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Test Policy - Administrative
Policy Number: Posted Date: 4/28/2016 Approved Date: 4/28/2016 Last Modified Date: Download Link: Download Departments:

This policy related to:
Covenant Master Manual

Code Blue Collaborative Guideline – Page 1 of 28

Administrative Manual

CODE BLUE/MEDICAL EMERGENCIES COLLABORATIVE GUIDELINE

Policy Number: 3.20 Page 1 of 28

Objective:To inform the Covenant HealthCare employees what resources and equipment are

available for Code Blue/Medical Emergencies at each campus/facility. To describe the process for managing Code Blues/Medical Emergencies and appropriate communication of the need for Emergency Medical Response.

Support:Follow American Heart Association Protocols.

Definition:Code Blue/Medical Emergency is defined as any medical emergency i.e., cardiac arrest, respiratory arrest, cardiopulmonary arrest, neuro incident (seizure), or any time a response emergency team is required.

Pediatric Code Blue is paged for any child needing the code team’s assistance. After paging “Pediatric Code Blue”, the operator will state the location of the patient, e.g., “Pediatric Code Blue/2N Harrison”, or "Pediatric Code Blue/Cooper CT ".

Code Pink is called when assistance is needed for an obstetrical/newborn emergency. The Neonatal Response Team responds. This includes Neonatologist/NNP, NICU RN and Registered Therapist (NRP Certified)

Newborn Code Blue is called for a Birth Center newborn experiencing respiratory and/or cardiac arrest in any area of the facility (except RNICU.) The Neonatal Response Team responds. All arrests in the RNICU are handled internally.

The Code Blue Team does not respond to a Code Pink or a Newborn Code Blue.

For any arrests/emergencies occurring outside of the building 911 is to be called.

For any arrests/emergencies occurring outside of any building, or off site location, i.e. Irving, Mackinaw, Michigan, 900 building, etc. 911 is to be called and MMR will respond and a Code Blue is called.

Scope:All Covenant HealthCare Employees

Note:Care of Medical EmergenciesProcedurePage 2

Maintaining Emergency EquipmentProcedurePage 3

Replacing Supplies/EquipmentProcedurePage 3

Code Blue Team Resources and EquipmentPage 5-7

Crash Cart Check List - Life Pak 20 Defibrillator Page 8

Every Shift ListPage 9

Crash cart location & Difficult Airway cart locations

Cooper CampusPage 12-13

Harrison CampusPage 13-14

Michigan/Mackinaw/Off SitePage 14

Adult Crash Cart ContentPage 15-18

Pediatric Crash Cart ContentPage 19-21

Mackinaw and Surgicare Crash Cart ContentPage 22-24

Code Blue/Medical Emergencies Record (Form PF00727)Page 25-26

Policy:

To call a Code Blue/Medical Emergency dial 5-2222 and state the location of the arrest/emergency. The switchboard operator will then page “attention, attention, code blue, location” which will be repeated three times.
The switchboard operator will then notify the appropriate response team members by pager system. (see table, page 6 & 7 for individual response team members)
In the event MMR is needed the operator or first responder will call 911. Upon the arrival of MMR they will take over the management and documentation of the medical emergency situation.
All Code/Cardiac Arrest equipment is available in locations as described on the attached sheet. Complete equipment and drug lists are available on each crash cart. Master equipment list maintained in Sterile Processing and drug list in Pharmacy.
Critical Care units will have an extra intubation tackle box available.
Critical Care units will each have a cricothyrotomy catheter set available on each crash cart.
Adult critical care units and the ECC each have a cart for difficult airways.
Glidescopes are located in PICU, all adult critical units and ECC.
Code Blue may be called for cardiac arrest, respiratory arrest, neuro, or any time an emergency response team is required.
Once a Code Blue victim has been identified, appropriate treatment is initiated and CPR is started if indicated.
A response team has been identified for each campus/facility. See Table.
The events of the code must be documented on Code Blue Form/Medical Emergency (PF# 00727) lastest version 03/12.
The Code Blue Form is to be completed every time a Code Blue/Medical Emergency is called, both front and back.
Immediately following the Code, the Code leader (or ACLS team member) will hold a short debriefing to identify areas of improvement.
The Nurse Manager will review the completed form and then send to the Patient Safety Officer in care of the Patient Safety and Quality Dept., Cooper.
The Code Blue Committee reviews code Blue documentation forms for appropriateness of care.
After the code is completed and before taking used cart off unit, obtain a new crash cart from sterile processing. Take used cart to pharmacy.
The Crash Cart is checked and maintained according to Code Blue Policy.

Procedure:AT THE CODE BLUE LOCATION

1) The Discoverer:

a) STAYS WITH THE VICTIM AND CALLS FOR HELP

b) Places backboard under victim’s back and begins CPR (uses ambu bag), if indicated.

c) Provides event details to Emergency Team.

d) Once details given, exits room and remains outside as runner.

2) First Responder(s):

a) Brings emergency equipment to emergency location and places quick combo pads on victim and turns the Lif Pak on using the AED mode in adult areas (ACLS certified personnel may disable the AED mode).

b) If help needed, positions victim for optimal CPR.

c) Connects oxygen and suction equipment (Respiratory).

d) Moves furniture or other patients/visitors from the room or area.

e) Assist with CPR, or in the event of medical emergency provides supportative care.

f) If roommate unable to be removed from room, stays with patient and provides reassurance.

g) Exit room when no longer needed.

3) Team Leader (Physician/Intensivist/Neonatologist/NNP or MMR team): Note: ACLS/PALS/NRP RN until physician arrives.

a) Directs resuscitative efforts or medical interventions for medical emergencies.

b) Assigns roles of team members.

c) Delegates one person to be responsible for documentation

d) Ensures compressor provides quality CPR

e) Interprets EKG tracings and intervenes as indicated

f) Determines decisions regarding patient disposition to appropriate unit of care or

pronouncement of death as warranted

4) ACLS/PALS/NRP RN (IV Medications):

a) Directs resuscitative efforts until physician arrives

b) Ensures IV established

c) Administers medications per ACLS protocol and/or physician order.

d) Monitors vital signs

e) Monitors patient and provides appropriate interventions as ordered by team leader or indicated by victim’s condition

f) Clearly informs recorder and team leader when a task begins or ends (“Atropine 0.5 mg in”)

g) Offer team leader good ideas for differential diagnosis or additional ACLS recommended treatment

h) Assists with transporting patients as indicated.

