The other day one of our patients crashed. She was a difficult intubation and we ran out of some of the supplies on our crash cart. I ran across the hall and told the other unit that I needed something on their crash cart.
The nurse there promptly told me that she had just inspected it, and this was really an inconvenience. Did I really need it now? What's wrong with our crash cart? Will she get it back intact?
I was like, hey, we're having an emergency here.
"I didn't hear a code called!" Uhm...my floor never calls codes.
Finally, in a huff, she was like, "Well I guess if it's an emergency, but please make sure we get it back."
I mean, I know they need a full crash cart too and everything, but she didn't need to lecture me on that. I NEEDED it then for our unresponsive, not breathing patient who was currently being bagged.
On floors that are known for having codes, a red, locked tool box with extra basic drugs is usually kept in the med room for just such emergencies. It is checked weekly by nurses and pharmacy that it remains locked. When lock is broken it is send back to be restocked just like crash cart. This saves so much worry, time and energy. Just a thought for those who have not experienced a day of double whammies. Blessings.
Our pharmacists are so fast to arrive that we hardly ever use the meds in the crash cart. The just show up with a big bag of meds, needles, syringes and start drawing up what the doc orders except bags of meds/fluids. It's great because it leaves nurses free to do other things.
So I'm confused. Are your ET tubes kept in the crash cart along with the RSI drugs or do you have a separate intubation box? Sometimes with swelling that goes along with mucousitis in the throat, you need a much smaller ETT than you'd think (like a 6.0 on an average sized adult). The first patient I was taking care of that crashed and needed intubation was a situation like you described, multiple failed attempts, lots of discarded ETTs and discussion over the need to crich - but our unit kept small ETTs on hand and we managed to get a small but effective airway.
I would look up in your unit's P&P about how the cart should be stocked, whether or not your unit is in compliance and see if things need to be altered for the BMT, because nothing ever goes according to ACLS algorhythms in there. Especially when you are airlocked in and short vital equipment and don't call hospital-wide codes.
We had plenty of drugs and everything, and do keep extra drugs in our med room. Pharmacists don't respond to codes, I don't think, but we didn't even call a code. My unit generally doesn't call codes.
We keep our intubation supplies on an intubation tray that's stored on the crash cart. I took the other unit's intubation tray off their crash cart. We had plenty of tubes, as well, but they were looking for a 7.5 size, which we couldn't find. Apparently we don't keep this size on our crash carts. They ended up getting an 8 in.
The only thing we didn't have enough of was the CO2 detectors. I guess it was assumed that you get the tube in, connect the CO2 detector, and figure you're good. In our case, we got the tube in, used the CO2 detector, pt started desatting, put new tube in, needed new CO2 detector.
If she didn't hear a code called, you can't blame her for wondering. However, your very first indication to her that an emergency situation existed should have been sufficient.
As to her telling you to be sure to return stuff/restock, I can understand her feelings and thoughts on the matter but it was not appropriate at the time. If you hadn't restocked when all was said and done, then she should have asked you to please do so.
I guess there is a huge liability in not having the right supplies or enough of them, so I hope this gets straightened out immediately.
I can sort of understand the other nurse's fear that her floor might need their crash cart at any moment and why should they risk being short when it was another floor that was going to be taking their stuff. Sort of like the story of the ten unprepared virgins who didn't have their lamps filled with oil when the bridegroom came. Still, what were you supposed to do besides borrow? It wasn't your fault.
barefootlady, ADN, RN
2,174 Posts
On floors that are known for having codes, a red, locked tool box with extra basic drugs is usually kept in the med room for just such emergencies. It is checked weekly by nurses and pharmacy that it remains locked. When lock is broken it is send back to be restocked just like crash cart. This saves so much worry, time and energy. Just a thought for those who have not experienced a day of double whammies. Blessings.