Memorandum

TO: All medical and nursing staff; departments of Anaesthesia and Pharmacy

FROM: Drugs & Therapeutics Committee

DATE: July 2011

SUBJECT: Emergency intubation kits

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Sometimes a patient may require immediate intubation by anaesthetists at ward level. The necessary drugs for intubation are not kept as stock items on most wards, and the absence of these drugs may cause unnecessary delay and therefore risk to the patient.

Emergency intubation kits containing such drugs are now available in the following wards: CCU; St Joseph’s HDU; St Luke’s 3; St Anne’s and St Brigid’s HDU (i.e one emergency intubation kit on each hospital floor). A spare kit is also available out of hours in the Parenteral Nutrition (PN) storage room on the first floor. The individual drugs (not in emergency kits) are also stocked in Theatres, Emergency Department and ICU.

The Emergency intubation kits are comprised of two separate components:

Part 1: Stored in the fridge. Contains neuro-muscular blocking agents (NMBAs)

Part 2: Stored on the cardiac arrest trolley

Component

/ Storage / Contents
Part one (fridge pack) / Store in the fridge / Suxamethonium 50mg / 1ml pre filled syringes x2
Atracurium 50mg / 5ml vials x 2
Part two / Store at room temperature on cardiac arrest trolley / Propofol 200mg x 2
Midazolam 10mg/2mls x 5
Ephedrine 30mg/1ml x 2
Phenylephrine 10mg/1ml x 2
Noradrenaline 2mg/2mL x 4
Atropine minijet x 1
Dexamethasone 8mg / 2ml vial x 1
The box will include
·  syringe labels
·  5 mL, 10 mL, 20 mL and 50mls syringes (2 of each)
·  4 x 0.9% sodium chloride mini plascos
·  100 mL bag of sodium chloride 0.9% (to prepare phenylephrine infusion).

Emergency intubation kits are available for use by ANAESTHETISTS ONLY

As part of the daily check on emergency drugs, nursing staff in the specified locations should ensure the availability of both parts of the intubation kit (in the fridge and on the cardiac arrest trolley) and that the kit is in date. Contact the ward pharmacy technician or the Pharmacy if a replacement pack is required or if the kit has expired.

If a kit is removed from the PN storage room, this should be documented in the PN record book.

The Department of Anaesthesia should inform their staff of the availability of these intubation trays and their locations.

When Emergency intubation kits are used, ward staff should return the unsealed boxes (Part 1& 2) to the Pharmacy Department for re-stocking.

For further information, contact the Pharmacy department (extension 4518 / 4139)