5) Airway (Respiratory Therapist) or MMR:

a) Assembles equipment

b) Maintains airway

c) Provides effective ventilation and assess as such (chest rise and fall)

d) Connects suction (if not already completed) and provides suction if needed

e) Draws ABGs as needed

f) Assists with transport of patient

g) Alternates compressions with compressor every 2 minutes (5th cycle)-prevent rescuer fatigue.

h) Assesses adequacy of CPR (rate, depth and recoil)

i) Offer team leader good ideas for differential diagnosis or additional ACLS recommended treatment

6) Defibrillator (RN) or MMR

a) Delivers appropriate joules

b) Clearly informs recorder and team leader when a task begins or ends

c) Prints monitor strips with pulse checks and PRN; or code summary at the termination of the code

7) Patient’s Staff RN:

a) Stays with the patient and is available for the team

b) Establishes IV line, if necessary

c) Provides patient chart for team

d) Provides pertinent history and information to team and remains available to team

e) Assists in traffic control in room eliminating unnecessary staff

f) Assists with procedures as needed (CPR, suction, etc.)

g) Notifies and updates family and attending physician

8) Lab:

a) Stands by for blood draw

9) EKG:

a) Stands by for EKG/Rhythm strips as needed

10) Shift Administrator:

a) Attends arrests in non-critical care areas and provides assistance as necessary

b) Assists with families as necessary

c) Calls Critical Care units and provides support by phone

11) Pastoral Care/:

a) Assists with patient family communications

b) Support for family members, staff as needed

Procedure:MAINTAINING EMERGENCY EQUIPMENT

1) A Registered Nurse checks the emergency supplies and/or crash cart:

a) Daily or twice daily depending on unit hours of operation

b) Immediately after each use (see reverse side of Crash Cart Checklist)

2) Emergency equipment is checked by verifying its presence and proper functioning as listed on the Crash Cart Checklist, and documents in the proper location for the assigned shift. Document any actions taken for equipment that is not present or not functioning appropriately

3) AED: located at Harrison and Cooper front lobbies. It is checked daily by Resource Team to verify that battery is charged

4) AED’s: located at Irving, Michigan, Mackinaw front lobbies, off-site practices will be checked per attached grid

5) AED located by time clock 1st floor Andersen Building will be checked monthly by Central Education

Procedure:REPLACING SUPPLIES/EQUIPMENT

Crash Cart
1. Make sure the unit always has a complete ready to go crash cart at all times. Obtain a new cart from Sterile Processing.
2. Remove equipment and supplies (Monitor/Defibrillator, Suction Machine & Tubing, Code Sheets on Clipboard & Crash Cart Checklist). from the top of the cart. Please note: Backboard, Medication Dosing References, ACLS/PALS Algorithms, Pharmacy Reference book and Stroke: Code 180 Binder remain on the cart with exchange.
3. A licensed personnel will take used cart to Pharmacy who will first replace drugs and then take to Sterile Processing for refill of supplies.

Crash Cart Oxygen Tanks – if not functioning or below 1000 PSI, obtain a new O2 tank
Lif Pak Defibrillator/Monitor – failed test, defective cable, etc., Contact Bio-Med for replacement immediately
Suction Machine – if not functioning, Contact Bio-Med for replacement immediately

Related Policies:

Administrative Policy #1.03 – Advanced Directives

Administrative Policy #3.47 – Medical Treatment, Withholding & Withdrawing Guidelines

Administrative Policy #1.02– Patient Representative/Legal Medical Decision Maker

Administrative Policy #1.72 – - Patient Rights

Administrative Policy #3.74 – Person Injured on Hospital Grounds, but Not in the Hospital Patient

Administrative Policy #3.27 – Do Not Resuscitate

Administrative Policy #8.04 – Overhead Telepage Announcement Policy

Patient Services Policy – Neonatal Response Team/Neonatal Referral Policy and Procedure

Reviewed by:

Code Blue Committee: 01/24/2007, 03/18/2009, 05/18/2011, 12/2012

Medical Executive Committee: March, 2014

Effective Date: 03/2014

Review Date: 03/2017

Approval:

