CRASH CART

SHAMSAD SALIM B Sc; M Sc Nursing student

SAJITH KUMAR. RN,RM, MSc N ; Asst.Professor, International Life Support Instructor
VENUGOPALAN. P. P. MB;BS; DA, DNB, MNAMS ;Chief, Emergency Medicine, eputy irector, MIMS
Academy, irector, Masters Program in Emergency Medicine !"#$ $SA

INTRODUCTION
A crash cart is the trolley for storing lifesa%ing e&uipment and drugs in a hospital emergency room,
intensi%e care unit, clinics and other areas. 'he cart is characteri(ed )y )eing easily mo%a)le and readily accessi)le into all
sides of the cart for &uic*ly %ie+ing and remo%ing e&uipment and drugs during a crisis situation.
'he first cardiac crash cart +as created at ,ethany Medical Center in -ansas City, -ansas. 'he first
crash cart +as fa)ricated )y one of the doctor.s fathers. It contained an Am)u )ag, defi)rillator paddles, a )ed )oard and
endotracheal tu)es.
A crash cart or code cart /crash trolley in $- medical 0argon1 is a set of trays2dra+ers2shel%es on
+heels used in hospital emergency rooms for transportation and dispensing of emergency medication2e&uipment at site of
medical2surgical emergency for life support protocols li*e Ad%anced Cardiac Life Support2Ad%ance Life Support
/ACLS2ALS1, Pediatric Ad%anced life Support 3PALS4 to potentially sa%e someone.s life.
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PURPOSES:
5. 'o enhance the Code ,lue team6s response to patients +ith emergency medical situations )y pro%iding immediate
access to supplies and medications.
7. An emergency cart or crash cart is a cart that facilitates coordination of emergency e&uipment.
8. A specific crash cart type facilitates staff familiarity +ith e&uipment
9. It is help to ensure a properly stoc*ed emergency cart +ill )e readily a%aila)le
:. It also ensures a properly functioning defi)rillator +ill )e readily a%aila)le.
;. It helps to sa%e the %alua)le time at the time of emergency.
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CONTENTS
'he contents of a crash cart %ary from hospital to hospital, )ut typically contain the tools and drugs needed to treat a person
in or near cardiac arrest. 'hese include )ut are not limited to<
Monitor2defi)rillators and suction de%ices
Ad%anced Cardiac Life Support /ACLS1 drugs such as Epinephrine, Atropine, Amiodarone, Lidocaine, Sodium
)icar)onate, opamine, and =asopressin
>irst line drugs for treatment of common pro)lems such as< Adenosine, e?trose, ia(epam or Mida(olam,
Epinephrine, Nalo?one, Nitroglycerin, and others
rugs for rapid se&uence intu)ation< Succinylcholine or other paralytic agents li*e Pancoronoum , a sedati%e drugs
such as Etomidate or Mida(olam; endotracheal tu)es and other intu)ating e&uipment
=ascular access de%ices ! Intra =enous/I=1 Cannulae, rip sets 3Micro and Macro4, I= fluids 3Normal Saline/NS1,
Lactated @inger/@L1, Aydro?y ethyl starch
Bther drugs and e&uipment as chosen )y the facility.
TYPES OF CRASH CART:-
BASED ON AGE OR DEVELOPMENTAL VARIATIONS
Adult Emergency Crash Cart
Pediatric Emergency Crash Cart
Ne+)orn Intensi%e Care Crash Cart
GENERAL INFORMATION<
5. A Licensed Staff mem)er as designated )y the head of the department is responsi)le for chec*ing the crash cart,
o?ygen cylinder le%els, defi)rillator, and documenting compliance on crash cart chec*list.
7. Each emergency cart is e&uipped +ith a loc* and *ept loc*ed unless in use.
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8. If the loc* is not intact, the cart is to )e chec*ed and unit personnel +ill replace any missing supplies.
9. Crash cart is chec*ed e%ery shift and recorded.
:. efi)rillator load chec*s +ill )e performed e%ery shift +ith the defi)rillator plugged in and unplugged.
;. All carts +ill )e opened and chec*ed for contents once monthly and follo+ing each use. Sterile items +ill )e chec*ed
for pac*age integrity and e?piration date. Items +ith e?piration dates e?piring +ithin the month +ill )e replaced. 'he
medication dra+er +ill not )e opened if it is sealed and intact.
C. Laryngoscopes +ill )e chec*ed prior to placement on the cart and monthly.
D. B?ygen cylinders are replaced +hen the tan* has emptied.
E. ra+ers of crash carts are to )e clearly la)eled to identify contents.
5F.Special procedure trays are *ept on the )ottom shelf.
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EQUIPMENT (!!"#$%&':
F()"# *$+ S$, *$+
ra+ers are organi(ed and arranged from top to )ottom in different order in different institutions )ut
it contain medications, I= solutions and tu)ing, miscellaneous.

