A crash cart or code cart contains medications, supplies, and equipment needed to respond to medical emergencies like cardiac arrest. It includes a defibrillator, ambu bags, oxygen, IV supplies and medications like epinephrine, atropine, lidocaine, sodium bicarbonate. The crash cart must be checked regularly, standardized, and placed in an easily accessible location. It is organized with equipment and medications grouped by function in drawers and sections for quick access during emergencies. Common arrhythmias include premature beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias which can be harmless or potentially fatal depending on their type and underlying heart condition.

1. CRASH CART
FAMILIARIZATON
& ARRYTHMIAS
E.R. STAFF

2.  Define the term crash cart
 Understand the purpose of crash cart
 Identify the content of crash cart, their use
and the nursing consideration for all the:
 medications
Supplies
Objectives

3.  A crash cart or code cart is a special mobile
unit with drawers used in health care
facilities and emergency rooms that contain
the necessary medications and equipment
to respond to a cardiopulmonary arrest.
Definition of Crash Cart

4.  The purpose of the crash cart is to have a
portable life saving unit that contains all the
medications, supplies and equipment
necessary to initiate a treatment in
emergency and life threatening situations
on all health care facilities.
Purpose of Crash Cart

5. 1. Crash cart must be checked by head
nurse/staff nurse every shift and document in
checklist
2. Standarization must be maintained.
3. Defibrillator will be checked by biomed
department regularly or as necessary.
4. Crash cart items must be checked monthly for
expiry dates.
5. Each unit will have crash cart placed in and
easily place accessible location.
Policy

6.  Top shelf
 Defibrillator and manual
 spO2 probe
 ECG strips
 Ultrasound jelly for DC Shock
 Checklist
 Right side
Adjustable iv pole
 Ambu bag adult with mask
 Ambu bag pedia with mask
 Oxygen cylinder
Arrangement of Crash Cart

8.  Top Slide
Penlight
Stylet
Scissors
Magills forcep
Extra battery
Lidocaine Gel
Curve/straight forcep
Laryngoscope
Disposable razors
Airway different sizes

9.  Chest leads
 Chest electrodes
 Conductive gel
 ECG recording paper
 Defibrillator paddles
To know the rhythm and or delivering shock
defibrillator

11. First Drawer
EMERGENCY DRUGS
 Adenosine
 Adrenaline
 Amiodarone
 Aminophylline
 Atropine
 Calcium Chloride
 Dexamethasone
 Diazoxide
 Digoxin
 Dopamine
 Sodium bicarbonate
 Procainamide
 Dextrose 50%
 Dobutamine
 Isoproterenol
 Magnesium Sulfate
 Methylprednisolone
 Noradrenaline
 Hydrocortisone
 Furosemide
 Calcium chloride
 Potassium chloride
 Propranolol
 Verapamil
 Vasopressin
 Lidocaine 1% and 2%
 Hydralazine

12. AIRWAY/BREATHING
Oxygen mask (Adult/Pedia)
Nasal cannula/cath
Adul/pedia neb. Kit
ETT all sizes
LAMA
Stylet
Nasopharyngeal tubes
Second Drawer

14. CIRCULATION
 IV Set
 IV cannula all sizes
 3way stopcock
 Foley catether
 NGT all sizes
 Blood transfusion set
 Syringes all sizes
 BP APP
 TORNIQUET
Third Drawer

15.  IV Fluids
 RL
 NS
 D5W
 D5NS ½
 D5NS ¼
 D5NS
 D10
 HUMAN PLASMA
 ALBUMIN
 MANNITOL
 EXTRA AMBUBAGS
FRONT SIDE
 CARDIAC BOARD
Lower Portion

17. Adenosine
 Antiarrhythmic
 Conversion to sinus rhythym of paroxysmal
supraventricular tachycardia
 Dose: 6mg by rapid bolus: for repeat dose, use 12mg
by IV bolus within 1-2 mins.
Epinephrine
 Adrenergic agent choice for cardiac arrest,
vasopressor used in Pulseless VT/VF, Asystole and
PEA
 Dose : 1mg IV every 3-5mins or more frequently. May
be given endotracheal route.
 Stocked 1mg/ 10ml 1:10,000.
 If used for hypersensitivity reaction 0.1- 0.25mg SC
EMERGENCY DRUGS

18. AMIODARONE (antidysrhythmics, 3rd)
-malignant Ventricular Arrythmia, V-Fib/Pulseless V-
Tach
-markedly prolongs action potential and repolarization
-300 mg IV x1 after dose of epinephrine if no initial
response to defibrillation. May repeat 150 mg IV q5-
10min. Rapid IV push if pulseless/no BP.
Not to exceed 2.2 g/day, may be diluted in N.S. or D5W
AMINOPHYLLINE (Xanthine Derivatives)
-Acute Bronchospasm
-Methylxanthines directly relaxes the smooth muscle of
the Respi Tract.
-6 to 7 mg/kg IV/PO; infuse iv over 20 mins

