Description
A crash cart is an emergency trolley set up to manage emergencies at acute care setting. The emergency trolley usually contains the emergency medications, supplies and equipment that are used by medical personnel to resuscitate a person experiencing a cardiac arrest.
A crash cart is an emergency trolley set up to manage emergencies in an acute care setting. Any facility treating patients with acute illness is recommended to have an emergency trolley in every unit. The crash cart is set up based on ACLS standards. Usually, a mobile trolley on wheels with multi-level drawers is commended as a crash cart.
Purpose
- To enhance the efficiency of code blue team’s responses to the patient with medical or surgical emergency.
- To provide immediate access to supplies and medications in life saving measures.
- To save the time in emergency situations.
- To provide systematic care to the patient.
Contents of a crash cart
The crash cart usually has multi-level drawers. Each part of the drawers is arranged in a standard manner. The carts across the whole hospital system should be arranged in a uniform manner. It is recommended that the crash cart be kept in a centralized accessible area in the unit near a reliable power source as there are equipment on the crash cart that need power to be fully charged.
Organizing a Crash Cart
The required emergency supplies and medicines are organized in the cart as given in table. The equipment’s included are not limited to but can be modified with minor variations as per the hospital policies.
| Sl.No | Placement of crash cart | Items | Specific supplies |
| 1 | Side of cart | Oxygen cylinder, face mask and oxygen tubing. | |
| 2 | Crash cart top | Defibrillator, inventory/ cash cart check list, code blue sheet, clip board drug calculation reference sheet. | ECG leads, electrodes conducting gel pads, transcutaneous pacemaker or combination unit. |
| 3 | Compartment/ drawers | Airway and breathing article | Oral and nasal airway endotracheal tubes:Size: 5.5,5.0, 4.5 and 4.0.(5,5-2.0 mm). Stylet. Laryngoscope with curved and straight blades. Magill forceps. Lubricating jells. Ambu bag. Nasal cannula. Venturi mask. Nebulization kit. Intubation tray. Suction catheter. Endotracheal tubes. Bougie stylet. Laryngeal mask. Heat and moisture exchanger (HME filter). |
| Circulation articles (intravenous) | IV cannula size: 14G, 16G, 18G, 20G, 22G. Adhesive tape, syringes, needles and adapter. IV fluids: Isolyte P,500 mL,0.9-45 % Normal saline (NS) Ringer lactate (RL). Dextrose with normal saline (DNS). 25% dextrose,5% dextrose, 10% dextrose and IV tubing. Macro drip and micro drip sets. Extension tubing. Pressure monitoring kit. Arm boards- long and short. Three-way adapter. Micro and macro-blood transfusion set. ABG analysis kit. Heparinized aspirators. Needles, alcohol, swabs and syringes. | ||
| Medication drive or box. | All emergency medications such as: Inj. Hydrocortisone. Inj. Sodium bicarbonate. Inj. Dexamethasone Inj. Aminophylline. Inj. Dobutamine. Inj. Ranitidine. Inj. Diazepam. Inj. 50% Dextrose. Inj. 25% Dextrose. Inj. Epinephrine. Inj. Dopamine. Inj. Adenosine. Inj. Amiodarone. Inj. Magnesium sulphate (MgSo4). Inj. Atropine. Inj. Adrenaline. Inj. Calcium gluconate. Inj. Midazolam. Inj. Deriphyllin. Inj. Potassium chloride (KCI). | ||
| Miscellaneous items shelf | Restraints, ECG electrodes, jelly, sterile gloves, flashlight, masks with face shields, or marks and eye protection pads. Pressure cuff, blood collection tubes, gauze pads, IV splint, gloves, kidney tray, tourniquets, spirit swab, plastic apron. | ||
| 5. | Bottom shelf | Special procedure trays | Intubation tray, intubation pillow, ICD set, percutaneous tracheotomy set, scalpels with blades, dressings, drain sponge, povidone-iodine solution, suture material, cardiac needle, sterile towels, three-lumen central venous catheter kit, chest tubes, suction catheter, Open intravenous line (cut-down), Tracheostomy and central line insertion set. |
Crash cart policies
Crash cart policies are standardized, though specific to every agency.
- All units will set up their carts to include age-appropriate equipment, based on the ages of patients to be served as needed, using appropriate supplies.
- Crash carts in all patient care areas should be arranged in a uniform manner as per guidelines.
- Crash cart should be placed in an easily accessible, specific location. Location of crash cart to be specified by a poster “CRASH CART” on the wall so that after use it will be returned to the same place.
- Crash cart must be checked every shift and documented in the check list by the nursing officer/nurse-in-charge of the unit on duty.
- Items in the crash cart should be used only for emergency. Once used it should be replenished immediately.
- Defibrillator check should be performed every shift with the defibrillator plugged in and unplugged. Confirm that battery back is available.
- All drawers/shelves to be opened and checked for contents once a month, e.g., first day of every month.
- Medicines to be checked for expiry dates and any drug with less than three months to expiry, should be promptly replaced. Sterile trays should be checked for package integrity and expiry date. This check should include consumable items, such as ET tubes, suction tubes, etc. Items expiring within a month should be replaced.
- The crash cart is kept locked in the unit and if the lock is found broken, the cart must be returned to pharmacy or central supply for restocking.
- The medication compartment should not be opened daily, if it is sealed and intact.
- Laryngoscopes and working condition of batteries to be checked.
- A”B” type oxygen cylinder should always be attached to cart. It should be checked every day. If the cylinder is full, pressure gauge will show 140 kg/cm2. Replace the cylinder if the pressure is less than 40 kg/cm2.
- Compartments of crash carts are to be clearly labelled to identify contents.
- Special procedure trays like tracheotomy set, cut-down set, etc. should be checked for the sterilization indicator.
Mobility of the crash cart should be ensured i.e. the cart should move freely. The wheels should be in good condition and repairs to be done, if necessary
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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