crash cart

Crash Cart

Objectives
 To understand what is crash cart
 To learn how to arrange crash cart contents
 T determine the role of nurse during checking on the crash cart.
INTRODUCTION

A crash cart OrCode cart is a set of trays/drawers/shelves

On
Wheels used in hospitals for dispensing
of emergency medication/equipment at site of
medical/surgical /emergency for life support protocols
(ACLS/ALS) to potentially save someone's life.
 A crash cart is the trolley for storing lifesaving
crash cart:
drugs and equipment 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.
 To enhance the Code Blue team’s
response to patients with emergency An emergency cart or crash cart is a
medical situations by providing cart that facilitates coordination of
immediate acces to supplies and emergency equipment.

Purposes medications.

It is help to ensure a properly

A specific crash cart type facilitates
stocked emergency cart will be
staff familiarity with equipment.
readily available.

It also ensures a properly

It helps to save the valuable time at
functioning defibrillator will be
the time of emergency.
readily available.
Contents

The contents 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,
 Suction devices,
 And bag valve masks (bvms) of different sizes
 Endotracheal tubes and other intubating equipment
Contents

Advanced cardiac life support (ACLS) drugs such as

 Epinephrine
 Nor-epineprine
 Atropine
 Amiodarone
 Lidocaine
 Dopamine
Contents

 Drugs for rapid sequence intubation:

 A sedative such as midazolam;
 Endotracheal tubes
 And other intubating equipment
 Pediatric equipment (common pediatric drugs, intubation equipment, etc.)
 Other drugs and equipment as chosen by the facility
 TYPICAL CONTENTS OF A CRASH CART
MAIN ITEMS SPECIFIC SUPPLIES
Back
Cardiac board

Side Suction device with canister and tubing, face mask, and oxygen tank
Portable suction machine, bag-valve device, Container for disposing of needles, syringes, and other sharp items
and oxygen tubing
Top ECG leads, electrodes, conductive gel or adhesive electrode
Monitor-defibrillator with recorder, clipboard
with code record and drug calculation reference
pads; possible transcutaneous pacemaker or combination unit
sheets

Airway equipment drawer or box Oral and nasal airways, ETTs, stylet, laryngoscope handle and curved
and straight blades, lubricating jelly, 10-mL syringes, and tape,
exhaled CO2 detector

IV equipment drawer IV catheters of various sizes, tape, syringes, needles and needleless adaptors, IV
fluids (NS, Ringer’s lactate solution, and D5W); and IV tubing
Medication drawer or box All IV push emergency medications in prefilled syringes if available, sterile
water and NS for injection, and IV infusion emergency medications
Miscellaneous supply drawer Sterile and nonsterile gloves, suction catheters, nasogastric tubes, chest tubes,
blood pressure cuff, blood collection tubes, sutures, pacemaker magnet, extra
ECG recording paper, gauze pads, face masks
Procedure kits Arterial blood gas, tracheotomy, intraosseous insertion kit, central line
insertion kit, chest tube tray
 Maintenance of Crash Cart

 The worst thing ever is to reach for a piece of emergency equipment or an emergency medication and
find it inoperable or expired.
 It is important that the crash cart be checked regularly and maintained so that its contents are there
when needed.
 Follow is a maintenance routine that should be completed at least monthly
 Expiration dates on medications should be checked on the first day of the month
 Expired medications should be promptly removed and replaced
 The defibrillation pads on the AED or the defibrillator should be checked for expiration date
 The battery charge on the monitor and/or AED should be checked and documented
Instructions for Crash Cart Use
 Carts are of three types.
 Adult crash carts,
 Pediatric crash carts,
 And newborn intensive care crash carts.

The guidelines for crash cart use

➠ the crash carts have to be conveniently placed near the emergency rooms, treatment rooms for anaphylaxis, etc.

➠ There has to be an inventory of medications, equipment, and IV fluids listed by the contents of each drawer in the carts.

➠ The inventory of the crash cart items, such as the drugs and the IV fluids, should contain the name, strength, and amount of
the drug along with its expiration date.