19. Atropine Sulfate
 Parasympatholytic
 Anticholinegic
 Antidote for organophosphate poisoning
 Agent used for symptomatic bradycardia, PEA
 Dose : 0.5-1mg IV push, repeat at 3-5 mins
 Intervals to max. total dose of 0.4mg/kg
 May b given via endotracheal route. Stocked 1mg/
10ml
Digoxin
-(antidysrhythmics, 5th, inotropic agents)
-heart failure, A-FIB,
-0.4-0.6 mg once then may cautiously give add’tl doses
of 0.1-0.3 mg q6-8hrs until adequate.
-slow IV push over 5 mins

20. DOBUTAMINE
-inotropic agents
-low cardiac output and CHF
-0.5-1 mcg/kg/min IV initially, then 2-20 mcg/kg/min; not
to exceed 40mcg/kg/min
-infuse to large vein via infusion pump
DOPAMINE
-inotropic agents
-hypotension, cardiac output and poor perfusion of vital
organs. Mean arterial pressure in Septic shock patients
-in large vein, via infusion pump.

21. D50W (glucose-elevating agents)
-hypoglycemia
-10-25g (20-50ml 50% solution)
-high concentrations should be administered via Central Veins and
only after appropriate dilution
SODIUM BICARBONATE
-alkalinizing agent
-cardiac arrest, hyperkalemia
-1 mEq/kg/dose IV x 1
POTASSIUM CHLORIDE (Electrolytes)
-conduction of nerve impulses in the heart, contraction of cardiac,
smooth muscle
-hypokalemia
-40 to 100 mEq KCL diluted in an appropriate amount and type of
solution to be intravenously infused once at a rate not to exceed
10 to 40 mEq/hour.

22. CALCIUM GLUCONATE
-antidote, calcium salts
-hypocalcemia (hypocalcemic tetany, hypoparathyroidism)
cardiac arrest (+ hyperkalemia, hypocalcemia,
hypermagnesemia)
-1.5-3g IV over 2-5 minutes, diluted in N.S or D5W
-rapid IV admin.: arrythmias, hypotension, M.I. or
vasodilation
CALCIUM CHLORIDE
-antidote, calcium salts
-hypocalcemia, arrythmias, hypermagnesemia
-500-1000mg IV over 5-10 mins/
-C/I in Vfib during CPR,PVT

23. DEXAMETHASONE (corticosteroid)
-hormones and synthetic substitutes
-inflammation, cerebral edema and shock
-1-6 mg/kg IV or 40 mg IV q2-6hrs PRN, diluted in D5W, N.S.
DIAZOXIDE (Glucose Elevating Agents)
-hyperinsulinemic hypoglycemia
-now in oral form.
-the injectable form used for HTN emergency is no longer available
FUROSEMIDE (loop diuretic)
-edema asso. With CHF, liver cirr. & Renal dse. HTN
-A.Pulmonary Edema, HTN crisis, ICP
- 0.5-1mg/kg (40mg) IV over 1-2 mins. Or up to 80 mg but should
not exceed 200mg
-hyperkalemia, hypermagnesemia (hpk: 40-80 mg IV; hpm: 20-
40mg iv/q3-4hrs PRN)

24. HYDRALAZINE (vasodilators)
-HTN crisis, CHF
-^ 10-50 mg IM, or 10-20 mg IV, repeat PRN
-may induce SLE-type syndrome
-D5W
HYDROCORTISONE (corticosteroids)
-status asmaticus, anti-inflammatory & immunosuppressive
-Initial dose: 100mg -500mg PRN, may repeat q2, 4, 6hrs PRN

25. ISOPROTERENOL
-beta 1/beta2 adrenergic agonist
-V.A’s due to (AV) heart block, Adams-Stokes attacks,
cardiac arrests and shock
-IV Bolus: 0.2-0.06mg initially THEN doses of 0.01-0.2mg.
-IV Infusion: .5mcg/min, THEN doses of 2-20mcg/min. by
infusion pump in D5W
* Direct IV, IM, SC or Intracardiac inj.(EXTREME cases)
MAGNESIUM SULFATE (antidysrhythmics, V,
Electrolytes)
-hypomagnesemia, toxemia of Pregnancy and Torsades de
Pointes V-TACH
-with Pulse: 1-2g slow iv (10ml/D5W) over 5-60 mins, then
0.5-1g/hr IV
-Cardiac arrest: same as above but over 5-20 mins.