________________________________________March, 2014

Sara Rivette, MD – Chief of StaffDate

________________________________________March, 2014

Carol Stoll – Vice President Patient Services/CNODate

________________________________________March, 2014

Edward Bruff – Executive Vice President/COODate

COVENANT HEALTHCARE SYSTEM

Code Blue Collaborative Guideline – Page 1 of 28

Cardiac Arrest Team Resources and Equipment

Cooper	Harrison (including Select)	Michigan	Mackinaw	Covenant Walkway	MSO, Irving, Med Express & Frankenmuth & Covenant owned Practices	900 Building CDU, CVRU, Dx, Wound Care
Initial Response: CPR until Response Team responds.	Initial Response: CPR until Response Team responds.	Initial Response: CPR until Response Team / MMR responds	Initial Response: CPR until Arrest Team/MMR arrives.	Initial Response: CPR until Response Team arrives.	Initial Response: CPR until MMR arrives.	Initial Response: CPR until Response Team responds.
Assistance Call 5-2222 page Overhead audible page Codes: Blue – Adult Newborn Code Blue- Birth Center Newborn Pink – OB Mom Pediatric code blue – Pediatric patients	Assistance: Call 5-2222 Overhead audible page Codes: Blue – Adult Pink – OB Mom Newborn Code Blue- Birth Center Newborn Pediatric code blue – Pediatric patients	Assistance: Arrest paged overhead by calling 5-2222. Operator to call 911	Assistance: Tenants and public areas dial 911. Covenant Pt. Care areas dial 3-5000 to alert operator who will page. Press HOT Button on Alert system. (Alerts security) *Radiation Oncology Building dials 911.	Assistance: Call 5-2222 – announce location: Walkway Harrison (area from Harrison to Houghton) Or Walkway Cooper (area from Houghton to Cooper) If Pediatric patient, announce Pediatric code blue/then location Newborn Code Blue- Birth Center Newborn	Assistance: 911	Assistance: Call 5-2222 Overhead audible page Codes: Blue – Adult Pink – OB Mom Pediatric code blue – Pediatric patients
Response Team: Hospitalist ECC ACLS RN Staff RN (Patient’s Nurse) Respiratory Care Lab EKG Pastoral Care Administrative Coordinator Anesthesia if called Pediatric: PICU Intensivist PICU RN & All above except hospitalist	Response Team: Hospitalist ECC ACLS RN Staff RN (Patient’s Nurse) Respiratory Care Lab EKG Pastoral Care Administrative Coordinator Anesthesia if called Pediatric: PICU Intensivist PICU RN & All above except hospitalist Newborn Code Blue- Neonatal Response Team Pastoral Care	Response Team: Physician when in house 1 RN/LPN from TCU, Rehab 3, & Rehab 4 (TCU staff only to respond to 2nd floor). Lab when in-house Security for traffic control. Respiratory Care when available.	Response Team: No response team available ACLS RNs and others will respond when possible, but 911 is to be called Security will respond to direct traffic	Response Team: Harrison responds to Harrison side of walkway ECC responds to both sides	Response Team: Physician and Staff as available (ACLS)	Response Team: Hospitalist ECC ACLS RN Staff RN (Patient’s Nurse) Respiratory Care Lab EKG Pastoral Care Administrative Coordinator Anesthesia if called Pediatric: PICU Intensivist PICU RN & All above except hospitalist.
Equipment: Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction & 02. Ambu bags are located where patient testing, procedures or care is provided. Contents list attached to crash cart. Cricothyrotomy Catheter Set on SICU & CCU ECC has neonatal emergency cart	Equipment: Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction & 02. Ambu bags are located where patient testing, procedures or care is provided. Contents list attached to crash cart. Cricothyrotomy Catheter Set on HICU Birth Center has neonatal emergency carts	Equipment: AED located 3rd floor. Crash cart (located in basement and 2, 3, & 4th floors and sleep lab) with defibrillator, ambu bag, portable suction & 02. 3rd floor brings crash cart to arrest location on first floor. Ambu bags are located where patient testing, procedures or care is provided.	Equipment: AED located @ front desk on wall. Adult/Pediatric combo crash cart comes from 1, 2, 3, 4th floors. Crash cart includes Defibrillator. (2nd floor has internal paddles), ambu bag, O2 tank, intubation tray Adult/Pediatrics portable suction.	Equipment: AED located in each wing of Walkway. Harrison 3 Main BC staff bring Crash cart with defibrillator, ambu bag with mask, portable suction to Harrison side of walkway. Cooper crash cart located in Center for the Heart. ER will bring on way to code Contents list attached to cart. Neonatal response team brings equipment	Equipment: AED as available Ambu bag Oxygen Portable suction Airways (oral/nasal) Medication box	Equipment: Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction 02. Ambu bags are located where patient testing, procedures or care is provided. Contents list attached to crash cart.
Transfer: Patient stabilized and transferred as needed.	Transfer: Patient stabilized and transferred as needed.	Transfer: Security direct ambulance staff and assists PRN. Pt. transported as needed	Transfer: Patient stabilized and transported as needed.	Transfer: Patient stabilized and transported as needed.	Transfer: Supportive Care & Pt. transported as needed.	Transfer: Patient stabilized and transferred as needed
Equipment/supply Restocking: Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy. Unit staff delivers used cart to Pharmacy. Pharmacy restocks drugs, sealed and returns to Sterile Processing. Sterile Processing restocks, seals & stores cart.	Equipment/supply Restocking: Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy. Unit staff delivers used cart to Pharmacy. Pharmacy restocks drugs, sealed and returns to Sterile Processing. Sterile Processing restocks, seals & stores cart.	Equipment/supply Restocking: Unit staff call Sterile Processing to exchange Crash cart	Equipment/supply Restocking: Response team staff obtain restocked cart from Sterile Processing before used cart is returned. Staff delivers used cart to Pharmacy & indicates that it was used & who it was used on. Pharmacy restocks drugs, seals and returns to Sterile Processing. Sterile Processing restocks, seals & stores cart. If arrest occurs when depts. are closed, cart is returned the next morning.	Equipment/supply Restocking: Express RN to obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy Express RN delivers used cart to Pharmacy. Pharmacy restocks drugs, sealed and returns to Sterile Processing. Sterile Processing restocks, seals & stores cart.	Equipment/supply Restocking: Each practice orders through Pharmacy/ Materials Mgmt.	Equipment/supply Restocking: Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy. Unit staff delivers used cart to Pharmacy. Pharmacy restocks drugs, sealed and returns to Sterile Processing. Sterile Processing restocks, seals & stores cart.
Critical Care maintains an extra intubation tackle box from Sterile Processing.	Critical Care maintains an extra intubation tackle box from Sterile Processing.
Daily Maintenance: Frequency of cart check per Policy. Check: Defibrillator O2 Tank full/wrench with tank Suction Backboard Cart is locked	Daily Maintenance: Frequency of cart check per Policy. Check: Defibrillator O2 Tank full/wrench with tank Suction Backboard Cart is locked	Daily Maintenance: Frequency of cart check per Policy. Check: Defibrillator O2 Tank full/wrench with tank Suction Backboard Cart is locked	Daily Maintenance: Frequency of cart check per Policy. Check: Defibrillator O2 Tank full/wrench with tank Suction Backboard Cart is locked	Daily Maintenance: AED is checked by Express RN every month.	Daily Maintenance: Frequency of cart check per Policy. Check: AED Ambu Bag Oxygen Suction Airways Med expiration	Daily Maintenance: Frequency of cart check per Policy. Check: Defibrillator O2 Tank full/wrench with tank Suction Backboard Cart is locked
POLICY Units open 24 hours: - Check each shift 12 hour shifts 2x/day 8 hour shifts 3x/day Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.	POLICY Units open 24 hours: - Check each shift 12 hour shifts 2x/day 8 hour shifts 3x/day Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.	POLICY All areas - Check daily: Record on the checklist when the unit is closed, i.e., at night, on weekend, etc. AED is checked twice daily on the nursing units and daily at the front desk by the front desk staff.	POLICY All areas - Check daily: Record on the checklist when the unit is closed, i.e., at night, on weekend, etc. AED is checked monthly.	POLICY All areas - Check daily: AEDs are checked once a month by BioMed	POLICY All facilities: - Check daily: Record on the checklist when the facility is closed, i.e., at night, on weekend, etc. AED checked once a month	POLICY Units open 24 hours: - Check each shift 12 hour shifts 2x/day 8 hour shifts 3x/day Record on the checklist when the unit is closed, i.e., at night, on weekend, etc. AED checked once a month

Cooper

Harrison

(including Select)

Michigan

Mackinaw

Covenant Walkway

MSO, Irving, Med Express & Frankenmuth & Covenant owned Practices

900 Building

CDU, CVRU, Dx,

Wound Care

Initial Response:

CPR until Response Team responds.

Initial Response:

CPR until Response Team responds.

Initial Response:

CPR until Response Team / MMR responds

Initial Response:

CPR until Arrest Team/MMR arrives.

Initial Response:

CPR until Response Team arrives.

Initial Response:

CPR until MMR arrives.

Initial Response:

CPR until Response Team responds.