➠ The inventory of the crash cart contents has to be checked on a monthly basis to check for the IV fluids and drugs and their
expiration date.
Cont….
➠ The drugs need to be replaced before the expiration date.
➠ In case of a battery-assisted equipment, batteries need to be checked.
➠ Defibrillator load checks must be performed once daily, with the defibrillator plugged in, as well as unplugged.
➠ If changes are made to the cart's contents, the drug and equipment inventory list needs to be updated.
➠ The crash cart must be locked or should have an integrity seal.
➠ If the seal of the cart is broken, the reason for the same needs to be documented, with the necessary details such
as the date, time, individual's initials, and the new lock or seal number.
➠ The oxygen tanks must be secured to the side of the cart.
➠ If the oxygen tank is empty, oxygen cylinders need to be replaced.
➠ Drawers of the crash cart need to be clearly labelled.
INJ. EPINEPHRINE

INJ. AMIODARONE
Drawer - A
INJ. LIDOCAINE

INJ. MAGNESIUM
SULPHATE

INJ. ATROPINE

INJ. ADENOSINE

INJ. DOPAMINE

INJ. NOR-EPINEPHRINE

INJ.CALCIUM
GLUCONATE

INJ. HEPARIN

INJ. XYLOCARD
Drawer – B

 MISCELLANEOUS ITEMS
 Roller bandage : To secure any dressing
 PM line : To connect IV cannula with infusion pump
 IV Cannula

SIZE FLOW RATE

14 gz 270 ml/min

16 gz 180 ml/min

18 gz 80 ml/min

20 gz 54 ml/min
Cont…..

3 way tops : To administer medication

Syringe 50 ml, 20 ml : To prepare infusion and administer

medication

Syringe 10ml,5ml, 2ml,1ml : To prepare infusion and

administer medication

Torch, Spare battery : To visualize any area properly

Tongue depressor steel : To depress the tongue to allow

for examination of the mouth and throat.
 Drawer – c

 Miscellaneous items

1.Micro Set :
 A micro-drip set that delivers 60 drops/ml.
 Micro-drip IV tubing is used mostly in pediatric or neonatal care,
 when small amounts of fluids are to be administered over a long period of time.
 2.Macro set : A macro-drip solution administration set that
delivers 15 drops , /ml. Macro-drip sets are used for routine
primary infusions.
 It consists of the following parts:
 Backcheck valve: prevents fluid or medication from
travelling up the iv
 Access ports: used to infuse secondary medications
and give IV push medications
 Roller clamp: used to regulate the speed of, or to
stop or start, a gravity infusion
3. O2 mask
 It can deliver a fio2 of 40-60% at 5-10 liters.
 This device is best used for short-term emergencies,
 operative procedures,
 or for those patients where a nasal cannula is not appropriate.
 Ctd…

4. Ryles tube (size 14fr, 16 fr) SIZE COLOR STANDARD

 A nasogastric tube is a narrow bore tube LENGTH
passed into the stomach via the nose.
 It is used for short- or medium-term
nutritional support, and also for 14 fr Green 120 cm
aspiration of stomach contents – Eg., for
decompression of intestinal obstruction.
16 fr Orange 120 cm
 Drawer – D
 Iv fluids
Normal saline(0.9%) :
 Normal saline is useful to increase intravascular volume,
 and are utilized to treat vomiting, diarrhea,
 shock,, and for resuscitation purposes.
 cont…..

 RL- 500 ml: it is also an isotonic solution. It is used for replacing fluids
and electrolytes in those who have low blood volume or low blood pressure. It is also
used to treat metabolic acidosis in cases other than those caused by lactic acidosis
 25% dextrose : it is a sterile, nonpyrogenic, hypertonic solution of dextrose in water
for injection administered by intravenous injection to restore blood glucose levels in
hypoglycemia and as a source of carbohydrate calories.
 Distilled water : it is a sterile, nonpyrogenic preparation of water for injection which
contains no bacteriostat, antimicrobial agent or added buffer and is supplied only in
single dose containers to dilute or dissolve drugs for injection.

