Whats in your crash box?

Re: Whats in your crash box?

Martin Atkinson — Fri, 29 Nov 2013 16:48:38 GMT

[quote user="bob lehner"]

I guess you might look a bit silly if an animal died despite the use of emergency drugs and it came to light that the products you had been using were five years beyond their expiry date......? I rather suspect the VDS might not be best pleased.

[/quote] How displeased would they be if it died because I hadn't got the appropriate drugs because it was economically un-viable to keep them and there wasn't time for a referral or the owner couldn't afford the fee to make them viable? I am a quiet sole-charge practice that has to stock the same drugs as a busy multi-man practice and I hardly if ever use them. I don't seek to justify using either out of date drugs (indeed following the VMD visit there are none - not that there were many before) or failing to keep them because of the cost, I'm just pointing out the reality of the situation. They may be cheap but lots of cheap things still add up.

.[quote user="bob lehner"]Would you be happy if you were the patient in an ER and they tried to revive you with out-of-date stuff ?[/quote] This is an unrealistic comparison as they would use in an hour what I would use in a year but as said if the choice was out-of-date drugs or nothing I'd take the drugs.

PS You took this quote out of context Bob: 'the crash box is more for show than anything - I don't think I've ever had to use it'. Your sarcasm was unfounded, I don't profess to be so brilliant that I've never needed to revive anything, I was merely agreeing with Mike that the resources necessary are available from other sources in the operating room which is where a patient would most likely to be or would be transferred within 10 seconds.

Re: Whats in your crash box?

bob lehner — Fri, 29 Nov 2013 16:00:15 GMT

[quote user="Martin Atkinson"]anyway, the crash box is more for show than anything - I don't think I've ever had to use it[/quote]

Well, I'm sure other people (marginally less brilliant than you, of course) have done.

Most things have a pretty long life before reaching their expiry date - and you don't need to keep more than the minimum size pack of any individual product (say adrenaline/atropine/lidocaine) - so I don't think the economics are really too daunting in the big scheme of things. Many people charge a GA fee - and this can easily be factored in there if needs be.

Would you be happy if you were the patient in an ER and they tried to revive you with out-of-date stuff ?

Re: Whats in your crash box?

Martin Atkinson — Fri, 29 Nov 2013 14:21:26 GMT

[quote user="bob lehner"]Because these products are (hopefully) not used very often they can go out of date. Delegate someone to check expiry dates every month(and sign that they have done so).[/quote] For this reason there is a lot less in the crash box following my recent VMD inspection than there used to be!!. It is a pity that something might die because of pedantism over use-by dates when we all know the stuff will still work and given the choice between an out of date drug and squat diddly I know which I would choose. I can't see too many clients being told there's an extra £50 on the bill to cover all the drugs we had to throw away. We must of course obey as common sense sadly fails to be very common under VMD/PSS rules. I follow the Mike Martin logic on this anyway, the crash box is more for show than anything - I don't think I've ever had to use it, we've just gone to the drug cupboards and dressings drawers.

Re: Whats in your crash box?

Mike Martin — Wed, 27 Nov 2013 10:23:23 GMT

PS. I forgot adrenaline !

Re: Whats in your crash box?

Rob Loxley — Tue, 26 Nov 2013 13:36:40 GMT

[quote user="Mike Martin"]Is a 'crash box' a PSS standard?[/quote]

There must be suitable means of resuscitation. A resuscitation pack must always be maintained and be readily available for instant use, and checked to ensure the contents are in date.

I guess if you demonstrate you have all the materials to hand, it doesn't need to be in a box?

Re: Whats in your crash box?

Mike Martin — Tue, 26 Nov 2013 09:22:02 GMT

Is a 'crash box' a PSS standard?

Re: Whats in your crash box?

Mike Martin — Tue, 26 Nov 2013 09:21:11 GMT

The stuff I have used most have been:

1. Intubate and ventilate

2. Electrical defib (before cardiac massage)

3. Lidocaine i/v

And rarely, for a weak heart, with a slow rate response needing a kick - then dobutamine i/v.

This is a biased population as seen by a cardiologist.

Re: Whats in your crash box?

Rob Loxley — Mon, 25 Nov 2013 23:09:26 GMT

[quote user="Mike Martin"]Defib and all drugs are within arms reach. Works for us. [/quote]

Maybe a more useful answer for the OP might then be which drugs and equipment do your have 'within arm's reach'?

Re: Whats in your crash box?

KathW — Mon, 25 Nov 2013 19:10:11 GMT

[quote user="Mike Martin"]

In the event of a dog/cat 'crashing', or collapsing, it is carried to the prep room table. Intubated, ventilated. Defib and all drugs are within arms reach. Works for us.

[/quote]

My fear with our set up is what if it's a 50kg Rottie in the kennels or an animal mid op - our drugs and tubes are in dirty preps - out of theatre back through clean preps into dirty preps to grab a syringe and some adrenaline or other drug.

Re: Whats in your crash box?

Hannah Wynne Richards — Mon, 25 Nov 2013 18:13:09 GMT

Probably stating the obvious-but if you don't often have animals crashing,then check drugs in date regularly

Wynne

Re: Whats in your crash box?

Evelyn Barbour-Hill — Mon, 25 Nov 2013 17:53:28 GMT

[quote user="Mike Martin"]

We don't have a "crash box".

Is that wrong / bad? Does that mean we would fail a PSS inspection?

