Information

  • Conducted on

  • Prepared by

Checklist

  • Checklist completed daily

Top of Trolley

  • Defibrillator checked (remove battery and reinsert to start self-test)

  • Defibrillator pads in date

  • x1 pair if scissors, x1 razor and paper towels in AED case

  • Sharps box on side of trolley

  • x1 stethoscope and sphygmomanometer on side of trolley (Manual BP monitor)

  • Hypoglycemic box on top of trolley

  • Suction machine on top of trolley with yankauer sucker attached

  • Oxygen canister in date and at least 3/4 full

  • HemoCue box on top of trolley

  • Emergency IV fluid tray on top of trolley

Draw 1 - Airway & Breathing

  • ET Tube x2 size 7 AND x2 8

  • Nebuliser kit with face mask x1

  • Anaesthetic face mask x1

  • Oxygen face mask x1

  • Flexi-lock catheter mount x1

  • I-gel - x1 size 4 AND x1 size 5

  • Airway tray consists of - ribbon, gauze, x1 syringe & lubricant

  • Guedel Airways - x1 size 3 AND z1 size 4 AND x1 size 5

  • Guide tube (blue) x1

  • Magil forceps x1

  • Laryngoscope blade x2

  • Goggles/eye protection x1 pair

  • FFP3 mask x1

Draw 2 - Circulation

  • x2 2ml syringes

  • x2 5ml syringes

  • x2 10ml syringes

  • x2 20ml syringes

  • x1 tourniquet

  • x3 SC/IM needles (x1 green/x1 orange/x1 blue)

  • x3 cannulas (x1 pink/x1 blue/x1 green)

  • x3 blunt needles

  • x1 gauze

  • x2 cannula dressings

  • x2 alcohol wipes

  • x1 roll of micropore tape

  • x2 10ml saline pods

  • x1 bung

  • x1 extension clave

  • x1 tap connection for cannula

Draw 3 - Fluids

  • x1 bag of 1000mls of Hartmann's solution

  • x1 IV giving set

  • x1 fluid pressure bag

Draw 4 - Breathing and Suction Equipment

  • x6 deep suction catheters

  • x1 yankauer sucker

  • x1 suction connection tube

  • x1 bag valve mask (face mask & reservoir)

  • x1 breathing circuit/resuscitation bag

Draw 5 - Emergency Drugs

  • x1 adrenaline (epinephrine) 1:100,000 injection for IV, IO or ET tube use

  • x1 atropine solution for infection 3mg/10ml for IV use

  • x2 pre-filled ephedrine syringes

  • x2 amiodarone solution for infection 150mg for IV use

  • x1 filter needle

  • x1 10ml syringe

Draw 5 - Naloxone Box

  • x1 5ml syringe

  • x1 10ml syringe

  • x1 10ml 0.9% sodium chloride

  • x2 alcohol wipes

  • x2 filter needles

  • x1 bung

  • x3 naloxone 400mcg/ml ampules

Draw 5 - Anaphylactic Box

  • x3 2ml syringes

  • x2 10ml syringes

  • x1 20ml water for injection pod

  • x2 10ml 0.9% sodium chloride pod

  • x2 vials of adrenaline 1:1000

  • x1 10mg vile of chlorphenamine

  • x1 10mg vial of hydrocortisone

  • x3 blunt needles/drawing up needles

  • x1 blue needle

  • x1 green needle

  • x1 orange needle

  • x3 alcohol wipes

  • x1 extension clave

Additional comments

  • Additional comments:

Signatures

  • Staff Signature

  • Auditor Signature

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