Kingdom of Saudi Arabia

Ministry of Health
East Jeddah Hospital
CRASH CART CHECKLIST [PERSO]

DEPARTMENT:
Date:
Shift: 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11
1. Front
Cardiac Arrest Board
2. Back
Oxygen Cylinder with Regulator
Top
Defibrillator & ECG Leads & O2&CO2 Probe & Paddles
Electrodes (Adult & Paed ) 1 each
Ambu Bag (Adult & Paed & Infant) 1 each
Stethoscope 1 piece
Medication Expiry Checklist 1 piece
CPR Monthly Crash Cart Checklist 1 piece
CPR Record Form 1 piece
4. First Drawer
Vasopressin IV (20U/ml) 2 amps
Atropine Abboject (1mg/amp) 4 syringes
Noradrenaline ( 4mg /4ml) 1 amp
Amiodarone HCL (150mg/3ml) 6 amps
Calcium Chloride (10%) 2 respules
Lidocaine Abboject (100mg/5ml) 3 syringes
Adenosine (6mg/2ml) 6 amps
Procainamide (1g/10ml) 2 vials
Magnesium Sulphate (10%) 2 respules
Dopamine HCL (40mg/ml) (5ml) 1 amp
Hydrocortisone (100mg) 2 vials
Naloxone (0.4mg/ml) 2 amps
Dobutamine (250mg/5ml) 1 amp
Promethazine (50mg/ml) 3 amps
Flumazenil (0.5mg/5ml) 1 amp
Furosemide (20mg/ml) 2 amps
Verapamil (2.5mg/ml) (2ml) 2 amps
Water for Injection 5 respules
5. Second Drawer
Sodium Bicarbonate 8.4% (50mmol/50ml) 4 vials
Dextrose 50% (50mg) 2 vials
Epinephrine 1:10,000/ 1:1000 (1mg/1ml) 10 syringes

CODE: IPP-MS-047/01 A 1 of 3 Issue Date : 20/03/2016

Date:
Shift: 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11
Third Drawer
Lubricating Jelly 1 piece
Tongue Depressor 7 pieces
Magill’s Forceps (Adult & Paed) 1 each
Stylette (Adult & Paed) 1 each
Artery Forceps (Adult & Paed) 1 each
Bougie 1 set
Oral Airway of Different Sizes 2 each
6. Nasal Airway #6 & #7 1 each
Non-Rebreathe Mask (Adult & Paed) 1 each
Rolled Gauze 2 pieces
Pen Torch 1 piece
Scissors 1 piece
ET Tubes of Different Sizes 2 each
Laryngeal Mask (different sizes) 1 set
Oxygen Facemask (Adult & Paed) 2 each
Nasal Cannula (Adult & Paed & Infant) 1 each
Fourth Drawer
Tourniquet / Adhesive Plaster 1 each
Alcohol Swabs 1 box
IV Cannulas of Different Sizes 3 each
Sterile Gauze 3 packs
Transparent Dressing 10 pieces
Syringes 1,3,5, 10, 20, 50cc 3 each
3 Way Stop cock 3 pieces
7. Asepto syringes 2 pieces
Spinal needles #18, #20 2 each
Scapel blades Different Sizes 2 each
ABG Syringes 2 pieces
Blood Sample Tubes 2 each
Kidney Basin 2 piece
Shaver & Razor 1 set
Intraosseous Cannula #15 & #18 1 each
Butterfly #21, #23, #25 2 each
Bottom Drawer
Dextrose 5% (500ml) 2 bottles
Normal Saline Solution 0.9% 500ml 2 bottles
8. Ringer Lactate (500ml) 2 bottles
Dextrose 10%(500ml) 2 bottles
D5 NS(500ml) 2 pieces
BP Apparatus 1 piece
CODE: IPP-MS-047/01 A 2 of 3 Issue Date : 20/03/2016
 Disposable Gloves Large Size 1 box
Complete Laryngoscope Set (Adult & Paed) 1 set each
Extra Battery & bulbs 1 set each
IV Set & Soluset & Blood Set 2 each
Sterile Green Sheet 2 piece

RN / SIGNATURE

DATE:
SHIFT: 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11 7 3 11
Left Side
Portable Suction Machine 1 set
9. Suction Catheters of Different Sizes 2 each
NGT Tubes of Different Sizes 2 each
Surgical Gloves of Different Sizes 2 each
Right Side
10
Sharp Container 1 piece

CRASH CART LOCK NUMBER :

RN / SIGNATURE :

CODE: IPP-MS-047/01 A 3 of 3 Issue Date : 20/03/2016