CRASH CART CHECK LIST

S NO ITEMS QTY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

TOP SHELF MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN
1 GLOVES NO 6-8(each) 5
2 DISPOSIBLE GLOVES 1PKT

MIDDLE TRAY
3 E C G LEADS 10
4 3 WAY EXTENSION 3
5 TEGADERM 2
6 XYLOCAINE JELLY 1
7 BANDAGE 10CM 1
8 DISTILLED WATER 10ML 5
9 HME FILTER 1
10 ET TUBE FIXATOR 1

MIDDLE TOP TRAY

11 AMBU BAG 1
LARYNGOSCOPE WITH BLADES
12 AND BATTERY (A&P) 1
13 AIRWAY NO (1-4) 1
14 TORCH 1
15 VACCUM SUCTION SET 1
16 MAGELLES FORCEPS 1
17 TONGUE DEPRESSOR 1
18 STILLETTE (S,M,L) 1
19 ET TUBE NO.(6-8.5) 1
20 XYLOCAINE JELLY 1
21 SYRINGE 10ML 1
 LEFT SIDE
22 SUCTION CATH NO 8-16 5each
23 BUGGIE 1

RIGHT SIDE
24 OXYGEN CYLINDE WITH MASK 1

DRAWER-1
25 INJ.ATROPINE 10
26 INJ.DOPAMINE 2
27 INJ.HYDROCORTISONE 3
28 INJ.ISOPRENALINE 5
29 INJ.DERIPHYLINE 2
30 INJ.DYTOR 2
31 INJ.KCL 2
32 INJ.ADINOSINE 2
33 INJ.CARDARONE 6
34 INJ.MIDAZ 2
35 INJ.XYLOCARD 2 % 1

DRAWER -2
36 INJ.ADRENALINE 20
37 INJ.DOBUTAMINE 2
38 INJ.PAN 40MG 2
39 INJ.METOLAR 2
40 INJ.LASIX 10
41 INJ.NORAD 5
42 INJ.CA.GLUCONATE 5
43 INJ.AVIL 2
44 INJ.NITROGLYCERINE 2
45 INJ.AMINOPHYLLINE 2
46 INJ.SODA BICARB 5

DRAWER=3
47 B.T SET 2
48 I V SET 5
49 PEDIA SET 1
50 I V CANNULA NO-16 G 2
51 I V CANNULA NO-18G 2
52 I V CANULA NO-20 G 2
53 I V CANULA NO-22 G 2
54 I V CANULA NO-22G 2
55 I V CANULA NO-24G 2
56 I V CANULA NO -26 G 2
57 ET TUBE NO (2.5-5.5) 2
58 RYLES TUBE NO (12-18) 2 each
59 NASAL PRONGS ADULT 1
60 NEB. MASK ADULT 1

DRAWER - 4
61 D/S SYRINGE 50ML 5
62 D/S SYRINGE 20ML 2
63 D/S SYRINGE 10ML 5
64 D/S SYRINGE 5ML 5
65 D/S SYRINGE 2ML 5
66 P M O LINE (M-F) 200CM 2
67 10CM EXTENSION 2
68 D/S NEEDLE NO-16 2
69 D/S NEEDLE NO-18 2
70 D/S NEEDLE NO-20 2
71 D/S NEEDLE NO-22 2
72 D/S NEEDLE NO-24 2

DRAWER-5
73 FOLEYS NO (12-18) 1
74 UROBAG 1

BOTTOM SHELF
75 NS 500ML 2
76 DNS 500ML 2
77 RL 500ML 2
78 5%DEXTROSE 2
79 VOLUVEN 1
80 HEMACCEL 1
81 25% DEXTROSE 2
82 50% DEXTROSE 2
83 BAIN CIRCUIT (A&P) 1

FRIDGE
84 INJ.VASOPRESSIN 2
85 INJ.SUCCNYL COLINE 1

SIGNATURE :-
19 20 21 22 23 24 25 26 27 28 29 30 31
MN MN MN MN MN MN MN MN MN MN MN MN MN
CRASH CART CHECK LIST
S NO ITEMS QTY 19 20 21 22 23 24 25 26 27 28 29 30 31
TOP SHELF MN MN MN MN MN MN MN MN MN MN MN MN MN
1 GLOVES NO 6-8(each) 5
2 DISPOSIBLE GLOVES 1PKT

