The crash cart is the commonly used term to describe a self-contained, mobile unit that contains virtually all of the materials, drugs, and devices necessary to perform a code. The configuration of crash carts may vary, but most will be a waist high or chest high wheeled cart with many drawers. Many hospitals will also keep a defibrillator and heart monitor on top of the crash cart since these devices are also needed in most codes. Since the contents and organization of crash carts may vary, it is a good idea for you to make yourself aware of the crash cart that you are most likely going to encounter during a code.
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The size, shape, and contents of a crash cart may be different between hospitals and between different departments within the same hospital. For example, an adult crash cart is set up differently than a pediatric crash cart or crash cart on the medical service may be different than the one on a surgical service.
Medications
Medications are usually kept in the top drawer of most crash carts. These need to be accessed and delivered as quickly as possible in emergent situations. Therefore, they need to be available to providers very easily. The medications are usually provided in a way that makes them easy to measure and dispense quickly.
The common set of first drawer medications might be:
If the crash cart also contains pediatric medications these may be contained in the second drawer. Often these would include:
The second drawer of the crash cart might also contain saline solution of various sizes like 100 mL or 1 L bags. A crash cart in the surgery department may include Ringer's lactate solution.
Intubation
Many crash carts will also include most of the materials necessary to perform intubation. These may be contained in the third or fourth drawers depending on the setup of the particular crash cart.
The adult intubation drawer will contain:
Pediatric intubation materials may be in a separate cart or if they are included in the adult crash cart they may occupy their own drawer. The pediatric intubation supply drawer may contain the following:
Intravenous lines
It is usually the case that the equipment necessarily to start an IV is in a separate drawer from materials needed to maintain an IV, such as the fluids in the tubing. The IV drawer(s) usually contain the following:
Procedure drawer
The bottom drawer on crash carts is usually devoted to keeping prepackaged kits available for various urgent and emergent procedures (or it is where the IV solutions are kept). In any case, the following kits may be found in the procedure drawer:
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That is up to each individual facility's rules and regulations
The crash cart requirement is determined by each State's Department of Health.
Those are decisions that need to be made by your hospital based on response needs
According to our medical experts, most facilities place plastic locks on their crash carts. This enables anyone to know that the crash cart has been opened and that there are potentially things missing. So it must be restocked anytime the lock is "cracked". They are opened and checked monthly because the medications must be checked for expiration dates on a monthly basis. It is just convenient to check the entire cart at the same time and then relocked.
It is recommended checks are done at the beginning of the shift to identify any issues and fix them accordingly. The organization should create a standard for all defibrillators in use.
Regulators dictate that you should be able to respond to emergencies arising from your practice. Most offices stock those medications necessary for cardiac arrest, allergic reaction, SVT (SVT medical abbreviation of supraventricular tachycardia), and respiratory emergencies in the first 15 minutes (assuming EMS arrival in that time frame). An interdisciplinary team of pharmacy, providers, and nursing is recommended to determine the needs for your organization.
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You have to be practicing in an area that is using the expertise taught in the course. You could certainly teach BLS but it would be difficult to remain current with ACLS if you are not practicing.
The purpose of the list of expiration dates is just to make it easier to replace them each month. There is no "requirement" for keeping those checklists. The hospital that I am affiliated with keeps theirs for a year.
Although there are no explicit requirements, you are required to stock equipment and medications required for all possible scenarios in your practice. For conscious sedation that includes ventilation equipment, reversal agents, medications for allergic reactions and medications required in first 20 minutes (unless your EMS has a longer response time) of cardiac arrest. In addition, you must have the ability to defibrillate and monitor your patient appropriately.
ACLS does not change the practice of medicine. A physician with prescribing privileges can certainly prescribe and administer any medication. ACLS simply reviews the skills to do so. It is not a certification but an educational course.
There is no suitable replacement, hospitals are diluting 1: as a substitute, however, this should be done by the pharmacy with very clear dosing and warnings regarding concentration. Diluting at the bedside is not recommended as this is a high-risk medication.
