08.02 Crash Cart

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Included In This Lesson

Outline

Overview

  1. What is a crash cart?
    1. Mobile unit used for medical emergency
    2. Necessary supplies for 1st 30 minutes of treatment
    3. Can differ in supplies based on location
  2. Where is it required?
    1. Hospitals
    2. Outpatient surgery centers
    3. Urgent care centers
    4. Where moderate sedation is performed
    5. Office setting
      1. If procedures are performed
    6. Some nursing homes
  3. When is it required?
    1. Patient in grave situation
    2. Immediate life-saving steps required

Nursing Points

General

  1. What’s in a crash cart?
    1. Medications
      1. Typically in top drawer
        1. Easy access
      2. Examples
        1. Alcohol swabs
        2. Amiodarone
        3. Atropine
        4. Sodium bicarbonate
        5. Calcium chloride
        6. Sodium chloride flush
        7. Dextrose
        8. Dopamine
        9. Epinephrine
        10. Lidocaine
        11. Vasopressin
        12. Narcan
    2. Basic airway equipment
      1. Bag valve mask
      2. Oral/nasal airways
      3. Oxygen masks
      4. Nasal cannulas
    3. Advanced airway equipment
      1. Intubation tubes
        1. Endotracheal
        2. Nasopharyngeal
        3. Oropharyngeal
      2. Magill forceps
      3. Syringe to inflate cuff
      4. Stylets
      5. Bite blocks
      6. Tongue depressors
    4. IV or IO access equipment
      1. IV start kit
      2. Angiocatheters
      3. Disinfectants
        1. Chloraprep, betadine
      4. Tourniquet
      5. IV tubing
      6. Vacutainers
      7. IV fluids
        1. Sometimes in bottom drawer
    5. Monitoring equipment
      1. Pads for defibrillator/AED
      2. ECG electrodes
    6. Procedure drawer
      1. Typically bottom drawer
        1. Sterile gloves
        2. Various sutures
        3. Suction
        4. Salem pump
        5. Cut down pack
        6. Drapes
    7. Additional crash cart items
      1. AED/Defibrillator
        1. Top of crash cart
      2. Backboard
        1. Back of crash cart
      3. Medication algorithms
      4. Description of drawer contents
      5. Supplies for charting

Therapeutic Management

  1. Maintenance of crash cart
        1. Check daily
        2. Verify no missing items
        3. Check expiration dates
          1. Medications
          2. AED/defibrillator pads
        4. Battery charged
  2. Tips for nurse
    1. Be familiar with crash cart
      1. Location and contents

Nursing Concepts

  1. Clinical judgement
  2. Oxygenation
  3. Perfusion
  4. Teamwork and collaboration

Transcript

Hey guys! I am sure you all are familiar with what a crash cart is if you have spent any time at all in the clinical setting but you might not know exactly what is in it!  Today I am going to help you gain a better understanding of the crash cart in general. 

So what exactly is a crash cart?  Basically guys this is a mobile unit with either drawers or shelves that can be taken to a patient who is in the midst of a medical emergency and needs life saving interventions.  Typically held within the crash cart are supplies that can be used for the 1st 30 minutes of treatment. So guys the crash cart is just a means to stabilizing a patient to then get them to a place of even more stability like the ICU or surgery.  Supplies within the crash cart can definitely differ based on the facility or even where the craht cart is located. For instance, the supplies of a crash cart in a surgical unit are going to differ than the supplies in a crash cart that is on a pediatric unit…so keep that in mind!

 

As nurses we are lucky because we have the opportunity to work in a variety of environments or locations but with that said it still may be necessary to have a crash cart available.  Where exactly are they required? Crash carts are required most definitely in the hospital setting, outpatient surgery centers, urgent care settings, any establishment where moderate sedation is given and even in some office settings where procedures are performed and even nursing homes depending on the code status of the patients.

So what exactly is in a crash cart?  Medications will definitely be necessary to intervene in cardiac arrest situations, airway equipment because as we all know airway is a priority, IV access supplies are essential to administer medications and fluids, we have to monitor our patients to know where they stand, and we might need additional supplies for a procedure.