Assistance

Call 5-2222 page

Overhead audible page

Codes:

Blue – Adult

Newborn Code

Blue- Birth Center

Newborn

Pink – OB Mom

Pediatric code blue –

Pediatric patients

Assistance:

Call 5-2222 Overhead audible page

Codes:

Blue – Adult

Pink – OB Mom

Newborn Code

Blue- Birth Center

Newborn

Pediatric code blue – Pediatric patients

Assistance:

Arrest paged overhead by calling 5-2222.

Operator to call 911

Assistance:

Tenants and public areas dial 911.

Covenant Pt. Care areas dial 3-5000 to alert operator who will page.

Press HOT Button on Alert system. (Alerts security)

*Radiation Oncology Building dials 911.

Assistance:

Call 5-2222 – announce location:

Walkway Harrison (area from Harrison to Houghton)

Or Walkway Cooper (area from Houghton to Cooper)

If Pediatric patient, announce Pediatric code blue/then location

Newborn Code

Blue- Birth Center

Newborn

Assistance:

911

Assistance:

Call 5-2222 Overhead audible page

Codes:

Blue – Adult

Pink – OB Mom

Pediatric code blue –

Pediatric patients

Response Team:

*Hospitalist

ECC

ACLS RN

Staff RN (Patient’s Nurse)

Respiratory Care

Lab

EKG

Pastoral Care

Administrative Coordinator

Anesthesia if called

*Pediatric:

PICU Intensivist

PICU RN & All above except hospitalist

Response Team:

*Hospitalist

ECC

ACLS RN

Staff RN (Patient’s Nurse)

Respiratory Care

Lab

EKG

Pastoral Care

Administrative Coordinator

Anesthesia if called

*Pediatric:

PICU Intensivist

PICU RN & All above except hospitalist

Newborn Code

Blue- Neonatal

Response Team

Pastoral Care

Response Team:

Physician when in house

1 RN/LPN from TCU, Rehab 3, & Rehab 4

(TCU staff only to respond to 2nd floor).

Lab when in-house

Security for traffic control.

Respiratory Care when available.

Response Team:

No response team available

ACLS RNs and others will respond when possible, but 911 is to be called

Security will respond to direct traffic

Response Team:

Harrison responds to Harrison side of walkway

ECC responds to both sides

Response Team:

Physician and Staff as available (ACLS)

Response Team:

*Hospitalist

ECC

ACLS RN

Staff RN (Patient’s Nurse)

Respiratory Care

Lab

EKG

Pastoral Care

Administrative Coordinator

Anesthesia if called

*Pediatric:

PICU Intensivist

PICU RN & All above except hospitalist.

Equipment:

Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction & 02.
Ambu bags are located where patient testing, procedures or care is provided.
Contents list attached to crash cart.
Cricothyrotomy Catheter Set on SICU & CCU
ECC has neonatal emergency cart

Equipment:

Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction & 02.
Ambu bags are located where patient testing, procedures or care is provided.
Contents list attached to crash cart.
Cricothyrotomy Catheter Set on HICU
Birth Center has neonatal emergency carts

Equipment:

AED located 3rd floor.
Crash cart (located in basement and 2, 3, & 4th floors and sleep lab) with defibrillator, ambu bag, portable suction & 02.
3rd floor brings crash cart to arrest location on first floor.
Ambu bags are located where patient testing, procedures or care is provided.

Equipment:

AED located @ front desk on wall.
Adult/Pediatric combo crash cart comes from 1, 2, 3, 4th floors.
Crash cart includes Defibrillator. (2nd floor has internal paddles), ambu bag, O2 tank, intubation tray Adult/Pediatrics portable suction.

Equipment:

AED located in each wing of Walkway.
Harrison 3 Main BC staff bring Crash cart with defibrillator, ambu bag with mask, portable suction to Harrison side of walkway.
Cooper crash cart located in Center for the Heart. ER will bring on way to code
Contents list attached to cart.
Neonatal response team brings equipment

Equipment:

AED as available
Ambu bag
Oxygen
Portable suction
Airways (oral/nasal)
Medication box

Equipment:

Crash cart with defibrillator. (on each unit), ambu bag with mask, portable suction 02.
Ambu bags are located where patient testing, procedures or care is provided.
Contents list attached to crash cart.

Transfer:

Patient stabilized and transferred as needed.

Transfer:

Patient stabilized and transferred as needed.

Transfer:

Security direct ambulance staff and assists PRN.

Pt. transported as needed

Transfer:

Patient stabilized and transported as needed.

Transfer:

Patient stabilized and transported as needed.

Transfer:

Supportive Care & Pt. transported as needed.

Transfer:

Patient stabilized and transferred as needed

Equipment/supply

Restocking:

Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy.
Unit staff delivers used cart to Pharmacy.
Pharmacy restocks drugs, sealed and returns to Sterile Processing.
Sterile Processing restocks, seals & stores cart.

Equipment/supply

Restocking:

Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy.
Unit staff delivers used cart to Pharmacy.
Pharmacy restocks drugs, sealed and returns to Sterile Processing.
Sterile Processing restocks, seals & stores cart.

Equipment/supply

Restocking:

Unit staff call Sterile Processing to exchange Crash cart

Equipment/supply

Restocking:

Response team staff obtain restocked cart from Sterile Processing before used cart is returned.
Staff delivers used cart to Pharmacy & indicates that it was used & who it was used on.
Pharmacy restocks drugs, seals and returns to Sterile Processing.
Sterile Processing restocks, seals & stores cart.
If arrest occurs when depts. are closed, cart is returned the next morning.

Equipment/supply

Restocking:

Express RN to obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy
Express RN delivers used cart to Pharmacy.
Pharmacy restocks drugs, sealed and returns to Sterile Processing.
Sterile Processing restocks, seals & stores cart.

Equipment/supply

Restocking:

Each practice orders through Pharmacy/ Materials Mgmt.

Equipment/supply

Restocking:

Unit staff obtain restocked cart from Sterile Processing before used cart is returned to Pharmacy.
Unit staff delivers used cart to Pharmacy.
Pharmacy restocks drugs, sealed and returns to Sterile Processing.

Sterile Processing restocks, seals & stores cart.

Critical Care maintains an extra intubation tackle box from Sterile Processing.

Daily Maintenance:

Frequency of cart check per Policy.

Check:

Defibrillator

O2 Tank full/wrench with tank

Suction

Backboard

Cart is locked

Daily Maintenance:

Frequency of cart check per Policy.

Check:

Defibrillator

O2 Tank full/wrench with tank

Suction

Backboard

Cart is locked

Daily Maintenance:

Frequency of cart check per Policy.

Check:

Defibrillator

O2 Tank full/wrench with tank

Suction

Backboard

Cart is locked

Daily Maintenance:

Frequency of cart check per Policy.