MIDDLE TRAY
3 E C G LEADS 10
4 3 WAY EXTENSION 3
5 TEGADERM 2
6 XYLOCAINE JELLY 1
7 BANDAGE 10CM 1
8 DISTILLED WATER 10ML 5
9 HME FILTER 1
10 ET TUBE FIXATOR 1

MIDDLE TOP TRAY

11 AMBU BAG 1
LARYNGOSCOPE WITH BLADES
12 AND BATTERY (A&P) 1
13 AIRWAY NO (1-4) 1
14 TORCH 1
15 VACCUM SUCTION SET 1
16 MAGELLES FORCEPS 1
17 TONGUE DEPRESSOR 1
18 STILLETTE (S,M,L) 1
19 ET TUBE NO.(6-8.5) 1
20 XYLOCAINE JELLY 1
21 SYRINGE 10ML 1
 LEFT SIDE
22 SUCTION CATH NO 8-16 5each
23 BUGGIE 1

RIGHT SIDE
24 OXYGEN CYLINDE WITH MASK 1

DRAWER-1
25 INJ.ATROPINE 10
26 INJ.DOPAMINE 2
27 INJ.HYDROCORTISONE 3
28 INJ.ISOPRENALINE 5
29 INJ.DERIPHYLINE 2
30 INJ.DYTOR 2
31 INJ.KCL 2
32 INJ.ADINOSINE 2
33 INJ.CARDARONE 6
34 INJ.MIDAZ 2
35 INJ.XYLOCARD 2 % 1

DRAWER -2
36 INJ.ADRENALINE 20
37 INJ.DOBUTAMINE 2
38 INJ.PAN 40MG 2
39 INJ.METOLAR 2
40 INJ.LASIX 10
41 INJ.NORAD 5
42 INJ.CA.GLUCONATE 5
43 INJ.AVIL 2
44 INJ.NITROGLYCERINE 2
45 INJ.AMINOPHYLLINE 2
46 INJ.SODA BICARB 5

DRAWER=3
47 B.T SET 2
48 I V SET 5
49 PEDIA SET 1
50 I V CANNULA NO-16 G 2
51 I V CANNULA NO-18G 2
52 I V CANULA NO-20 G 2
53 I V CANULA NO-22 G 2
54 I V CANULA NO-22G 2
55 I V CANULA NO-24G 2
56 I V CANULA NO -26 G 2
57 ET TUBE NO (2.5-5.5) 2
58 RYLES TUBE NO (12-18) 2 each
59 NASAL PRONGS ADULT 1
60 NEB. MASK ADULT 1

DRAWER - 4
61 D/S SYRINGE 50ML 5
62 D/S SYRINGE 20ML 2
63 D/S SYRINGE 10ML 5
64 D/S SYRINGE 5ML 5
65 D/S SYRINGE 2ML 5
66 P M O LINE (M-F) 200CM 2
67 10CM EXTENSION 2
68 D/S NEEDLE NO-16 2
69 D/S NEEDLE NO-18 2
70 D/S NEEDLE NO-20 2
71 D/S NEEDLE NO-22 2
72 D/S NEEDLE NO-24 2

DRAWER-5
73 FOLEYS NO (12-18) 1
74 UROBAG 1

BOTTOM SHELF
75 NS 500ML 2
76 DNS 500ML 2
77 RL 500ML 2
78 5%DEXTROSE 2
79 VOLUVEN 1
80 HEMACCEL 1
81 25% DEXTROSE 2
82 50% DEXTROSE 2
83 BAIN CIRCUIT (A&P) 1

FRIDGE
84 INJ.VASOPRESSIN 2
85 INJ.SUCCNYL COLINE 1

SIGNATURE :-
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
TOP SHELF
1 AMBU BAG 1

