Did You Know?
Designed by the father of one of the doctors at the Bethany Medical Center in Kansas City, the first cardiac crash cart comprised an Ambu bag, defibrillator paddles, a bed board, and endotracheal tubes.
The term 'Code Blue' refers to a situation when a patient in a hospital requires resuscitation or immediate medical attention due to a life-threatening situation such as a respiratory or cardiac arrest. For such situations, a well-stocked crash cart (code cart) is placed in emergency rooms. Basically, a crash cart is a specially designed wheeled chest of drawers, or a trolley that contains life-saving drugs and equipment. Carts are often positioned in intensive care units/emergency rooms, or places where these are easily accessible to the doctors. The contents of a crash cart help the doctors handle an emergency.
There's no denying the fact that time is of great essence in such situations, which is why these carts are built in such a way that they can be readily moved to the emergency site. The doctors and nurses involved in such cases have to be familiar with the contents of the cart so that the emergency is handled properly. They have to be trained in life support protocols such as Advanced Cardiac Life Support/Advance Life Support (ACLS/ALS) and Pediatric Advanced life Support (PALS). It must be noted that the contents of an emergency cart can slightly vary from hospital to hospital. However, the cart mainly contains life-saving drugs, IV solutions and tubing, breathing equipment, defibrillator, procedure trays, other medical supplies, etc. The arrangement of the drugs and the emergency equipment could also vary, depending on the institution and the type of cart. The number of drawers present in a cart can vary from 3 to 7.
Contents of the Emergency Crash Carts
? Placed on top of the crash cart is the defibrillator, which administers an electric shock of a certain voltage to the heart so as to restore the normal rhythm of the heart in the event of a cardiac arrest. Other items that are placed on the shelf, containers, and the left side include defibrillator pads, latex gloves, stethoscope, BVM masks, sharps container, oxygen, inventory checklist/Code Blue sheets, etc. A cardiac board is often placed on the rear.
? The first drawer contains emergency or ACLS first-line, rapid sequence drugs such as epinephrine, atropine, amiodarone, lidocaine, nitroglycerin, diazepam, naloxone, sodium bicarbonate, dopamine, and vasopressin.
? Pediatric medication and IV solutions might be placed in the second drawer.
? The adult intubation supplies are mostly placed in the third drawer. These include endotracheal tubes, tracheostomy tube, ambu bag, oral airways, pressure cuffs, carbon dioxide detector, suction catheters, nasal cannulas, laryngoscope, forceps, guidewire, bulbs, blades, batteries, straight and curved blade, syringe, lubricant, adhesive tape, exam gloves, IV cannulas, disposable syringes, etc.
?The infant and pediatric intubation supplies are placed in the fourth drawer. Pediatric doses of emergency drugs, and small-sized endotracheal tubes, blood pressure cuffs, oxygen masks, cannulas, etc., can be found in this drawer.
? The fifth drawer contains IV supplies (cannulas, drip sets, fluids) and blood draw supplies. It usually contains catheters, tourniquets, syringes, tubes, and tape.
? Intravenous solutions, tubing, and different types of surgical kits are usually placed in the last drawer.
http://www.youtube.com/watch?v=7PuDp7w7YsQ
It must be noted that the arrangement of the equipment and the drugs in a crash cart could vary, depending on the policy of the hospital. In fact, for pediatric population, the drawers of the cart are color-coded, based on the Broselow Pediatric Emergency Tape. The drawers are organized as per the patient's length and weight range. The drawer contains the drugs in the pediatric doses and the equipment and supplies for resuscitation are appropriately sized for the child in that specific weight range.
Instructions Related to Crash Cart Use
Carts are of three types. These include adult crash carts, pediatric crash carts, and newborn intensive care crash carts. The guidelines for crash cart use that need to be followed by the hospitals and clinics include:
? 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.
? 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.
? The defibrillator should be checked on a daily basis, and it has to be documented.
? 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 labeled.
On a concluding note, it is extremely essential that carts are well-stocked with all the necessary drugs and equipment to ensure that the doctors are able to confidently handle emergencies. A licensed official is designated for the purpose of checking the defibrillator, oxygen cylinder levels, and the other contents of the crash cart. He/She is also responsible for rechecking and restocking the cart following its use. He is also responsible for documenting compliance on crash cart checklist. In fact, code drills are often conducted to check the response of the staff during such situations.
Disclaimer: The aforementioned checklist for crash cart supplies is intended for informational purposes only. It provides just the basic supplies and equipment required for medical emergencies, and the items can vary from hospital to hospital.