Check:

Defibrillator

O2 Tank full/wrench with tank

Suction

Backboard

Cart is locked

Daily Maintenance:

AED is checked by Express RN every month.

Daily Maintenance:

Frequency of cart check per Policy.

Check:

AED

Ambu Bag

Oxygen

Suction

Airways

Med expiration

Daily Maintenance:

Frequency of cart check per Policy.

Check:

Defibrillator

O2 Tank full/wrench with tank

Suction

Backboard

Cart is locked

POLICY

Units open 24 hours:

- Check each shift

12 hour shifts 2x/day
8 hour shifts 3x/day
Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.

POLICY

Units open 24 hours:

- Check each shift

12 hour shifts 2x/day
8 hour shifts 3x/day
Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.

POLICY

All areas

- Check daily:

Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.
AED is checked twice daily on the nursing units and daily at the front desk by the front desk staff.

POLICY

All areas

- Check daily:

Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.
AED is checked monthly.

POLICY

All areas

- Check daily:

AEDs are checked once a month by BioMed

POLICY

All facilities:

- Check daily:

Record on the checklist when the facility is closed, i.e., at night, on weekend, etc.
AED checked once a month

POLICY

Units open 24 hours:

- Check each shift

12 hour shifts 2x/day
8 hour shifts 3x/day
Record on the checklist when the unit is closed, i.e., at night, on weekend, etc.
AED checked once a month

COVENANT HEALTHCARE SYSTEM

Code Blue Collaborative Guideline – Page 1 of 28

Crash Cart Check List

Life Pak 15 and 20/20e Defibrillator/Monitor Tests without PADDLES

Plug the test plug into the therapy cable
Disconnect the LIFEPAK from AC power, wait 2 seconds, press ON
Press ANALYZE and confirm REMOVE TEST PLUG message appears
Reconnect AC power and confirm AC Mains LED is lit
Switch to manual mode by opening the door or pressing the ENERGY SELECT button
Press OPTIONS
Select USER TEST and select YES to initiate test
Confirm user test succeeded
1. If the user test failed, contact Clinical Engineering (Bio Med) via VoceraDocument on Crash Cart Checklist

Life Pak 15 and 20/20e Defibrillator/Monitor Tests with PADDLES

Disconnect the LIFEPAK from AC power, wait 2 seconds, press ON

Note: Must be in PADDLES lead to perform this test. If not in PADDLES lead, push the LEAD button to change

Confirm paddles are properly seated in wells and cable is connected
If the defibrillator is in AED mode, switch to manual mode by opening the poor or pressing the ENERY SELECT button
Select 50 J (20) or 10J (20e) and press CHARGE button on paddles

Note: If CONNECT CABLE message appears, contact Bio-Med immediately

When fully charged press SHOCK buttons simultaneously on the paddles and look for ENERGY DELIVERED message

Note: If service LED is lit, power off and then back on. If service LED stays lit, contact contact Bio-Med immediately

Reconnect AC power and confirm AC Mains LED is lit
Press OPTIONS
Select USER TEST and select YES to initiate test

Note: If CONNECT TEST PLUG mesage appears and the standard paddles set is properly seated in the paddle wells, contact contact Bio-Med immediately

Confirm user test succeeded
1. If the user test failed, contact Clinical Engineering (Bio Med) via Vocera
Document on Crash Cart Checklist

Suction Check

Unplug suction machine
Turn suction machine on (black button on top)
Place finger over open end of suction canister of tubing and wait for sound change to indicate suction is working
Turn off machine and PLUG BACK IN

Oxygen Check

Check gauge on the top of the cylinder for level of O2 tank pressure.
1. If less than 1000 PSI, replace tank
Document on Crash Cart Checklist level of PSI

Other Checks

Check the medication drawer lock and check expiration date on drawer
Check the supply drawer lock and check supply list for expiration dates
Check for back board on back of cart
Check for 2 sets of Medtronic Quik Combo Pads (or pads specific to unit- Adult or Pediatric)
Check for 1 unopened pack of electrodes
Check for Cardiopulmonary Arrest Record (PF # 00727) – lastest version 3/12

COVENANT HEALTHCARE SYSTEM

Code Blue Collaborative Guideline – Page 1 of 28

COVENANT HEALTHCARE SYSTEM

Code Blue Collaborative Guideline – Page 1 of 28

700 Cooper Building

Basement

Radiology/Nuclear Med1 adult cart with suction

First Floor

Radiology (North)1 adult crash cart

1 pediatric crash cart

(West)1 adult crash cart

1 pediatric crash cart

Front Lobby – Cashier’s Office1 adult cart with suction

AED stored behind Reception Desk

Second Floor

SpecialsSpecials Holding

1 pediatric cart with Suction

CCL 4 adult carts

EP Lab3 adult carts

Sterile Processing3 adult carts

1 pediatric cart

CVRR1 adult cart with suction

OR2 adult carts

1 pediatric cart

POHA/PACU1 adult cart with suction

1 pediatric cart with suction

Third Floor

Medical Cardiology2 adult carts with suction

CCU1 adult cart with suction

1 difficult airway cart

3 East1 adult cart with suction

Fourth Floor

4 North1 adult cart with suction

4 Main1 adult cart with suction

1 pediatric cart with suction

4 East1 adult cart with suction

1 difficult airway cart

Fifth Floor

Ortho/Neuro2 adult carts with suction

5 East1 adult cart with suction

Sixth Floor1 adult cart with suction

Seventh Floor

SICU2 adult carts with suction

1 difficult airway cart

900 Cooper Building

Basement

Clinical Decision Unit (CDU)1 adult cart with suction

First Floor

ECC4 adult carts with suction

2 pediatric Broslow carts 1 LifePak 20

1 difficult airway cart

Second Floor

CVRU 1 adult cart

Center for the Heart 3 adult carts and 3 defibrillators

Third Floor

Endoscopy1 adult cart with suction

Fourth Floor

Wound Care Center1 adult cart

Harrison Campus

First Floor

Radiology1 adult cart with suction

Front Lobby AED stored behind Reception Desk

Second Floor

2 Main1 adult cart with suction

2 North2 pediatric carts with suction

Third Floor

Birth Center1 adult cart with suction

1 neonatal emergency cart (Birth Center maintains contents)

3 Main1 adult cart with suction

Harrison Ambulatory1 adult cart with suction

1 pediatric cart with suction

3 South1 adult cart with suction

Fourth Floor

Birth Center1 adult cart with suction

Several Neonatal emergency carts

4 Main1 adult cart with suction

Labor and Delivery1 adult cart with suction

Fifth Floor

RNICU1 Newborn cart with suction

OR1 adult cart with suction

1 pediatric cart

Sterile Processing3 adult carts

1 pediatric cart

Sixth Floor

6 Main1 adult cart with suction

ICU1 adult cart with suction

1 difficult airway cart

Seventh Floor

7 Main1 adult cart with suction

ANDERSEN BUILDING

FIRST FLOOR AED -stored near time clock

MICHIGAN CAMPUS

TCU1 adult cart with suction (unit)

