – oral,cuffed sizes 6, 7 & 8
• lubricating gel & gauze tracheal introducer (bougie - store straight)
• yankauer sucker x 2 catheter mount
• lubricating gel & gauze
Additional equipments
• tracheal tube tie
• laryngoscope handles with size 4 long blade 10ml syringe
• magill forceps ETCO2 detector
• scissors
• tracheal suction catheters sizes 12 x 2, 14 x 2
• O2 mask with reservoir bag (non-rebreathing)
• spare laryngoscope bulbs & batteries if appropriate
• stethoscope
CIRCULATION second drawer
• blood giving set x 2 IV access tray
• syringe pump giving set tourniquet
 • arterial blood gas syringes x 3 IV cannula dressing
• gauze & tape cannulae x 2 each of 16g (grey) 18g(green)
• sealed ECG electrodes compatible with defib leads 10ml syringe
• IV cannula dressings & tape green needle
• extra cannulae 14g (brown) x4, 16g (grey) x 4, 10ml N/saline flush 18g (green) x 4, 20g (pink) x 4
• pericardiocentesis needle ( BD Secalon T 14 G )
• 50ml luer lock syringe
DRUGS & FLUIDS third drawer
• Adrenaline (epinephrine) 1mg (1:10,000) x 6 20ml syringes & green needles
• Atropine 3mg x 1 Normal saline 10ml ampoules x20
• Amiodarone 300mg x 2 5ml syringe & green needle for magnesium
• Calcium Chloride 10ml of 100mg per ml x1
• Magnesium Sulphate 50% solution 2g (4ml) x1
• Sodium Bicarbonate 8.4% - 50ml x1
• 0.9% sodium chloride 1000ml x2
• Gelofusine 500ml x 2
BOTTOM OF TROLLEY
• large scissors (for removal of clothes) gloves, aprons & goggles
• spare defib pads spare cardiac arrest record forms
• Seldinger central venous catheter kit x1 as agreed locally (i.e. doesn’t need to be on every trolley
in a local area)
• Additional equipment appropriate to your area, e.g.
• laryngeal masks sizes 4 & 5
• tracheostomy equipment

Bibliography
1.http://www.suht.nhs.uk/Media/suhtideal/TopNavigationArticles/SkillsForPractice/R2.citationService
s/ADULTRESUSCITATIONTROLLEYMRXAUG2008Pacingdefib.pdf
3.http://remotehealthatlas.nt.gov.au/resuscitation_trolley.pdf
4. http://apps.med.buffalo.edu/procedures/defibrillation.asp?p=9
 DEFIBRILLATION

INDICATIONS:
· ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) and
associated cardiac arrest (unresponsive patient without a pulse)

CONTRAINDICATIONS:
· awake, responsive patients
· any arrhythmias in a patient with a pulse

MATERIALS:
· defibrillator
· many different machines/models
· become familiar with equipment where you are practicing
· paddles
· adult size (8-9cm diameter) for patient weight > 10 kg.
· pediatric size ( 2.2 cm diameter) for patient weight < 10 kg.
· Electrode pads
· Self – adhesive
· Conductive material
· Gel, paste or pads

PRE-PROCEDURE PATIENT EDUCATION:

· Not necessary (or possible) for an emergent, potentially life-saving procedure in an
unresponsive patient

PROCEDURE/TECHNIQUE:
· Sudden death/cardiac arrest patients in VF or VT without a pulse should be defibrillated
as soon as possible (even before CPR, medications or advanced airway procedures)
· Initiate CPR/ACLS protocols until defibrillator available
· Power on the defibrillator and select “unsynchronized/defibrillation” mode
· turn monitor selector to “paddles”
· Apply conductive materials (depends on what is available) before paddle placement
· Apply defibrillator monitor cables, pads, or “quick-look” paddles to patient in cardiac
arrest to determine rhythm
· Paddle placement:
· First (“sternum”) paddle: to the right of the upper sternum and below the clavicle
· Second (“apex”) paddle: to the left of the nipple in the midaxillary line, centered in
the 5th intercostal space
· Avoid placing both paddles next to one another on the anterior chest wall
· Lead placement:
· “White-on-the-right” will help you to remember the white electrode is placed on the
right side of the chest just below the right clavicle
· “smoke over fire” will help you to remember that the black lead is placed on the
left chest just below the left clavicle, and the red lead is placed in the left midaxillary
line below the expected PMI of the heart
· electrode pad placement:
· can be placed as described above for paddles, or
· anterior pad just to the left of the sternum, and posterior pad on the patient’s back
to the left of the spine. (This technique “sandwiches” the heart between the pads)
 · assess rhythm to confirm VF/VT:
· if you see a flatline, turn up the gain to rule out fine VF, if flatline remains (and you
have checked monitor, connections, and the patient) rotate paddles 90 degrees and
re-assess rhythm to assure VF or (pulseless) VT remains
· choose energy level and charge defibrillator (“charge” buttons may be located on the
paddles or on the machine itself)
· deliver shock(s) by simultaneously pressing the discharge buttons located on the
paddles (or on the monitor for electrode pads) after ensuring “all clear” from the patient
for equipment and providers
· re-assess patient, consider recommended medications, further management