OXYGEN HIGH
2 FLOW MASK 1
3 OXYGEN TUBING 1
4 FACE MASK 1
5 VEIN CIRCUIT 1
SMALL OPEN CONTAINERS
7 INJ.ATROPINE 10
8 INJ.EFFCORLIN 5
9 INJ.AVIL 5
10 INJ.ADRENALINE 10
INJ 25%
11 DEXTROSE 2
INJ SODA
12 BICARBONATE 10
13 INJ EPSOLIN 10
14 FRONT SHELF
15 DEFIBRILATOR 1
16 E C G MACHIENE 1
17 E C G CABLE 1
18 E C G JELLY 1
DRAWERS
A- Intubation aids

19 Laryngoscope+Blades 1
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
20 Laryngoscope bulbs
21 Torch 1
22 Lox jelly 1
23 Dynaplast 1
24 Magles forceps 1
25 Stillet 2
26 10cc Syringe 2
B- E T Tube/Airway
E T Tube cuffed (all
27 sizes) 2E
28 Airway no 2,3,4 1E
C-Oxygen Therapy
30 Venti mask 1
31 Face Mask 1
32 T- Piece 1
33 Nebulization kit 1
MEDICINES
INJ. Calcium
Gluconate / INJ.
34 Perinorm 5/5
35 INJ. Norad 5
INJ. Dopamine / Inj
36 Lasix 5/5
INJ. Nitro Glycrine /
37 INJ.Dytor 5/5
INJ.Dobutamine /
38 INJ.Vit K 5/5
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
39 INJ.Midazolam 2
40 INJ.Gardinal 5
INJ.Trenexa /
41 INJ.Propofol 5/2
42 INJ. Scolin /
INJ.Emeset 1/5
INJ.Tramadol /
43 INJ.Deriphyllin 5/5
INJ.Diclofenac/
44 INJ.Digoxin 5/2
INJ.Aminophyllin /
45 INJ.Cardarone 5
46 INJ.Xylocard 1
NEB.Duolin /
47 INJ.Diazepam 5/2
NEB.Budecort /
48 INJ.Lorazepam 5/2
INJ.Lobet / INJ.
49 Levera 5/2
INJ .Solumetrol /
50 NEB.mucomet 1/5
INJ.Magnisium
51 Sulphate 5
INJ.Sodium
Valporate /
52 NEB.Asthalin 2/5
INJ.Dilzem /
53 INJ.Adinosine 2/2
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
E- Syringes//IV cannula/Needles
70 10cc Syringe 5
71 5cc Syringe 5
72 I V Set 5
73 P M O Line 5
74 B T Set 5
75 Ryles tube(all sizes) 5
76 I V cannula(all sizes) 2
77 3-Way 5
78 I V Fixer 5
F- Suction
Catheter
Suction catheters (all
79 sizes) 5E
Foleys catheter (all
80 sizes) 2E
81 Uro Bag 2
82 Uro Meter 2
83 Xylocaine Jelly 1
Bottom Shelf
84 Surgical gloves no.6 2

85 Surgical gloves no.6.5 2

86 Surgical gloves no.7 2

87 Surgical gloves no.7.5 2

 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
88 Surgical gloves no.8 2
89 Vaccum Suction 1
90 D/S Cap 1P
91 D/S Mask 1P
92 D/S Gloves 1P
93 IVF NS 500ml 2
94 IVF NS 1000ml 2
95 IVF RL 2
96 IVF 5% DEXTROSE 2
IVF 10%
97 DEXTROSE 2
98 INJ Haemaccel
Signature of Staff
emp code
Signature of
Incharge
emp code
Signature of HOD
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

EXP.
Sr. ITEMS QTY DATE
M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N M
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