'he medicines mainly used in crash cart is Adenosine, Amiodarone, Atropine,e?trose, o)utamine,
opamine, Epinephrine, Etomidate, >luma(enil, Lidocaine, Magnesium, Nalo?one, Norepinephrine, Procainamide, Sodium
)icar)onate, =asopressin, =erapamil etc. are the some medicines +e can commonly see in crash cart
Along +ith this +e can see other e&uipments to esta)lish and maintain air+ay, )reathing and
circulations li*e am)u )ag, nasal cannulae, oral air+ays, intu)ation trays /laryngoscope, straight and cur%ed )lade, 5Fcc
:
syringe, lu)ricant1,tongue )lades, adhesi%e tape, e?am glo%es, suction catheters, endotracheal tu)es, tracheostomy tu)es, I=
cannulae, disposa)le syringes, o?ygen cylinder, defi)rillatorGetc.
Arrangement of medicines and e&uipment in crash cart is different from different institutions )ased
on their policy. ifferent types of arrangements are follo+ing<
51. )ased on the air+ay, )reathing, circulation and
7.1 )ased on the need and necessity of medicines and e&uipment.

51 ,ASE BN AI@#AH, ,@EA'AIN" AN CI@C$LA'IBN<I
ra+er 5I Medications-
Adenosine, Amiodarone, Epinephrin, Magnesium Sulfate,
AtropinGetc
ra+er 7 I ,reathing and Air+ayI
Am)u )ag B7 Nasal cannulae, Bral air+ays, Intu)ation tray,
suction catheters, Endotracheal tu)es, 'racheostomy tu)es, Inner
cannulae,G.etc
ra+er 8 ! Circulation<
I= supplies,8I#ay, ,lood set, A," *its, heparini(ed aspirators,
Needles, Alcohol s+a)s, SyringesG.etc
ra+er 9ICirculation< I= solutions and tu)ingI
@L, NS, :#, I= 'u)ing, Macro J Micro drip, E?tension tu)ing,
,lood pump tu)ing, Arm )oards< long J shortGetc
ra+er :I Cardiac, Chest ProceduresI
EC" electrodes, @estraints, Sterile glo%es, Mas*s +ith face shields or mas*s and eye protection, Scalpels
+ith )lades, ressings, drain sponge, ,etadine solution, Sutures, sil* +ith needle, Cardiac needle, Sterile
to+els,8 I lumen Central =enous Pressure catheter *it, Chest tu)esG.etc
;
7.1 ,ASE BN 'AE NEE AN NECESSI'H B> MEICINES AN EK$IPMEN'S<I
5. Medicines<
It is again classified )ased on the priorityIfirst, Second and 'hird priority medicines.
7. E&uipments ILi*e @yle6s tu)e, Macro set J micro set ,lood set, I.= splint, Micro
pore, "lo%es, -idney tray, EC" electrodes J 0elly, 'ourni&uets J spirit s+a)
8. I= fluidsI Li*e NS EL :FF ml, NS EL 5FF ml, Isolyte P, =ol%en :FF ml
9. Bpen tray on the topIisposa)le syringes, E?tension no.5Fcm, 7FFcm, I= cannulae,
Needles, Intra osseous needle, efi)rillator
:. ,ottom of crash cartIPlastic apron, Intu)ation tray, Intu)ation pillo+, IC set,
Percutaneous tracheostomy set
Commonly on the top of the Crash Cart +e can place efi)rillator, In%entory
Chec*list2 Code ,lue sheets. Bn the side of the Crash Cart +e can find an B?ygen Cylinder
and al so +e can find a Cardiac ,oard.
In pediatric settings +e are using different types of crash cart )y using
,roselo+ CartI A colorIcoded pediatric Code ,lue cart3Color coding is )ased on the
Broselow Pediatric Emergency] 'ape containing age specific supplies and medications
for pediatric patients. 'he ,roselo+ Cart is designed to pro%ide appropriately si(ed
e&uipment for a pediatric patient. Each dra+er is colorIcoded and contains supplies )ased
on the age and +eight of the patient. 'he top dra+er contains medications for all ages.


C
-.-,(%+( /,$%#($c c%(#


BROSELO0 PEDIATRIC EMERGENCY TAPE



No+ a day6s different types of crash *its are also a%aila)le i t contain
different emergency drugs, o?ygen system, Am)u disposa)le resuscitator and
manual suction unit. 'his types of crash *its help us to deli%er ACLS measures
outside the hospital settings also.