COMPLICATIONS, Prevention & Management:

· Soft tissue injury can occur after repeated shocks. The presence of liquid (body
fluids, medications, or IV fluids) may cause electrical arching thermal burns to the skin
and soft tissue and produce ineffective defibrillation by allowing the current to pass across
the trunk rather than transthoracic. To minimize this potential complication, ensure that
any body fluids or liquids are wiped away from the skin before defibrillation attempts.
· Myocardial and epicardial injury may result from the electrical current (not direct
thermal injury)applied in defibrillation. Use the minimal recommended energy levels to
minimize injury
· Post-defibrillation cardiac dysrhythmias are more common following prolonged VF
and higher energy level countershocks. Early defibrillation at the recommended energy
levels minimizes this complication. Follow ACLS protocols to manage resulting
dysrhythmias.
· Electrical injuries to health care providers can result if participants remain in
contact with the patient during delivery of a countershock, because they can serve as a
ground for the current discharged. Fires which can result from sparks in the presence of
nitroglycerin patches or ointment, flammable gasses, or an oxygen-rich environment can
also be a source of injury to the patient or healthcare providers. Ensure “all clear” from
the patient prior to delivery of shock to avoid these complications.

DOCUMENTATION FOR THE MEDICAL RECORD:

· most facilities have a “code sheet” to be filled out by a member of the code team.
This sheet should be reviewed for accuracy and completeness and signed by the physician
(resident and/or attending) in charge of the code.
· A brief progress note should be written in the chart to include the circumstances of
the “code,” patient outcome, disposition, and the notification of attending physician and
family members. You should also make reference to the code sheet for medications given
and other details of the code.
Cardioversion

MedlinePlus Topics

Arrhythmia

Cardioversion is a method to restore an abnormal heart rhythm back to normal.

Information

Cardioversion can be done using an energy shock (electric cardioversion) or medications

(pharmacologic cardioversion).

ELECTRIC CARDIOVERSION

Electric cardioversion may use a device that can be placed inside (internal) or outside (external)
the body.

External electric cardioversion uses a device called a defibrillator. Electrode patches are placed
on the front and back of the chest and connected to the defibrillator. When the defibrillator
paddles are placed on your chest, an energy shock is delivered to your heart. This shock
interrupts all existing electrical activity of the heart and then allows the normal heart rhythm to
return.

Reasons you may have external electric cardioversion:

• An external cardioversion may be done during an emergency situation. Some abnormal

rhythms, such as ventricular tachycardia or ventricular fibrillation can be life-threatening.
An energy shock can be life saving.
• People who have an arrhythmia (usually atrial fibrillation) that began recently, or one that
cannot be controlled with medicines may be scheduled for external cardioversion. First,
tests such as a transesophageal echocardiogram are often done to make sure that there
are no blood clots in the heart. Some people may need to take blood thinners before the
cardioversion procedure. If you are having a scheduled cardioversion, you will usually be
given a sedative before the procedure starts.

After the external cardiovresion, you may be given medicine to prevent blood clots and to help
prevent the arrhythmia from coming back.

Internal cardioversion uses a device called an implantable cardioverter defibrillator (ICD). ICDs
have two parts: a pulse generator and electrodes (wires). The generator is implanted under the
skin, like a pacemaker. The wires connect the generator to the heart. This device also delivers
an electric shock to your heart. An implantable cardiac defibrillator is placed in people who are at
high risk of sudden cardiac death from dangerous arrhythmias such as ventricular tachycardia or
ventricular fibrillation.
See also: Implantable cardiac defibrillator

PHARMACOLOGIC CARDIOVERSION

Cardioversion can be done using drugs that are taken by mouth or given through an intravenous
line (IV). It can take several minutes to days for a successful cardioversion. If pharmacologic
cardioversion is done in a hospital, your heart rate will be regularly checked. Although rare,
cardioversion using drugs can be done outside the hospital. However, this requires close follow-
up with a cardiologist.

As with electrical cardioversion, you may be given blood thinning medicines to prevent blood
clots from forming and leaving the heart (which can cause a stroke).

COMPLICATIONS

Possible complications of cardioversion are uncommon, but may include:

• Worsening of the arrhythmia

• Blood clots that can cause a stroke or other organ damage
• Bruising, burning, or pain where the electrodes were used
• Allergic reactions from medicines used in pharmacologic cardioversion

Those who perform external cardioversion may be shocked if the procedure is not done
correctly. This can cause heart rhythm problems, pain, even death.
Definition

Defibrillation is a process in which an electrical device called a defibrillator sends an electric

shock to the heart to stop an arrhythmia resulting in the return of a productive heart rhythm.