N
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

N
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

N
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

N
 Sanjivani Hospital
SHS/CL06/CC Crash Cart Checklist Sirsa, Haryana

N
 CRASH CART CHECK
ITEMS EXP.D
QTY ATE 1 2 3 4 5 6 7
TOP SHELF
1 AMBU BAG 1

2 OXYGEN RESERVOIR 1

OXYGEN TUBING 1

FACE MASK 1

3 BAINE CIRCUIT 2

Small open container

4 INJ ATROPINE 10

5 INJ ADRENALINE 10

6 INJ AVIL 5

7 INJ EFFCORLIN 5

8 INJ 25% DEXTROSE 2

9 INJ SODA BICARB 10

10 INJ EPSOLIN 10

FRONT SLAB
DEFIBRILLATOR 1

11 E C G MACHIENE 1

12 E C G CABLE 1

13 E C G JELLY 1

14 DRAWERS

A-Intubation Aids
LARYNGOSCOPE+BLADES 1

LARYNGOSCOPE BULBS 2

TORCH 1

LOX JELLY 1

DYNAPLAST
MAGLES FORCEPS 1

STILLETS 2
10 CC SYRINGE 2

B-ET Tube and Airways

ET TUBE CUFFED 2

AIRWAY NO.2,3,4 2E

NASOPHARYNGEAL AIRWAY NO.6,6.5,7 2E

LMA NO.3,4 1E

C-O2 THERAPY
POLY MASK 2

VENTI MASK 2

FACE MASK 2

T-PIECE+NEB KIT 1

D-MEDICINE
INJ CALCIUM GLUCONATE 5 5
INJ MgSO4 5

INJ KCL 5

INJ NORAD 5

INJ DOPAMINE 5

INJ LASIX 5

INJ DOBUTAMINE 5

INJ DYTOR 5

INJ NTG 5

INJ LOBET 5

INJ VIT-K 5

INJ MIDAZOLAM 2

INJ CARDINAL 5

INJPROPOFOL 2

INJ SUCCOL 2

INJ REGLAN 5

INJ DERIPHYLLINE 5

INJ EMESET 5

INJ TRAMADOL 5
INJ DICLOFENAC 5

INJ DILZEM 5

INJ AMINOPHYLLINE 5

INJ ADENOSINE 2

INJ CARDARONE 5

INJ XYLOCARD 2% 1

INJ DIAZEPAM 2

INJ DIGOXIN 2

INJ LORZEPAM 2

NEB.DUOLIN 5

NEB.BUDECORT 5

NEB FORACORT 5

NEB MUCOMET 5

NEB ASTHALIN 1

NEB SALBUTAMOL 1

INJ TRENEXA 5

INJ ENCORATE 2

INJ VALPORATE 2

E-Syringe/IV Cannula/Needle
10cc SYRINGE 5

5ccSYRINGE 5

I V SET 5 5
PO LINE 5 PMO LINE
B T SET 5

RYLES TUBE(ALL SIZES) 5

I V CANNULA(ALL SIZE) 2

3 WAY 5

I V FIXER 5

F-SUCTION CATH
SUCTION CATHETER (all sizes) 5 E

FOLEYS CATHETER (all size) 2E

URO BAG 2

URO METER 2

ECG ELECTRODES 5

BOTTOM SHELF
SURGICAL GLOVES NO.6 1PKT

SURGICAL GLOVES NO 6.5 1PKT

SURGICAL GLOVES NO.7 1PKT

SURGICAL GLOVES NO 7.5 1PKT

VACCUM SUCTION 1

D/S CAP 1PKT

D/S MASK 1PKT1PKT

EXAMINATION GLOVES 1PKT

NS 5OO ML 2

NS 1000 ML 2

RL 500 ML 2

INJ HAEMACCEL 2

INJ 5% DEXTROSE 2

INJ 25% DEXTROSE 2

INJ 10% DEXTROSE 2

SIGNATURE :-
RT CHECK LIST
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NARCOTICS
INJ MIDAZOLAM
INJ PROPOFOL
INJ PHENERGAN
INJ LORAZEPAM
INJ MORPHINE
IINJ BUTROPHENOL
INJ TRAMADOL
INJ PHENOBARBITONE
INJ HALOPERIDOLE
INJ FORTWIN
INJ DYNAPAR

LASA­SOUND ALIKE
INJJ ATROPINE/INJ ADRENALINE
INJ DOPAMINE/INJ DOBUTAMINE
INJ METROGYL/INJ MANNITOL
INJ KCL/ INJ CALCIUM

LASA­LOOK ALIKE
INJ NEOPRATE/INJ EPICETAM
INJ DEXONA/INJ EPSOLIN
INJ 25% DEXTROSE/INJ 3% NS
 CRASH CART CHECK LIST
ITEMS EXP.D
QTY ATE