1 adult cart with suction (replacement cart stored in storage room, 2nd floor)

REHAB FOURTH FLOOR1 adult cart with suction

REHAB THIRD FLOOR1 adult cart with suction

AED is stored in this area

INPATIENT REHAB GYM1 adult cart with suction

SLEEP LAB 1 adult cart with suction

MACKINAW CAMPUS

Cardiac Rehab1 adult cart with

Cancer Care1 adult cart with suction

Radiology1 adult cart

ADULT CRASH CART CONTENT

TOP OF CART

Monitor/Defibrillator

Suction Machine w/ tubing & Yankauer

Code Sheets on Clipboard

Crash Cart Checklist

Supplied by Unit : Electrodes (1 unopened pkg.) / Quik Combo Pads (2 pkgs.)

HANGING ON CART

Oxygen Tank

Leave on cart with exchange: Backboard

Medication Dosing References/Pharmacy Reference

ACLS/PALS Algorithms

Stroke: Code 180 Info - Crash Cart Binder

DRAWER I

MEDICATIONS	CONCENTRATION	PACKAGE	QUANTITY
Adenosine (Adenocard)	6mg/2ml	Syringe	5
Amiodarone (Cordarone)	150mg/3ml	Ampule	3
Atropine	1mg/10ml	Syringe	3
Calcium Chloride	1gm/10ml	Syringe	2
Dextrose 50%	25gm/50ml	Syringe	1
Diazepam (Valium)	10mg/2ml	Vial	2
Diphenhydramine (Benadryl)	50mg/ml	Vial	2
Epinephrine (Adrenalin)	1mg/ml	Ampule	2
Epinephrine (Adrenalin)	1mg/10ml	Syringe	6
Epinephrine (Adrenalin)	30mg/30ml	Vial	2
Flumazenil (Romazicon)	0.5mg/5ml	Vial	1
Furosemide (Lasix)	100mg/10ml	Syringe	2
Heparin	50,000/10ml	Vial	2
Hydrocortisone (Solu-Cortef)	500mg/4ml	Vial	1
Isoproterenol (Isuprel)	1mg/5ml	Syringe	2
Lidocaine 2%	100mg/5ml	Syringe	4
Magnesium Sulfate 50%	5gm/10ml	Syringe	2
Midazolam (Versed)	5mg/5ml	Vial	2
Naloxone (Narcan)	0.4mg/ml	Vial	2
Norepinephrine (Levophed)	4mg/4ml	Ampule	4
Procainamide (Procan)	1gm/10ml	Vial	2
Sodium Bicarbonate	50meq/50ml	Syringe	3
Sodium Chloride 0.9%		Vial	2
Vasopresin	20 units/ml	Vial	2
Verapamil (Isoptin/Calan)	5mg/2ml	Vial	4

DRAWER II

IV SOLUTION	PACKAGE	QUANTITY
Dobutamine Drip	500mg/250ml	2
Dopamine Drip	800mg/250ml	2
Lidocaine Drip	2gm/250ml	2
Dextrose 5% Water	50ml	4
Dextrose 5% Water	250ml	1
Normal Saline	250ml	2
Normal Saline	500ml	2
Normal Saline	1000ml	2

DRAWER III

SYRINGES	AMOUNT	NEEDLES	AMOUNT
3ml (w/needle)	10	25 ga	10
6ml	5	22 ga	10
12ml	5	20 ga	10
20ml	5	18 ga 1 ½”	10
60ml	2	18 ga Blunt	10
		18 ga 3 ½”	2

DRAWER III

IV CATHETERS	AMOUNT	SUPPLIES	AMOUNT
22 ga	4	Tourniquet Latex Free	2
20 ga	4	Durapore Tape 1”	1
18 ga	4	IV Medication Labels	5
16 ga	4	Alcohol Wipes	10
Primary plum	2	Bandaids	5
Primary IV set	2	Betadine Swab	6
		2x2’s Sterile	5
		T-Extension	2
		Stopcock	2

DRAWER IV

Op-Site	2
Lidocaine 1%	1
Sterile Water for Injection	1
Sodium Chloride for Injection	1
Gloves – latex free (7)	2
Gloves – latex free (7 ½)	2
Gloves - latex free (8)	2
Silk Suture 3-0 (straight needle)	2
7 Fr. 3-Lumen CVP Kit	1
Blades 11 & 15	1 each
4x4’s Sterile	4

ADULT CRASH CART CONTENT

INTUBATION TRAY - DRAWER V

Laryngoscope Handle with 2 batteries	12cc Syringe (slip)
Laryngoscope Blades: #3, #4 Miller (1 of each)	Bite Block
#3, #4 McIntosh (1 of each)	Bite Stick
Extra Light Bulbs (2)	KY Jelly (4)
Extra Batteries (2)	4 x 4 (2)
14 Fr Intubating Stylets (2)	1” Durapore Tape
Plain Tongue Blade	2” Durapore Tape
Oral Airway – 70mm, 80mm, 90mm, 100mm	Adult CO2 Detector
Yaunker Suction	Bio Hazard Bag
Endo Tube Holder
Cath and Glove 14 F (2)	Magill Forcep
Skin Prep (2)	Small Rubber Shod Hemostat
Hurricaine Spray	Endo Tubes: 6, 6.5 8.5 9 (1 of each)
Nasal Airway (28)	7, 7.5, 8 (2 of each)
Tincture Benzine

OTHER SUPPLIES

Adult Ambu Bag	ABG Kit (2)
Adult Mask (3 Flap non-Rebreather)	Barrel Connector
Oxygen Connecting Tubing	Trach Tube (size 8)
BP Cuff with Stethoscope	Salem Sump NG 18F – Anti reflux valve
Oxygen Flow Meter with nipple attached	Connecting Tubing (6 feet)
N.S. 500cc or 1000cc	60cc Syringe
Safety Glasses	Tube Tamer

In Critical Care areas there will be an additional Intubation tackle box available for intubation only.

PEDIATRIC CRASH CART CONTENT

TOP OF CART

Monitor/Defibrillator

Electrodes (3 pkgs.)

Defib Pads (2 pkgs.)

ETCO2 caps (2 pkgs.)