Purpose

Defibrillation is performed to correct life-threatening arrhythmias of the heart including

ventricular fibrillation and cardiac arrest. In cardiac emergencies it should be performed
immediately after identifying that the patient is experiencing an arrhythmia, indicated by lack of
pulse and unresponsiveness. If an electrocardiogram is available, the arrhythmia can be
displayed visually for additional confirmation. For medical treatment by a physician, in non-life
threatening situations, atrial defibrillation can be used to treat atrial fibrillation or flutter.

Precautions

Defibrillation should not be performed on a patient who has a pulse or is alert, as this could
cause a lethal heart rhythm disturbance or cardiac arrest. The paddles used in the procedure
should not be placed on a woman's breasts or over an internal pacemaker.

A portable defibrillator is used in an attempt to revive a man who had a heart

attack before he is transported to an emergency room. (

Cardiac arrhythmias that prevent the heart from pumping blood to the body can cause
irreversible damage to the major organs including the brain and heart. These arrhythmias
include ventricular tachycardia, fibrillation, and cardiac arrest. About 10% of the ability to restart
the heart is lost with every minute that the heart fibrillates. Death can occur in minutes unless a
productive heart rhythm, able to generate a pulse, is restored through defibrillation. Because
immediate defibrillation is crucial to the patient's survival, the American Heart Association has
called for the integration of defibrillation into an effective emergency cardiac care system. The
system should include early access, early cardiopulmonary resuscitation , early
defibrillation, and early advanced cardiac care.

Defibrillators deliver a brief electric shock to the heart, which enables the heart's natural
pacemaker to regain control and establish a productive heart rhythm. The defibrillator is an
electronic device that includes defibrillator paddles and electrocardiogram monitoring.

During external defibrillation, the paddles are placed on the patient's chest with a conducting gel
ensuring good contact with the skin. When the heart can be visualized directly, during thoracic
surgery , sterile internal paddles are applied directly to the heart. Direct contact with the
patient is discontinued by all caregivers. If additional defibrillation is required the paddles
should be repositioned exactly to increase the likelihood of further shocks being effective in
stopping the arrhythmia. The patient's pulse and/or electrocardiogram are continually
monitored when defibrillation is not in progress. Medications to treat possible causes of the
abnormal heart rhythm may be administered. Defibrillation continues until the patient's
condition stabilizes or the procedure is ordered to be discontinued.

Early defibrillators, about the size and weight of a car battery, were used primarily in
ambulances and hospitals. The American Heart Association now advocates public access
defibrillation; this calls for placing automated external defibrillators (AEDS) in police vehicles,
airplanes, and at public events, etc. The AEDS are smaller, lighter, less expensive, and easier to
use than the early defibrillators. They are computerized to provide simple, verbal instructions to
the operator and to make it impossible to deliver a shock to a patient whose heart is not
fibrillating. The placement of AEDs is likely to expand to many public locations.

Preparation

Once a patient is found in cardiac distress, without a pulse and non-responsive, and help is
summoned, cardiopulmonary resuscitation (CPR) is begun and continued until the caregivers
arrive and are able to provide defibrillation. Electrocardiogram leads are attached to the patient
chest. Gel or paste is applied to the defibrillator paddles, or two gel pads are placed on the
patient's chest. The caregivers verify lack of a pulse while visualizing the electrocardiogram,
assure contact with the patient is discontinued, and deliver the electrical charge.

Atrial defibrillation is a treatment option that will be ordered for treatment of atrial fibrillation
or flutter. The electrocardiogram will be monitored throughout the procedure. The paddles are
placed on the patients chest with conducting gel to ensure good contact between the paddles and
skin. If the heart can be visualized directly during thoracic surgery, the paddles will be applied
directly to the heart. The defibrillator is programmed to recognize distinct components of the
electrocardiogram and will only fire the electrical shock at the correct time. Again, all direct
contact with the patient is discontinued prior to defibrillation.

Aftercare

After defibrillation, the patient's cardiac status, breathing, and vital signs are monitored with a
cardiac monitor . Additional tests to measure cardiac damage will be performed, which can
include a 12 lead electrocardiogram, a chest x-ray, and cardiac catheterization . Treatment
options will be determined from the outcome of these procedures. The patient's skin is cleansed
to remove gel and, if necessary, electrical burns are treated.

Risks

Skin burns from the defibrillator paddles are the most common complication of defibrillation.
Other risks include injury to the heart muscle, abnormal heart rhythms, and blood clots.

Normal results

Defibrillation performed to treat life-threatening ventricular arrhythmias is most likely to be

effective within the first five minutes, preventing brain injury and death by returning the heart to
a productive rhythm able to produce a pulse. Patients will be transferred to a hospital critical
care unit for additional monitoring, diagnosis, and treatment of the arrhythmia. Intubation may
be required for respiratory distress. Medications to improve cardiac function and prevent
additional arrhythmias, are frequently administered. Some cardiac function may be lost due to
the actual defibrillation, but is also associated with the underlying disease.

Atrial defibrillation is successful at restoring cardiac output, alleviating shortness of breath, and
decreasing the occurrence of clot formation in the atria.