Each crash cart must have the requirements to respond to possible emergencies within that practice. Many patients in nursing homes receive opioids for chronic pain, so the presence of Narcan would be a requirement. As far as the location, it should be in a central location near patient care.
AHA doesn't have requirements for crash carts and supplies. The sterility of reusable instruments is a function of hospital policy and the manufacturer guidelines of the instrument being used. Depending on the type of patient care and the need for equipment and instruments, the use of disposable items is an option.
The guidelines for crash carts do not specifically list medications or equipment. Regulatory agencies require "equipment to respond to any emergency within the practice" This will differ with each type of practice. For emergency drugs that are on back order, communication regarding the length of the backorder, any substitutes, or other plans should be relayed to all parties that would be affected.
Most hospitals do in fact check the paddles, just because they represent the backup if pads are dry, opened, expired, or simply missing.
There are no guidelines or best practices. We recommend following manufacturer guidelines for the carts themselves.
Generally, the crash cart is for emergency use by all responders. Not all are trained in the use of a magnet to terminate an AICD. Many emergency departments require multiple crash carts to accommodate their patient volume and the need for a magnet to terminate an AICD is not considered emergency equipment.
The equipment and medications for your facilities should align with the experience level of your staff, the required certifications, and the needs of your patients. A crash cart can be tailored to your needs. If you don't have the knowledge and experience with current practice then having the equipment to intubate and medications for cardiac rhythms in a crash cart are not going to be beneficial. Perhaps that is a goal to aspire to, however for now, assess where you and your staff are as far as knowledge and experience. If the providers are not keeping up with the practice of intubation, each attempt to intubate can cause significant trauma that can impede intubation once a paramedic gets there. The focus of the staff should be on basic life support such as breathing with an ambu-bag, good compressions, using an AED if available, and calling for advanced life support.
There is no hard and fast rule. That decision is facility-based. A cart does not require sterilization, therefore it would not be a requirement. I've seen crash carts that wrap the sections of drawers so they can reuse those bundles and it makes it easier to check. Pharmacy checks and restocks medications and a designated department ensures items are not expired and that there is consistency in the items placed in the carts. Many facilities have committees that periodically review what they have and what is needed based on AHA updates, shortages, etc.
The contents of the crash cart depend on your facility's needs. It is not meant solely for cardiac arrest. If your facility desires, you can stock items and medications for anaphylactic shock, hypoglycemia, and control of bleeding to name a few.
Urinary catheters may certainly be added. The equipment list, as stated, will change depending upon practice. Many of our customers are prehospital (they do not utilize urinary catheteris), outpatient facilities who would have the child transported prior to the need. The needs of a crash cart are not regulated for that reason. They are meant to meet the needs of practice and so any list is not comprehensive and everything on any list does not necessarily apply to an individual's practice. Certainly a NICO or ED would stock urinary catheters. For example, there would be no need for an ED or NICU to stock coronary catheters in pediatric sizes, but a cardiac catheterization lab who does pediatrics would. There can never be an inclusive list of equipment for all practices.
No certifying agency (that I am aware of) defines an exact list of what you need. What they say is that 'you need to respond to emergencies that may arise in your practice with the appropriate equipment and medications'. That will differ depending upon your type of practice. There are also statements about your staff being 'educated to respond to complications of sedation, including respiratory arrest.' But you will not find a list required by an agency.
There is no such list. It would differ depending upon what type of practice, etc...
There would be a different list for a surgery center who does pediatric procedures vs a hospital OPerating room or a physician practice. A pediatric specials PT practice would have different requirements than an adult surgery center who also places ear tubes for pediatrics. An emergency department that sees pediatrics would have different needs than a mEd/surf floor who has occasional pediatrics for observation.
No you cannot. It depends upon the standing riders within your hospital.
JCAHO dictates that in hospitals if sedation or anesthesia is given someone must have airway training. The hospitals use ACLS certification for that. Whether or not ACLS is required is a function of whatever state licensure you fall under. Although, in my experience with many surgery centers, all RN's are ACLS certified and PALS if they do children. I hope this helps.
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