CRASH CART

By SAJITH KUMAR. RN,RM, MSc N / Emergency Medicine
 

 

CRASH CART
 
SHAMSAD SALIM B Sc; M Sc Nursing
SAJITH KUMAR. RN,RM, MSc N ; Asst.Professor, International Life Support Instructor
VENUGOPALAN. P. P.  MB;BS; DA, DNB, MNAMS   ;Chief, Emergency Medicine, Deputy Director, MIMS Academy, Director, Masters Program in Emergency Medicine –GWU USA
 
INTRODUCTION
A crash cart is the trolley for storing lifesaving equipment and drugs in a hospital emergency room, intensive care unit, clinics and other areas. The cart is characterized by being easily movable and readily accessible into all sides of the cart for quickly viewing and removing equipment and drugs during a crisis situation.
The first cardiac crash cart was created at Bethany Medical Center in Kansas City, Kansas. The first crash cart was fabricated by one of the doctor's fathers. It contained an Ambu bag, defibrillator paddles, a bed board and endotracheal tubes.
A crash cart or code cart (crash trolley in UK medical jargon) is a set of trays/drawers/shelves on wheels used in hospital emergency rooms for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency for life support protocols like Advanced Cardiac Life Support/Advance Life Support (ACLS/ALS), Pediatric Advanced life Support [PALS] to potentially save someone's life.
 
PURPOSES:
 
1.To enhance the Code Blue team’s response to patients with emergency medical situations by providing immediate access to supplies and medications.
2.An emergency cart or crash cart is a cart that facilitates coordination of emergency equipment.
3.A specific crash cart type facilitates staff familiarity with equipment
4.It is help to ensure a properly stocked emergency cart will be readily available
5.It also ensures a properly functioning defibrillator will be readily available.
6.It helps to save the valuable time at the time of emergency.
 
CONTENTS                                      
The contents of a crash cart vary from hospital to hospital, but typically contain the tools and drugs needed to treat a person in or near cardiac arrest. These include but are not limited to:
•Monitor/defibrillators and suction devices
•Advanced Cardiac Life Support (ACLS) drugs such as Epinephrine, Atropine, Amiodarone, Lidocaine, Sodium bicarbonate, Dopamine, and Vasopressin
•First line drugs for treatment of common problems such as: Adenosine, Dextrose, Diazepam or Midazolam, Epinephrine, Naloxone, Nitroglycerin, and others
•Drugs for rapid sequence intubation: Succinylcholine or other paralytic agents like Pancoronoum , a sedative  drugs such as Etomidate or Midazolam; endotracheal tubes and other intubating equipment
•Vascular access devices – Intra Venous(IV) Cannulae, Drip sets [Micro and Macro], IV fluids [Normal Saline(NS), Lactated Ringer(RL), Hydroxy ethyl starch 
•Other drugs and equipment as chosen by the facility.    
 
TYPES OF CRASH CART:-
 
BASED ON AGE OR DEVELOPMENTAL VARIATIONS
•Adult Emergency Crash Cart 
•Pediatric Emergency Crash Cart
•Newborn Intensive Care Crash Cart 
 
GENERAL INFORMATION:
1.A Licensed Staff member as designated by the head of the department is responsible for checking the crash cart,  oxygen cylinder levels, defibrillator, and  documenting compliance on crash   cart checklist.
2.Each emergency cart is equipped with a lock and kept locked unless in use.
3.If the lock is not intact, the cart is to be checked and unit personnel will replace any missing supplies.
4.Crash cart is checked every shift and recorded.
5.Defibrillator load checks will be performed every shift with the defibrillator plugged in and unplugged.
6.All carts will be opened and checked for contents once monthly and following each use. Sterile items will be checked for package integrity and expiration date. Items with expiration dates expiring within the month will be replaced. The medication drawer will not be opened if it is sealed and intact.
7.Laryngoscopes will be checked prior to placement on the cart and monthly.
8.Oxygen cylinders are replaced when the tank has emptied. 
9.Drawers of crash carts are to be clearly labeled to identify contents.
10.Special procedure trays are kept on the bottom shelf.
 
EQUIPMENT (essential):
 
Drawers are organized and arranged from top to bottom in different order in different institutions but it contain medications, IV solutions and tubing, miscellaneous.
The medicines mainly used in crash cart is Adenosine, Amiodarone, Atropine,Dextrose, Dobutamine, Dopamine, Epinephrine, Etomidate, Flumazenil, Lidocaine, Magnesium, Naloxone, Norepinephrine, Procainamide, Sodium bicarbonate, Vasopressin, Verapamil etc. are the some medicines we can commonly see in crash cart
Along with this we can see other equipments to establish and maintain airway, breathing and circulations like ambu bag, nasal cannulae, oral airways, intubation trays (laryngoscope, straight and curved blade, 10cc syringe, lubricant),tongue blades, adhesive tape, exam gloves, suction catheters, endotracheal tubes, tracheostomy tubes, IV cannulae, disposable syringes, oxygen cylinder, defibrillator…etc.
Arrangement of medicines and equipment in crash cart is different from different institutions based on their policy. Different types of arrangements are following:
1). based on the airway, breathing, circulation and
2.) based on the need and necessity of medicines and equipment. 
          