M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N

TOP SHELF
1 AMBU BAG 1
2 OXYGEN RESERVOIR 1
3 OXYGEN TUBING 1
4 FACE MASK 1
5 BAIN CIRCUIT 1
6 SMALL OPEN CONTAINERS
7 INJ.ATROPINE 10
8 INJ.ADRENALINE 10
9 INJ.AVIL 5
10 INJ.EFFCORLIN 5
11 INJ 25% DEXTROSE 2
12 INJ SODA BICARBONATE 10
13 INJ EPSOLIN 10
14 FRONT SHELF
15 DEFIBRILATOR 1
16 E C G MACHIENE 1
17 E C G CABLE 1
18 E C G JELLY 1
DRAWERS :-SIDE
Intubation aids
19 Laryngoscope+Blades
20 Laryngoscope bulbs
21 Torch 1
22 Lox jelly 1

CRASH CART CHECK LIST
EXP.D
ATE

M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N
23 Dynaplast 1
24 Magles forceps 1
25 Stillet 2
26 10cc Syringe 2
E T Tube/Airway
27 E T Tube cuffed (all sizes) 2E
28 Airway no 2,3,4 1E
29 L M A no. 3,4 1E
Oxygen Therapy
30 Venti mask 1
31 Face Mask 1
32 T- Piece 1
33 Nebulization kit 1
A-MEDICINES :-
34 INJ. Calcium Gluconate 5
35 INJ.Magnisium Sulphate 5
36 INJ.Pottassium 5
37 INJ. Norad 5
38 INJ. Dopamine 5
39 INJ.Lasix 5
40 INJ.Dobutamine 5
41 INJ.Dytor 5
42 INJ.NTG 5
43 INJ.Lobet 5

CRASH CART CHECK LIST
EXP.D
ATE

M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N

44 INJ.Vit K 5
45 INJ.Midazolam 2
46 INJ.Cardinal 5
47 INJ.Propofol 2
48 INJ.Scolin 2
49 INJ.Reglan 5
50 INJ.Deriphyllin 5
51 INJ.Emeset 5
52 INJ.Tramadol 5
53 INJ.Diclofenac 5
54 INJ.Dilzem 5
55 INJ.Aminophyllin 5
56 INJ.Adinosine 2
57 INJ.Cardarone 4
58 INJ.Xylocard 1
59 INJ.Diazepam 2
60 INJ.Digoxin 2
61 INJ.Lorazepam 2
62 NEB.Duolin 5
63 NEB.Budecort 5
64 NEB.mucomet 5
65 NEB.Asthalin 1
66 NEB.Solumetrol 1
67 INJ.Trenexa 5
68 INJ.Encorate 2

CRASH CART CHECK LIST
EXP.D
ATE

M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N
69 INJ.Sodium Valporate 2
B
70 INJ.Xylocaine 2
71 INJ.Xylocard 1
72 INJ.25% Dextrose 2
73 PMO LINE 5
74 3-Air way N0:2,3,4 2E
75 I V Cannula (all sizes) 2E
76 I V Fixer 5
C-
77 B T Set
78 I V set
79 Suction catheters (all sizes) 5E
80 Foleys catheter (all sizes) 2E
81 Uro Bag 2
82 Uro Meter 2
83 Xylocaine Jelly 1
84 Surgical gloves no.6 2
85 Surgical gloves no.6.5 2
86 Surgical gloves no.7 2
87 Surgical gloves no.7.5 2
88 Surgical gloves no.8 2
89 Vaccum Suction 1

CRASH CART CHECK LIST
EXP.D
ATE

D M N M N M N M N M N M N M N M N M N M N M N M N M N M N M N
90 D/S Cap 1P
91 D/S Mask 1P
92 D/S Gloves 1P
93 IVF NS 500ml 2
94 IVF NS 1000ml 2
95 IVF RL 2
96 IVF 5% DEXTROSE 2
97 IVF 10% DEXTROSE 2
98 INJ Haemaccel

Signature of Staff
emp code
Signature of Incharge
emp code
Signature of HOD