 Drawer – E

Intubation tray
 Endotracheal tube
 An endotracheal tube is a catheter that is inserted into the trachea through the mouth for the
primary purpose of establishing and maintaining a patent airway and to ensure the
adequate exchange of oxygen and carbon dioxide.
 Commonly used for airway management in the settings of
 general anesthesia,
 critical care,
 mechanical ventilation,
 and emergency medicine.
 Cont…..

 . Most tubes have an inflatable cuff to seal the trachea and bronchial tree against air leakage and
aspiration of gastric contents, blood, secretions, and other fluids.
 Uncuffed tubes are also available, though their use is limited mostly to pediatric patients (in small
children, the cricoid cartilage, the narrowest portion of the pediatric airway, often provides an
adequate seal for mechanical ventilation).
 tubes range in size from 2 to 10.5 mm in internal diameter (ID).
 The size is chosen based on the patient's body size, with the smaller sizes being used for pediatric
and neonatal patients. Tubes larger than 6 mm IS usually have an inflatable cuff.
Et tube size Age Weight
(Inner) diameter
(mm)
Preterm 3 kg 2.5–3.0
0–6 months 3.5 kg 3.0–3.5
6–12 months 7 kg 3.5–4.0
1–3 years 10–12 kg 4.0–4.5
4–7 years 16–18 kg 5.0–5.5
8–10 years 24–30 kg 5.5–6.5
Adult female 7.0-7.5
Adult male 8.0-9.0
AMBU Bag
Fill spontaneously after they are squeezed,
pulling oxygen or air into the bag

Remain inflated at all times

Can deliver positive-pressure ventilation

without a compressed gas source.

Require attachment of an oxygen reservoir to

deliver 100% oxygen
 Cont…..

Laryngoscope with blades

 A laryngoscope is an instrument used to view the larynx (voice box),.
 It consists of a “blade,” which goes into the patient’s mouth, and a handle.
 The laryngoscope handle and blade are used of the cords.
 The blade can be straight (miller) or curved (macintosh).
 Miller blades are usually reserved for pediatric patients while most physicians use a
macintosh blade for adults.
 An average sized adult patient would require a #3 macintosh blade.
 Application of Laryngoscope

Cont….. Helps in intubation during the administration of general

anaesthesia or for mechanical ventilation.

Detects causes of voice problems, such as breathing voice,

hoarse voice, weak voice, or no voice.

Detects causes of throat and ear pain.

Evaluates difficulty in swallowing: a persistent sensation of

lump in the throat, or mucous with blood.

Detects strictures or injury to the throat, or obstructive masses

in the airway.
 Cont…..
 Oral airway
 In basic airway management, the oropharyngeal airway is
used to provide a patent airway to facilitate chest
ventilation.
 In advanced airway management, it can be inserted
following endotracheal intubation to act as a bite-block to
protect the endotracheal tube.
 Cont….

 Magill forceps
 Magill forceps are angled forceps used to guide the endotracheal tube into
the laryngeal inlet during nasotracheal intubation or a nasogastric tube
into the esophagus under direct vision. It is also used to place pharyngeal
packs and removal of foreign bodies.
Cont….

Uses of magill forceps

 The most common application of this instrument is to maneuver the ET tube in nasal intubations. The
magill forceps is used to pick up the ET tube in the posterior oropharynx and place its tip into the laryngeal
inlet. .
 The magill forceps can also be useful in clearing foreign bodies from the upper airway in anesthetized
or unconscious patients.
 Another use of the device is in placing and removing throat packs.
 Cont….

 Xylocaine jelly
 ECG strips
 Sterile gloves
 Clean gloves
 MaskElectrodes
 DEFIBRILLATOR
 Defibrillation is the treatment of choice to end VF and pulseless VT
(shockable rhythms). Rapid defibrillation (within 2 minutes) is
critical to a successful patient outcome.
 Defibrillation involves the passage of an electric shock through the
heart to depolarize the cells of the myocardium.
 The goal is that the following repolarization of myocardial cells will
allow the SA node to resume the role of pacemaker. Defibrillators
deliver energy using a monophasic or biphasic waveform.
 CONCLUSION

 Crash cart is a specially designed trolley, used for transporting and dispensing medicines
and equipment's 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 equipment's to handle an emergency situation. A crash cart is enabling
healthcare providers to manage medical emergencies easily and confidently.