Pace/Cardiovert/Defib/Monitor Pads (2 pkgs.) –H2N only

Suction Machine – H2N only

HANGING ON CART

Code Sheets on Clipboard

Backboard

Medication Dosing Reference – PALS Algorithms

Pharmacy Reference

DRAWER I

MEDICATIONS	CONCENTRATION	PACKAGE	QUANTITY
Adenosine (Adenocard)	6mg/2ml	Syringe	3
Amiodarone (Cordarone )	150mg/3 ml	Ampule	2
Atropine	1 mg/ 10 ml	Syringe	2
Calcium Chloride	1gm/10ml	Syringe	1
Dextrose 25%	2.5gm/10ml	Syringe	1
Digoxin	0.5mg/2ml	Ampule	1
Digoxin	0.1mg/ml	Ampule	1
Diphenhydramine (Benadryl)	50mg/ml	Vial	2
Dopamine	200mg/5ml	Vial	2
Epinephrine (Adrenalin)	1mg/ml	Ampule	2
Epinephrine (Adrenalin)	1mg/10ml (1:10,000)	Syringe	6
Epinephrine (Adrenalin)	30mg/30ml (1:1000)	Vial	1
Lidocaine 2%	100mg/5ml	Syringe	4
Magnesium Sulfate 50%	5 gm/10 ml	Syringe	1
Midazolam (Versed )	5 mg/ 5ml	Vial	2
Naloxone (Narcan)	0.4mg/ml	Vial	1
Procainamide (Procan)	1gm/10ml	Vial	2
Flumazenil (Romazicon)	0.5 mg/5 ml	Vial	1
Sodium Bicarbonate (Infant) 4.2%	5 mEq/10ml	Syringe	2
Sodium Bicarbonate (Pediatric) 8.4%	10 mEq/10 ml	Syringe	2
Sodium Bicarbonate 8.4%	50 mEq/50 ml	Syringe	2

PEDIATRIC CRASH CART CONTENT

DRAWER II

IV SOLUTION	PACKAGE	QUANTITY
Dextrose 5% Water	50ml	4
Dextrose 5% Water	250ml	1
Lidocaine Drip	2 gm/250 ml	2
Normal Saline	250ml	2
Normal Saline	500ml	2
Normal Saline	1000ml	2

Please note: Packaging may change without notice due to product availability. If you have any questions, please call the Pharmacy Department.

DRAWER III

IV CATHETERS	AMOUNT	NEEDLES	AMOUNT
Insytc: 24	4	18 ga 1 ½”	5
22	4	18 ga 3 ½”	2
20	4	18 ga Blunt	5
18	4	20 ga	10
16 ga	2	22 ga	10
14 ga x 2 ¼”	2	25 ga	10
Introsseous Needle	1
Introsseous Needle	1

SYRINGES	AMOUNT	SUPPLIES	AMOUNT
60cc	2	Labels	5
35cc	2	Alcohol Wipes	10
20cc	2	Betadine Swab	10
12cc	2	Tourniquet Latex Free	2
6cc	4	2x2’s Sterile	10
3cc (no needle)	2	Betadine Pad	5
1cc TB Syringe	10	Durapore Tape 1”	2
60cc Piston	1	T-Extension	2
4-Way Stopcock	1	Stopcock	2
		IV Pump Sets	4

PEDIATRIC CRASH CART CONTENT

DRAWER IV

Op-Site	4
Lidocaine 1%	1
Water for Injection	1
Sodium Chloride for Injection	1
Gloves – latex free (7)	2
Gloves – latex free (7 ½)	2
Gloves - latex free (8)	2
Silk Suture 3-0 (straight needle)	2
Cut Down Tray	1
Microbore Tubing 36”	2
4x4’s Sterile	5

INTUBATION TRAY DRAWER V

Laryngoscope Handle with 2 batteries	12cc Syringe (slip)
Laryngoscope Blades: #0, #1 Miller (1 of each)	Mastisol
#1, #2 Welch (1 of each)	KY Jelly (4)
#2 McIntosh (1)	4x4 Non-Sterile (2)
Extra Light Bulbs (2)	1” Durapore Tape
Extra Batteries (2) “AA”	2” Durapore Tape
6 Fr, 14 Fr Intubating Stylets	CO2 Detector
Plain Tongue Blade	Bio Hazard Bag
Oral Airways – 0, 00, 50, 60, 70 80 (1 of each)	McGill Forcep
Cath/Glove - 5/6 Fr, 8 Fr, 10 Fr 14 Fr(2)	Endo Tubes: 2.5, 3, 3.5, 4, 4.5, 5, 5.5-uncuffed
Hurricaine Spray w/Red Adapter	5.5, 6, 6.5, 7-cuffed
	Nasal Airway (28)

OTHER SUPPLIES

Pediatric Nonrebreather Mask	Goggles
Yaunker Suction	Normal Saline 250ml
Oxygen Flow Meter w/nipple attached	Salem Sump NG
Oxygen Connecting Tubing	10Fr Repojel
Vycon 6Fr & 8Fr Salems	30cc & 60cc Bulb Syringe
ABG Kit (2) - Pediatrics	Barrel Connector

In PICU there will be an additional Intubation tackle box available for intubation only.

MACKINAW CRASH CART CONTENT

TOP OF CART

Monitor/Defibrillator

Electrodes (3 pkgs.)

Saline Defib Pads (2 pkgs.)

Pace/Cardiovert/Defib/Monitor Pads (2 pkgs.)

Suction Machine – with Suction Tubing & Yankauer

Box of Exam Gloves

Extra ECG Tracing Paper

One-Way Valve Mask

HANGING ON CART

Code Sheets on Clipboard

Backboard

Medication Dosing Reference – Pals PALS

Pharmacy Reference

Ambu Bags – Adult, Pediatrics, Neonatal

DRAWER I

MEDICATIONS	CONCENTRATION	PACKAGE	QUANTITY
Adenosine (Adenocard)	6mg/2ml	Syringe	5
Amoidarone (Cordarone	150mg/3ml	Ampule	2
Atropine	1mg/10ml	Syringe	3
Bretylium (Bretylol)	500mg/10ml	Vial	2
Calcium Chloride	1gm/10ml	Syringe	2
Dextrose 50%	25gm/50ml	Syringe	1
Diazepam (Valium)	10mg/2ml	Syringe	2
Diphenhydramine (Benadryl)	50mg/ml	Syringe	2
Epinephrine (Adrenalin)	1mg/ml	Ampule	2
Epinephrine (Adrenalin)	1mg/10ml	Syringe	6
Epinephrine (Adrenalin)	30mg/30ml	Vial	2
Flumazenil (Romazicon)	1mg/10ml	Vial	1
Furosemide (Lasix)	100mg/10ml	Syringe	2
Heparin	25,000u/5ml	Vial	2
Hydrocortisone (Solu-Cortef)	500 mg/4 ml	Vial	1
Lidocaine 2%	100mg/5ml	Syringe	4
Magnesium Sulfate 50%	5gm/10ml	Syringe	2
Midazolam (Versed)	5mg/ml	Vial	2
Naloxone (Narcan)	0.4mg/ml	Vial	2
Norepinephrine (Levophed)	4mg/4ml	Ampule	4
Procainamide (Procan)	1gm/10ml	Vial	4
Sodium Bicarbonate	50meq/50ml	Syringe	3
Sodium Chloride 0.9%		Vial	2
Verapamil (Isoptin/Calan)	5mg/2ml	Vial	4

