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Resus.org.uk

Acute care
Resuscitation
Council (UK)
Published by the Resuscitation Council (UK)
5th Floor
Tavistock H
ouse North
Copyright Resuscitation Council (UK)
Tavistock S
No part of this publication may be reproduced without the written permission of the Resuscitation Tel: 020 7388
Hyperlinks to other document sections or external websites are shown in blue. Fax: 020 7383 0773
Website: www.resus.org.uk
email: enquiri
es@resus.org.uk
Registered Charity No. 286360
November 2013

Drug tables for cardiac arrest are highlighted in the text with the symbol !
1 Introduction and scope

Healthcare organisations have an obligation to provide a high-quality resuscitation
service, and to ensure that staff are trained and updated regularly to a level of
proficiency appropriate to each individual’s expected role.
As part of the quality standards for cardiopulmonary resuscitation practice and
training this document provides lists of the minimum equipment and drugs required
for cardiopulmonary resuscitation. These lists are categorised according to the
clinical setting.
This document is referred to by the standards documents pertaining to specific
clinical settings. Links to these documents are provided below:
Community care *
Mental health – inpatient care *
* Documents currently in development The core standards for the provision of cardiopulmonary resuscitation across all healthcare settings are described in the document: to quality standards for cardiopulmonary practice and training 2 General points

All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest. The standard defibrillator sign should be used in order to reduce delay in locating a defibrillator in an emergency All settings must have a means of calling for help (e.g. landline telephone [internal or external], mobile telephone with reliable signal, or alarm bell). Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended. It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help. a. For example, in secondary or tertiary care specific locations may need special provisions (e.g. for failed intubation, tracheostomy care, cardiac arrest in pregnancy etc). b. Some settings need a wide range of equipment immediately available (e.g. resuscitation room in emergency department). Suggested options include having basic equipment (and possibly drugs) available immediately (on a resuscitation trolley), and further equipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response. Staff should be trained to use the available equipment according to their expected roles. Depending on the organisation, this risk assessment must be overseen by a Resuscitation Committee or a designated resuscitation lead. Expert advice should also be sought locally from those commonly involved in resuscitation (e.g. resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, prehospital care physicians). Resuscitation equipment should be single-patient-use and latex-free, whenever possible and appropriate. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed. Personal protective equipment (e.g. gloves, aprons, eye protection) and sharps boxes must be available, based on a local risk assessment and local polices. A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest. The frequency of checks should be determined locally. It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency. 10. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs. 11. Further equipment and drugs may be needed to manage other types of emergencies that are likely to be encountered in a particular setting; this may include: • monitoring equipment (e.g. blood pressure, pulse oximetry, 3-lead electrocardiogram [ECG], temperature, waveform capnography) • 12-lead ECG recorder • near-patient tests (e.g. blood glucose, blood gas analysis). 12. A formal procurement process that includes trialing of equipment before purchase is recommended. Trialing of resuscitation equipment can take place in actual care settings or in simulated clinical scenarios. 13. The precise availability of equipment and drugs should be determined locally. The equipment lists include a suggestion on the immediacy with which equipment and drugs should be available: Immediate – available for use within the first minutes of cardiorespiratory arrest (i.e. at the start of resuscitation). Accessible – available for prompt use when the need is determined by 14. These lists are not exhaustive. Local experts should be consulted to ensure that the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation. Acute hospital care – ADULT
AIRWAY AND BREATHING
Suggested
Comments
availability
Portable suction (battery or manual) with Yankauer sucker and soft suction catheters equipment. NPSA Signal. Reference number 1309. February 2011 Supraglottic airway device with syringes, i-gel®, laryngeal tube) and size will depend on local policy and staff training Oxygen cylinder (with key where necessary) For example, there is not consenus on the role of Laryngoscope handles (x 2) and blades (size 3 and 4) Spare batteries for laryngoscope and spare bulbs (if applicable) Syringes, lubrication and ties/tapes/scissors for tracheal tube Waveform capnograph – with appropriate airways or tracheal tube. NAP4 – 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011. Standards of monitoring - addendum regarding the use of capnography outside the operating theatre. Association of Anaesthetist of Great Britain and Ireland, 2011. EBA Recommendation for the use of Capnography. European Board of Anaesthesiology, 2011 Acute hospital care – ADULT
CIRCULATION
Suggested
Comments
availability
Manual and/or automated external defibrillator locations determined by a local risk assessment. Available to enable shock within 3 minutes of collapse Pacing function is recommended for cardiac units, cardiac catheter laboratories, emergency departments, intensive care units and operating theatres. It may also be appropriate for other settings, and this should be determined locally Pads should be suitable for external pacing if needed. Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol wipes, tourniquets Central venous access – Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine To identify and treat reversible causes of cardiorespiratory arrest Acute hospital care – ADULT
OTHER ITEMS
Suggested
Comments
availability
Further personal protective equipment may be required according to local policy Sharps container must be immediately available wherever sharps used Types of connectors, ports, and caps to be determined locally Guidance on colour coding for syringe labels. SResuscitation Council (UK) November 2009 Cardiorespiratory arrest record forms for patient records, audit forms and DNACPR forms Access to algorithms, emergency drug doses Acute hospital care – ADULT
CARDIAC ARREST DRUGS – FIRST LINE for intravenous use
Suggested
Comments
availability
depends on access to further syringes. 1mg needed for each 4-5 min of CPR Amiodarone 300mg as a prefilled syringe x 1 First dose required after 3 defibrillation attempts Acute hospital care – ADULT
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use
Suggested Comments
availability