Y)1 c%" 2%3 $# %! 4)1( )+"5
ifferent crash carts e?plained a)o%e is commercially a%aila)le and it is costly
also. If you are ready, you can also ma*e an emergency crash cart as your o+n. ,uy a
plastic dou)le ec*er )as*et +ith a lid and fe+ pearl pet 0ars. 'a*e pearl pet 0ars, put
the medicines and la)el it /stic* the la)el on the sides and top of the 0ar lid for
identification1 and *eep it on the top of the dou)le ec*er )as*et. -eep the needed
e&uipment and supplies in the )ottom of the )as*et. Co%er the )as*et +ith lid. No+
your emergency crash cart is ready. Hou can prepare and use this crash cart in any
settings +ith minimal cost.
D
MEDICINES USED IN CRASH CARTS
E
DRUG NAME ADULT DOSE PEDIATRIC
DOSE
INDICATION FREQUENCY
EPINEPA@INE 5mg I= or
7I: mg I= %ia E''
F.F5mg2*g I= or IB
or
F.5mg2*g %ia E''
Any pulseless
arrhythms
E%ery 8I: min
=ASBP@ESSIN 9F units I= Not indicated =>, Pulseless=' Single dose,may )e follo+ed at 5F min )y
epinephrine
AMIBA@BNE >or => or pulseless
='< 8FFmg I= push
>or => or pulseless
='< :mg2*g I=
push
=>, pulseless
=',=' +ith a
pulse,S='
May use 7
nd
dose of 5:Fmg for recurrent
=>2='.In children may )e repeated in
:mg2*g doses to a total of 5:mg2*g
LIBCAINE 5I5.: mg2*g I= push Same =>, pulseless
=',=' +ith a
pulse
7
nd
J su)se&uent doses of F.C:mg2*g e%ery :
min to a total dose of 8 mg2*g
MA"NESI$M 5I7g I= slo+ push 7:I:Fmg2*g I=
slo+ push
'orsde de pointes,
*no+n
hypomagnesemia
Single dose
P@BCAINAMIE 5C mg2*g I= slo+
)olus at ma?imum rate
of :Fmg2min
5: mg2*g I=
load;8I; mg2*g
o%er :min,not to
e?ceed 5FFmg2*g
=' +ith a pulse Continue infusion/9mg2min1 until K@S
+ideningM:FL,dysrhythmia terminated, onset
of hypotension; or 5C mg2*g infused.
A'@BPINE PerfusingPatients<
F.:mg I% push:min, to
ma?imum of 8mg.
Pulseless patients<
5mg I= push & : min,
to ma?imum of 8mg
F.F7mg2*g;minimu
m dose of F.5 mg
,radycardia,
asystole.
May )e repeated once upto ma?imum dose of
8mg
AENBSINE ; mg rapid I= push
through pro?imal
peripheral line; central
line dose is oneIhalf
F.5mg2*g rapid I=
push;ma?imum
dose,;mg
S=' If needed,7
nd
dose of 57 mg/pediatric,do)le
initial dose up to 57 mg1;8
rd
dose of 57I5D mg
ILI'IANEM F.7:mg2*g to a
ma?imum dose of
7Fmg I= push o%er
7min
Same S=' 7
nd
dose of F.8:mg2*g,ma?imum dose of 7:mg,
at 5:min;after con%ersion, start dilitia(em drip
at :I5: mg2A
ESMBLBL :FFMcg2*g )olus o%er
5 min
5FFI:FF Mcg2*g
)olus o%er 5min
S=' May gi%e another )olus if desired effect is not
achie%ed; start drip :FMcg2*g2min
A'ENBLBL :mg I= o%er :min Not indicated S=',MI @epeat in 5F min, then gi%e :Fmg oral load
ME'BP@BLBL : mg I= push Not indicated S=',MI @epeat t+ice at :min inter%als, then gi%e :F mg
oral load
5F
CONCLUSION<
Crash cart is a specially designed trolley, used for transporting and dispensing medicines and e&uipments at the
emergency site for participating in life sa%ing measures. Crash carts are located in areas of patient care in case of a lifeI
threatening occurrence. Physicians, nurses, pharmacists, and respiratory therapists must )ecome familiar +ith the contents
of this cart. It contains necessary e&uipments to handle an emergency situation. A crash cart is ena)ling healthcare pro%iders
to manage medical emergencies easily and confidently.
BIBILIOGRAPHY:I

5. Clinical Practice Policy and Procedure; emergency carts2defi)rillators uni%ersity of ne+ Me?ico health sciences
center
7. Minimum Crash Cart Supplies and rugs /)ased on 7FFC ACLS protocols1; American Aeart Association.
8. Code )lue cart management and replacement; Sarasota memorial hospital policy
9. Crash cart +++.+i*ipedia.com
:. $C a%is Aealth System standard crash cart; +++.ucdmc.ucda%is.edu
;. Stone C.-,Aumphries @.L,Lange/7FFD1.CURRENT DIAGNOSIS AND TREATENT !EERGENC" EDICINE.;
'A
Edition.'he Mc "ra+Ihill companies.
C. Sole,-lein,Moseley/7FFE1. INTRODUCTION TO CRITICA# CARE NURSING.:
'A
edition. Saunders else%ier
pu)lication
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