In the event of a dog/cat 'crashing', or collapsing, it is carried to the prep room table. Intubated, ventilated. Defib and all drugs are within arms reach. Works for us.

[/quote]

Ditto. Well, no defibrillator, but otherwise much the same.

Re: Whats in your crash box?

Richard Carter — Mon, 25 Nov 2013 17:42:46 GMT

[quote user="Nicola Lawlor"]Add in a corkscrew.... for getting hold of rubber balls stuck in the throat![/quote] - -I use a desert spoon

Re: Whats in your crash box?

Arlo Guthrie — Mon, 25 Nov 2013 17:42:22 GMT

[quote user="Nicola Lawlor"]Add in a corkscrew[/quote]

And a bottle of wine, just in case things go really tits up?

Re: Whats in your crash box?

Nicola Lawlor — Mon, 25 Nov 2013 17:29:43 GMT

Add in a corkscrew.... for getting hold of rubber balls stuck in the throat!

Re: Whats in your crash box?

Mike Martin — Mon, 25 Nov 2013 16:54:30 GMT

We don't have a "crash box".

Is that wrong / bad? Does that mean we would fail a PSS inspection?

In the event of a dog/cat 'crashing', or collapsing, it is carried to the prep room table. Intubated, ventilated. Defib and all drugs are within arms reach. Works for us.

Re: Whats in your crash box?

KathW — Mon, 25 Nov 2013 07:15:13 GMT

Thanks for the links Michael.

Re: Whats in your crash box?

Rob Loxley — Sun, 24 Nov 2013 23:31:47 GMT

We have a tool box which organises things well.

I'd add a tourniquet, tracheostomy tube, the right size et tube connector to fit a chunky hypodermic needle when you need a needle tracheostomy in a hurry, tape, scissors, stethoscope.

Re: Whats in your crash box?

bob lehner — Sun, 24 Nov 2013 21:00:05 GMT

Have to look at crash boxes at PSS inspections - many variations are seen. Most will have adrenaline, atropine, lidocaine - also see diazepam, dopram, naloxone, atipamazole, antihistamines and others. Should include a selection of needles, syringes, catheters, tracheostomy tubes, tourniquet.

What ever you keep in it I would advise:

1. Have a clearly typed and preferably laminated crib sheet of doses and routes of admin. firmly attached to the top of the crash box. In the heat of the moment people probably won't remember these doses - and you don't have time to go looking for the Formulary.

2. Keep the box tidy - best to use a small tool box or similar with separate compartments where individual products are kept. Again in the heat of the moment you don't want to be rootling around in a jumble of mixed up bottles and vials looking for one particular item.

3. Because these products are (hopefully) not used very often they can go out of date. Delegate someone to check expiry dates every month(and sign that they have done so).

4. Worth having a line on your admission consent form that in emergency non-veterinary licensed products may have to be used (see 'Specimen form of consent for anaesthesia and surgical procedures' on the RCVS website). It may seem unbelievable, but I'm told there have been cases where an animal has died on the table - despite proper use of emergency drugs - and the lawyers have subsequently picked up on the use of non-licensed products without the owner's informed consent (completely crazy but true).

Re: Whats in your crash box?

Adrienne McPartland — Sun, 24 Nov 2013 19:50:17 GMT

Thank you, exactly the sorts of suggestions I was looking for !

Any more also welcome :)

Re: Whats in your crash box?

Michael Woodhouse — Sun, 24 Nov 2013 17:53:58 GMT

I attach the table we have cut out and laminated in the lid of the box.

Use at your own risk and check the doses yourself etc etc.

(we no longer stock Dopram for various reasons)

Re: Whats in your crash box?

Michael Woodhouse — Sun, 24 Nov 2013 17:49:40 GMT

[quote user="KathW"]Is a BVM an amubag? Can I ask where you get them from?[/quote]

Boundtree are great. The disposable bag-mask-valve are so cheap

http://boundtree.co.uk/vinyl-disposable-bvm-with-pop-off-valve-adult?keyword=bvm&category_id=0

We have them in one of these boxes:

http://boundtree.co.uk/medical-bags-and-kits/hard-cases/flambeau-hard-paramedic-case-model-2072

We have fluids and giving sets in theatre so not stocking them as an extra item. There is a laryngoscope in there too that I see no reason to duplicate.

(there is also a cheap and nasty stethoscope in there and a pen torch).

Re: Whats in your crash box?

KathW — Sun, 24 Nov 2013 17:39:06 GMT

I've been looking at this as well.

Is a BVM an amubag? Can I ask where you get them from?

I was also thinking of a dog catheter - if ET tube can't be placed - can act as a guide to then feed an ET tube over.

100ml bag of saline to give a bolus I/v after adrenaline etc.

Narcan to reverse comfortan.

We also need a new box to store things in. Ideally with some compartments so people aren't rooting around for syringes etc. What do people use - any good ideas welcome!

Re: Whats in your crash box?

Michael Woodhouse — Sun, 24 Nov 2013 14:58:13 GMT

Adrenalin

Atropine

Diazepam

Adult sized BVM

Paediatric BVM

Selection of opened syringes attached to needles (1ml, 2ml, 5ml all with 21G 5/8" needles)

2 of each sized IV cannulae (14G to 24G)

Roll of elastoplast

Elastic band and forceps (improvised tourniquet)

Pair of curved scissors

Magill forceps

We have the ET tubes on the wall so not duplicating them in the box. Used mostly for diabetics epileptics fitting.

On the lid is a laminate for the drugs and their doses made out to common bodyweights.