Now M-D-Y H:M
R1
R2
R3
Is resus ultrasound clean and plugged in by room 21?
Yes
No
Sufficient
Insufficient
Par 20
How many nasal cannula are needed?
5 10 15 20
Sufficient
Insufficient
Par 20
How many NRBs are needed?
5 10 15 20
Sufficient
Insufficient
Par 10
How many etco2 nasal cannula are needed
5 10
Sufficient
Insufficient
Par 5
How many adult BVM are needed?
0 1 2 3 4 5
Sufficient
Insufficient
Par 2 each size
28 French
32 French
Pleur-evac (labeled as "chest tray")
Sufficient
Insufficient
Par 2 and 2 in storage room
How many pleur-evacs are needed?
1 2 3 4
Sufficient
Insufficient
Par: 3
How many thora-para kits are needed?
1
2
3
Sterile Bundles (labeled as "crit care drapes")
Sufficient
Insufficient
Par 3
How many sterile bundles are needed?
1 2 3 4 5
Par 3 and 2 in storage room
Triple Lumen Catheters / Shiley / Cordis
Sufficient
Insufficient
Par 3/2/2, Choose insufficient if any need stocking
TLC
Shiley
Cordis
Sufficient
Insufficient
Par 3
How many arterial line kits are needed?
1 2 3 4 5
Pigtail trays (labeled as "Wayne pneumothorax trays")
Sufficient
Insufficient
Par 2 and 2 in storage room
How many pigtail trays are needed?
1 2 3 4
Sufficient
Insufficient
Par 2
Sufficient
Insufficient
Par 2 and 2 in storage room
How many LP trays are needed?
1 2 3 4
Sufficient
Insufficient
Par 2
How many OB bundles are needed?
1 2
Trans-venous pacer kit ("pacing electrode tray")
Sufficient
Insufficient
Par 3
How many TVP kits are needed?
1 2 3
Par 3
Pacemaker/magnet in place
Yes
No
Par 1
Sufficient
Insufficient
Par 2
Sufficient
Insufficient
Par: 4
How many airway boxes are needed?
1 2 3 4 5
Yes
No
Par 1
Glidescope MAC Blades S3 / S4; Hyperangulated Blades S3 / S4
Sufficient
Insufficient
Par 2/2/2/2, Choose insufficient if any need stocking
Glidescope S3
Glidescope S4
Glidescope Hyperangulated S3
Glidescope Hyperangulated S4
CMAC present including video attachment
Yes
No
Par 1
CMAC Blades MAC 3/4 and Hyperangulated blades
Sufficient
Insufficient
Par 1/1/1, choose insufficient if any need stocking
CMAC S3 Blades
CMAC S4 Blades
CMAC Hyperangulated Blades
Sufficient
Insufficient
Par 3
How many hyperangulated stylets are needed?
1 2 3 4 5
Sufficient
Insufficient
Par 3/3
LMA 3.5
LMA 4.5
EtCO2 water trap, sample line, adapter (If needed, notify RT)
Sufficient
Insufficient
Par 5/5/5, choose insufficient if any need stocking
Water trap
Sample line
Adapter
Sufficient
Insufficient
Par 5
How many 11-blade scalpels are needed?
1 2 3 4 5
Awake intubation meds/equipment (2&4% lido, glyco, atomizer)
Sufficient
Insufficient
Par 1
2% lidocaine
4% lidocaine
glyco
atomizer
Sufficient
Insufficient
Par 5
How many bougies are needed?
1 2 3 4 5
Trachs (Shileys), 4.0 / 6.0
Sufficient
Insufficient
Par 2/2, choose insufficient if any need stocking
4.0
6.0
Long angiocatheters (18ga, 20ga)
Sufficient
Insufficient
Par 10 each size
18 gauge
20 gauge
Is the EZ IO Drill present?
Yes
No
Par 1
Is the EZ IO Drill functional?
Yes
No
Press it on to see if it works
EZ IO Needles (pink, blue, yellow)
Sufficient
Insufficient
Par 3/3/3, Choose insufficient if any need stocking
Pink
Blue
Yellow
Sufficient
Insufficient
Par 5
How many radial arterial lines are needed?
1 2 3 4 5
Sufficient
Insufficient
Par 2
Sufficient
Insufficient
Par 1/1
Sufficient
Insufficient
Par 1
Yes
No
BIPAP Masks (S / M / L) - If needed notify RT
Sufficient
Insufficient
Par 3/3/3, Choose insufficient if any need stocking
What size masks need restocked?
Small
Medium
Large
CMAC Blades MAC 3/4 and Hyperangulated blades
Glidescope MAC 3/4 and Hyperangulated blades
Sufficient
Insufficient
Par 3/3/3, 3/3/3, Choose insufficient if any need stocking
CMAC MAC 3
CMAC MAC 4
CMAC Hyperangulated
Glidescope MAC 3
Glidescope MAC 4
Glidescope Hyperangulated
Present
Not Present
Par 1
Is the LUCAS device plugged in?
Yes
No
Sufficient
Insufficient
Par 5
How many phenyl sticks are needed?
1 2 3 4 5
Sufficient
Insufficient
Par 5; Note: 1 mL epi from cardiac amp + 9 mL saline = 10 mcg/mL push-dose epi
How many epi sticks are needed?
1 2 3 4 5
Did you notify the Resus lead RN of the missing supply items?
Yes
No
Yes
No