So lets take a closer look at the medications included.  I just want to mention that traditionally meds are kept in the top drawer for easy access!  Guys medications can and will vary but I want to mention the most common medications which can include amiodarone, atropine which you can see here in the picture, sodium bicarbonate, calcium chloride, and dextrose.  So guys these are common medications that I can assure you will show up during a code.


Here are a few additional medications that you will also see in that top drawer which will include dopamine, epinephrine probably the most known emergency medication as you can see here in the picture, lidocaine, vasopressin, and narcan in the event of an overdose.


As nurses our ABC’s have been drilled into us!  So it’s no surprise a crash cart typically has its own drawer dedicated specifically to airway supplies.  Now these can be basic airway supplies like a bag valve mask, oral/nasal airways, oxygen mask, or a nasal cannula.  Or it can be more advanced airway equipment like an ET or endotracheal tube or nasopharyngeal tube as seen in the picture, or magill forceps which aid to intubate a patient also seen here.  Also included can be stylets which also help with intubation, bite blocks, and tongue depressors. As you can imagine patients in emergency situations who are conscious are not always cooperative (no fault of their own) as decreased oxygen can induce panic so with this said we need to be prepared with all things that will be helpful to gain airway access.


Having a way to get medications and fluids to your patient is absolutely essential which makes sense that we would need a drawer for IV or IO (Intraosseus) access.  In this drawer you can expect to find an IV start kit, angiocaths, a tourniquet, IV tubing and sometimes IV fluid although I have always found this in the bottom drawer of a crash cart.  It is also common to find vacutainers in the crash cart like you see here in the picture because a lot of time as clinicians we might not what the underlying issue is in the patient that is creating this emergency so lab work will be necessary!

 

Monitoring equipment is another component of the crash cart.  AED or defibrillator pads, if they are not included with the AED itself on top of the crash cart, they will be in a crash cart drawer.  You also will find ECG electrodes if a procedure is necessary.

Some but not all crash carts, I have seen both, may have a drawer that is specific to a procedure if necessary.  In this specific drawer you can expect to find sterile gloves and sterile drapes to create a sterile field , different types of sutures, suction, salem pump, and a cut down pack.

So we have focused a lot on what is in the crash cart but don’t forget guys the AED or defibrillator is typically placed on top of the crash cart.  In the facility where I work we have a back board attached to the back of the crash cart if needed, we also have hanging medication algorithms (although to be honest I don’t really think I’ve ever had time to look at an algorithm in a code) but even charting supplies.  So I know most organizations chart electronically but it common to have a transcriptionist who writes on paper because everything happens super quickly!

It’s super important that someone is assigned to maintaining the crash cart.  Can you imagine needing to use the cart in an emergency and the AED being dead or having no epinephrine?  This would be a disaster and something that most definitely can be prevented. A few tips that I can give you is to be familiar with the carts in your facility.  Maybe not all floors have them or maybe you work in the PACU but your crash cart is in the pre-op area…sounds crazy but each facility has their own protocol. A code or a medical emergency is already a super stressful situation, if you have seen or been involved in one you know what I am talking about!  Being prepared and having knowledge is how we prepare ourselves to deal with these situations to do what we do….provide the best care to our patients!

So lets review!  A crash cart is a mobile unit with drawers or shelves for emergency situations or a cardiac arrest, supplies can differ between carts and facilities.  The top drawer is typically for the medications which will include amiodarone, epinephrine, lidocaine, dopamine, and sometimes narcan. There are additional drawers for IV start kit, tourniquet, and IV fluids and airway supplies like masks, ET tubes, nasal cannulas, stylets, and bit block.  Monitoring equipment will be included in the crash cart like AED pads and leads and finally there may be a drawer in case of a necessary procedure like sterile gloves and drapes, suction tubing and tip, and various sutures.


What nursing concepts can we apply to the crash cart?  We as nurses are using our clinical judgement and working as a team during an emergency to know when the crash cart is necessary to provide life-saving actions to perfuse and oxygenate our patients.


We love you guys! Go out and be your best self today! And as always, Happy Nursing!