1) BASED ON AIRWAY, BREATHING AND CIRCULATION:-
 
•Drawer 1- Medications- Adenosine, Amiodarone, Epinephrin, Magnesium Sulfate, Atropin…etc
•Drawer 2 - Breathing and Airway- Ambu bag O2 Nasal cannulae, Oral airways, Intubation tray, suction catheters, Endotracheal tubes, Tracheostomy tubes, Inner cannulae,….etc
•Drawer 3 – Circulation: IV supplies,3-Way, Blood set, ABG kits, heparinized aspirators, Needles, Alcohol swabs, Syringes….etc
•Drawer 4-Circulation: IV solutions and tubing-  RL, NS, D5W, IV Tubing, Macro & Micro drip, Extension tubing, Blood pump tubing, Arm boards: long & short…etc
•Drawer 5- Cardiac, Chest Procedures-ECG electrodes, Restraints, Sterile gloves, Masks with face shields or masks and eye protection, Scalpels with blades, Dressings, drain sponge, Betadine solution, Sutures, silk with needle, Cardiac needle, Sterile towels,3 - lumen Central Venous Pressure catheter kit, Chest tubes….etc
 
2.) BASED ON THE NEED AND NECESSITY OF MEDICINES AND EQUIPMENTS:-
 
1. Medicines:It is again classified based on the priority-first, Second and Third priority medicines.
2. Equipments -Like Ryle’s tube, Macro set & micro set Blood set, I.V splint, Micro pore, Gloves, Kidney tray, ECG  electrodes & jelly,  Tourniquets & spirit swab
3. IV fluids- Like NS 9% 500 ml, NS 9% 100 ml, Isolyte P, Volven 500 ml
4. Open tray on the top-Disposable syringes, Extension no.10cm, 200cm, IV cannulae, Needles, Intra osseous needle,   Defibrillator
5. Bottom of crash cart-Plastic apron, Intubation tray, Intubation pillow, ICD set,   Percutaneous tracheostomy set
 Commonly on the top of the Crash Cart we can place Defibrillator, Inventory Checklist/ Code Blue sheets. On the side of the Crash Cart we can find an Oxygen Cylinder and al so we can find a Cardiac Board.
In pediatric settings we are using different types of crash cart by using Broselow Cart- A color-coded pediatric Code Blue cart[Color coding is based on the Broselow Pediatric Emergency] Tape  containing age specific supplies and medications for pediatric patients. The Broselow Cart is designed to provide appropriately sized equipment for a pediatric patient. Each drawer is color-coded and contains supplies based on the age and weight of the patient. The top drawer contains medications for all ages.
Now a day’s different types of crash kits are also available it contain different emergency drugs, oxygen system, Ambu disposable resuscitator and manual suction unit. This types of crash kits help us to deliver ACLS measures outside the hospital settings also.
You can make it as your own!
         Different crash carts explained above is commercially available and it is costly also. If you are ready, you can also make an emergency crash cart as your own. Buy a plastic double Decker basket with a lid and few pearl pet jars. Take pearl pet jars, put the medicines and label it (stick the label on the sides and top of the jar lid for identification) and keep it on the top of the double Decker basket. Keep the needed equipment and supplies in the bottom of the basket. Cover the basket with lid. Now your emergency crash cart is ready. You can prepare and use this crash cart in any settings with minimal cost.
CONCLUSION:
  Crash cart is a specially designed trolley, used for transporting and dispensing medicines and equipments at the emergency site for participating in life saving measures. Crash carts are located in areas of patient care in case of a life-threatening occurrence. Physicians, nurses, pharmacists, and respiratory therapists must become familiar with the contents of this cart. It contains necessary equipments to handle an emergency situation. A crash cart is enabling healthcare providers to manage medical emergencies easily and confidently. 
 
References                 
                                         
1.Clinical Practice Policy and Procedure; emergency carts/defibrillators university of new Mexico health sciences center
2.Minimum Crash Cart Supplies and Drugs (based on 2007 ACLS protocols); American Heart Association.
3.Code blue cart management and replacement; Sarasota memorial hospital policy
4.Crash cart www.wikipedia.com
5.UC Davis Health System standard crash cart; www.ucdmc.ucdavis.edu
6.Stone C.K,Humphries R.L,Lange(2008).CURRENT DIAGNOSIS AND TREATMENT ,EMERGENCY MEDICINE.6TH Edition.The Mc Graw-hill companies.
7.Sole,Klein,Moseley(2009). INTRODUCTION TO CRITICAL CARE NURSING.5TH edition. Saunders elsevier publication
 
Author’s affiliation
 
Department of Emergency Medicine
[International Academic Training Center –GWU USA
Regional Training center –American heart association]
MALABAR INSTITUTES OF MEDICAL SCIENCES,
Govindhapuram, Kozhikode
India
www.mimsindia.com,www.mimsacademy.org