PEDIATRIC SPECIFIC DRUGS SEPARATE

MEDICATIONS	CONCENTRATION	PACKAGE	QUANTITY
Digoxin	0.5mg	Ampule	1
Digoxin	0.1mg	Ampule	1
Dopamine	200mg	Vial	2
Hydrocortisone (Solu-Cortef)	1gm/8ml	Vial	1
Naloxone (Narcan)	0.02mg	Ampule	1
Sodium Bicarbonate	10meq	Syringe	2

DRAWER II

IV SOLUTION	PACKAGE	QUANTITY
Dobutamine Drip (Dobutrex )	500mg/250ml	2
Dopamine Drip	800mg/250ml	2
Lidocaine Drip	2gm/250ml	2
Dextrose 5% Water	50ml	4
Dextrose 5% Water	250ml	1
Normal Saline	250ml	2
Normal Saline	500ml	2
Normal Saline	1000ml	2

DRAWER III

IV CATHETERS	AMOUNT	NEEDLES	AMOUNT
Insyte: 24	4	18 ga 1 ½”	10
22	4	18 ga 3 ½”	2
20	4	18 ga Blunt	5
18	4	20 ga	10
16	2	22 ga	10
		25 ga	10
		20 ga x6 (special tech.)	1
		20 ga x6 (special tech.)	1

SUPPLIES	AMOUNT	SYRINGES	AMOUNT
Labels	5	3ml (w/needle)	10
Alcohol Wipes	10	6ml	5
Betadine Swab	10	12ml	5
Tourniquet Latex Free	2	20ml	5
Durapore Tape 1”	2	60ml	2
2x2’s Sterile	10	1cc TB Syringe	10
Betadine Pad	5
T-Extension	2
Stopcock	2
IV Pump Sets	4

MACKINAW CRASH CART CONTENT

DRAWER IV

Op-Site	4
Lidocaine 1%	1
Water for Injection (30cc)	1
Sodium Chloride for Injection (30cc)	1
Gloves – latex free (7)	2
Gloves – latex free (7 ½)	2
Gloves - latex free (8)	2
Silk Suture 3-0 (straight needle)	2
Blades 11 & 15	1 of each
4x4’s Sterile	5

ADULT INTUBATION TRAY (will be wrapped) – DRAWER V

Laryngoscope Handle with 2 batteries	12cc Syringe (slip)
Laryngoscope Blades: #3, #4 Miller (1 of each)	KY Jelly (4)
#3, #4 McIntosh (1 of each)	4x4 (2)
Nasal Airway: 26, 28, 30, 32, 34	1” Durapore Tape
Extra Light Bulbs (2)	2” Durapore Tape
Extra Batteries (2) “C”	CO2 Detector
14 Fr Intubating Stylets (2)	Bio Hazard Bag
Plain Tongue Blade	McGill Forcep
Oral Airways – 70mm, 80mm, 90mm, 100mm	Endo Tubes 5, 5.5, 6, 6.5, 8.5, 9 (1 of each)
Cath/Glove - 10 Fr, 14 Fr (2)	7, 7.5, 8 (2 of each)
Skin Prep (3)	Bite Block
Adult Mask (3 Flap non-Rebreather)	Bite Stick
Nasal Cannula

PEDIATRIC INTUBATION TRAY (will be wrapped) – DRAWER V

Laryngoscope Handle with 2 batteries	12cc Syringe (slip)
Laryngoscope Blades: #0, #1 Miller (1 of each)	Mastisol
#1, #2 Welch (1 of each)	KY Jelly (4)
#2 McIntosh (1)	4x4 Non-Sterile (2)
Extra Light Bulbs (2)	1” Durapore Tape
Extra Batteries (2) “AA”	2” Durapore Tape
4 Fr, 6 Fr, 14 Fr Intubating Stylets	CO2 Detector
Plain Tongue Blade	Bio Hazard Bag
Oral Airways – 0, 00, 50, 60, 70 (1 of each)	McGill Forcep
Cath/Glove - 5/6 Fr, 8 Fr, 10 Fr (1 of each)	Endo Tubes: 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6
Pediatrics Nonrebreather Mask	(uncuffed)
	Nasal Airway (28)

OTHER SUPPLIES

Oxygen Flow Meter w/nipple attached	Goggles
60cc Bulb Syringe	BP Cuff with Stethoscope
Barrel Connector	Tube Tamer
Oxygen Connecting Tubing	Hurricaine Spray
ABG Kit (2 adult) (2 pediatrics)

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Test Policy - Administrative

Policy Number: 3.20 Page 1 of 28

Edward Bruff – Executive Vice President/COODate

Assistance

Equipment/supply

Equipment/supply

Equipment/supply

Equipment/supply

Equipment/supply

Equipment/supply

Sterile Processing restocks, seals & stores cart.

POLICY

POLICY

POLICY

POLICY

POLICY

POLICY

POLICY

Suction Check

Oxygen Check

Other Checks

Basement

900 Cooper Building

Second Floor

ANDERSEN BUILDING

MICHIGAN CAMPUS

MACKINAW CAMPUS

TOP OF CART

HANGING ON CART

Leave on cart with exchange: Backboard

Adenosine (Adenocard)

Amiodarone (Cordarone)

Atropine

Calcium Chloride

Dextrose 50%

Diazepam (Valium)

Diphenhydramine (Benadryl)

Epinephrine (Adrenalin)

Epinephrine (Adrenalin)

Epinephrine (Adrenalin)

Flumazenil (Romazicon)

Furosemide (Lasix)

Heparin

Hydrocortisone (Solu-Cortef)

Isoproterenol (Isuprel)

Lidocaine 2%

Magnesium Sulfate 50%

Midazolam (Versed)

Naloxone (Narcan)

Norepinephrine (Levophed)

Procainamide (Procan)

Sodium Bicarbonate

Sodium Chloride 0.9%

Vasopresin

Verapamil (Isoptin/Calan)

IV SOLUTION

PACKAGE

QUANTITY

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