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
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
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
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
EtCO2 water trap, sample line, adapter (If needed, notify RT)
Sufficient
Insufficient
Par 5/5/5, choose insufficient if any need stocking
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
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
Long angiocatheters (18ga, 20ga)
Sufficient
Insufficient
Par 10 each size
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
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