Adrenaline 1mg (= 10 ml 1:10,000) prefilled be accessible for prolonged resuscitation attempts If decision is made to give further doses of amiodarone Calcium gluconate can be used as an alternative. Note: 10 ml 10% Calcium chloride = 6.8 mmol Ca2+ 10 ml 10% Calcium gluconate = 2.26 mmol Ca2+ Second-line treatment for anaphylaxis, can also be given intramuscularly Second-line treatment for anaphylaxis, can also be given intramuscularly For use in areas where large doses of local anaesthetic are used for regional blocks, according to Association of Anaesthetists Guidelines. Formulation to be determined locally. Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002. Volume and concentration according to local policy Acute hospital care – ADULT
OTHER DRUGS
Suggested
Comments
availability
First-line treatment for anaphylaxis – 0.5 mg intramuscular injection in adults. Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs Ipratropium bromide 500 microgram nebules Salbutamol 5mg nebules x 2 (and nebuliser 0.9% sodium chloride or Hartmann’s solution therapeutic hypothermia as part of post-cardiorerspiratory arrest care
NOTES: Acute Hospital Care – ADULT
Portable monitoring and other equipment for patient transfer should be readily available. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.
Supporting information
Association of Anaesthetists of Great Britain and Ireland (AABBI) Safety Guideline – Interhospital Transfer. 2009.
Intensive Care Society. Guidelines for the transport of the critically ill adult (3rd Edition 2011). http:/ Acute hospital care – PAEDIATRIC
AIRWAY AND BREATHING
Suggested
Comments
availability
Pocket mask with oxygen port – paediatric Oxygen mask with reservoir - paediatric and Self-inflating bag with reservoir - paediatric Clear face masks, size 00, 0, 1, 2, 3, 4, 5 Oropharyngeal airways, sizes 00, 0, 1, 2, 3, 4 Immediate Nasopharyngeal airways, sizes 4.0, 4.5, 5.0, of appropriate length may be used as an alternative according to local policy Portable suction (battery or manual) with Yankauer sucker (paediatric and adult) and soft suction catheters, sizes 5, 6, 8, 10, 12, 14 Magill forceps (adult and paediatric sizes) Supraglottic airway device with syringes, Tracheal tubes, uncuffed sizes 2, 2.5, 3, 3.5, Croup tube (uncuffed, longer than standard be substituted according to local policy (e.g. Cole’s® tubes) Tracheal tube introducer (stylet) small and Spare batteries for laryngoscope and spare bulbs (if applicable) Syringes, lubrication and ties/tapes (e.g. Elastoplast® / Hypofix® /ribbon gauze/tape) and scissors Waveform capnograph – with appropriate Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011. Acute hospital care – PAEDIATRIC
CIRCULATION
Suggested
Comments
availability
local risk assessment. AEDs are not intended for use in infants (less than 12 months old) and this should be considered at risk assessment. Availability of pacing function according to local policy Adhesive defibrillator pads – paediatric and Pads should be suitable for external pacing if needed ECG electrodes (paediatric & adult sizes) Intravenous cannulae (sizes 14, 16, 18, 20, 22, 24G) and 2% chlorhexidine / alcohol wipes, tourniquets and dressings Intravenous infusion sets (with and without IV extension set with 3-way taps and bungs Amount depends on access to further fluids Intra-osseous access device with needles suitable for neonates, children and adults Central venous access – Seldinger kit, full barrier precautions (hat, mask, sterile gloves, To identify and treat reversible causes of cardiorespiratory arrest Acute hospital care – PAEDIATRIC
OTHER ITEMS
Suggested
Comments
availability
Sharps container must be immediately available wherever sharps are used Blood glucose monitor with appropriate strips SResuscitation Council (UK) November 2009 Cardiorespiratory arrest record form for patient records and audit forms. DNACPR forms appropriate for children. doses, paediatric drug dose calculators (e.g. Broselow tape) Acute hospital care – PAEDIATRIC
CARDIAC ARREST DRUGS – FIRST LINE for intravenous use
Suggested
Comments
availability
Adrenaline 1mg (= 10 ml 1:10,000) prefilled depends on ease of access to further syringes if needed Acute hospital care – PAEDIATRIC
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use
Suggested
Comments
availability
ALERT: Atropine is available in various concentrations Calcium gluconate may be used as an alternative. Note: 10 ml 10% Calcium chloride = 6.8 mmol Ca2+ 10 ml 10% Calcium gluconate = 2.26 mmol Ca2+ Second-line treatment for anaphylaxis, can also give intramuscular For treatment of status epilepticus. Agent, dose and route of administration according to local policy Second-line treatment for anaphylaxis, can also be given intramuscularly Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002. Concentration and preparation according to local policy Acute hospital care – PAEDIATRIC
OTHER EMERGENCY DRUGS
Suggested
Comments
availability
Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs Ipratropium bromide 500 microgram nebules
NOTES - Acute Hospital Care – PAEDIATRIC
The volume and/or quantities of the listed fluids and drugs stored and their location should be determined by local policy. This should ensure that there is sufficient availability to manage a paediatric resuscitation according to Resuscitation Council (UK) resuscitation guidelines without undue delay. Portable monitoring and other equipment for patient transfer should be readily available. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies. All interventions (e.g. drug therapy, practical procedures, discussions with other staff or relatives) should be documented with date and time and signed by an identifiable member of staff.

Source: http://www.resus.org.uk/pages/QSCPR_Acute_EquipList__13-11-18.pdf

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