26. METHYLPREDNISOLONE (corticosteroids)
-allergic conditions, acute exacerbations of multiple sclerosis,
-dose: 10-250 mg IM/IV up to q4hr PRN
NITROGLYCERINE (nitrates)
- ANGINA, Renal Failure
-5mcg/min. if unresponsive to SL NTG
-increase by 5 mcg/min q3-5mins up to 20mcg/min.
-3ml/hr (50mg in 250ml D5W/NS)
NORADRENALINE (alpha/beta adrenergic agonist)
-acute hypotension, cardiac arrest, sepsis/septic shock
-initial: 8-12mcg/min IV Infusion. Titrate.
*extravasation: infiltrate with 10-15ml NS+5-10mg of phentolamine
mesylate.
*monitor BP

27. PROCAINAMIDE (antidysrythmics, 1a)
- arrythmia,
- IM: 0.5-1g IM q4-8hr
- IV: loading dose 15-18 mg/kg; slowly over 25-30 mins; may
repeat q5mins PRN; not to exceed 1g.
- Sol’n: 2g/250ml D5W/NS , in infusion pump
PROPRANOLOL(antidysrhythmics, II)
- beta-blockers(nonselective), antianginal
-HTN, ANGINA, Hypertropic SubAortic Stenosis,
SupraVentricular arrythmia & Portal HTN.
-SVA: 1-3mg at 1 mg/min 1st, repeat q2-5 min until 5mg. Once
achieved, no add’l dose for at least 4 hours.

28. LIDOCAINE (anesthetics pre-med agents)
- Cardiac arrythmias: 1.1-5mg/kg, slow IV over 2-3mins
(3mg/kg total)
- IV, IO/ET..Can be given IM! If, no IV and no ECG, for V.Ar
VASOPRESSIN (antidiuretics)
-Abdominal distention, Diabetes Insipidus, Gastrointestinal
Hemorrhage and vasodilatory shock.
-AD: initial: 5 units/IM, repeat q3-4hrs PRN up to 10 units.
-DI: 5-10 units IM/SC/intranasal q6-12 hrs.
-dilute to NS/D5W and via controlled infusion device.

29. Verapamil
 Antianginal
 Antiarrhythmic
 Antihypertensive
 Calcium channel blocker
 Therapeutic actions:
-inhibits the movement of calcium ions across the membranes
of cardiac and arterial muscle cells
 Indications: treatment of SVT, essential hypertension
 Dose:
Adult- IV initial dose- 5-10mg over 2mins; may repeat dose
of 10mg 30 mins after first dose
Pedia- 1year and younger: initial dose 0.1-0.2mg/kg over 2
mins.
1-15 years: initial dose 0.1-0.3mg/kg over 2mins. Do not exceed
5mg. Repeat above dose 30mins after initial dose if response is
not adequate. Repeat dose should not exceed 10mg.

30.  Monitor patient carefully (BP, cardiac rythym, and
output)
 Protect IV solution from light
 Monitor patients with renal or hepatic impairment
carefully for possible drug accumulation and
adverse reactions
Nursing Considerations

31.  Dose: IV Adult: 150mg loading dose over 10mins,
followed by 360mg over 6hr at rate of 1mg/min
 For maintenance infusion 540mg at 0.5mg/min over
18hr
 Remember Amiodarone should be diluted with D5W

32. An arrhythmia is an irregular heartbeat - the heart may beat too
fast (tachycardia), too slowly (bradycardia), too early (premature
contraction) or too irregularly (fibrillation). Arrhythmias are heart-
rhythm problems - they occur when the electrical impulses to the
heart that coordinate heartbeats are not working properly, making
the heart beat too fast/slow or inconsistently.
Many heart arrhythmias are harmless. We all occasionally
experience irregular heartbeats, which may feel like a racing heart
or fluttering. Some arrhythmias, however, especially if they veer too
far from a normal heartbeat or result from a weak or damaged
heart, may cause troublesome and even potentially fatal
symptomsRapid arrhythmias are called tachycardias, while slow
ones are called bradycardias. Irregular arrhythmias - when the
heartbeat is irregular - are called fibrillations, as in atrial or
ventricular fibrillation. When a single heartbeat occurs earlier than
it should it is called premature contraction.
ARRHYTHMIAS

33. The English word "arrhythmia" comes from the Greek word
rhymos, meaning "rhythm", the Greek suffix a (letter "a" added
to the beginning of a word) means "loss" - put together they
mean "loss of rhythm".
4 MAIN TYPES
1. Premature (extra) beats
2. Supraventricular arrhythmias
3. Ventricular arrhythmias
4. Bradyarrhythmias
PREMATURE (EXTRA) BEATS
- Most common type. They are harmless most of the time and
often don’t cause any symptoms. Premature beats that occur in
the atria (the heart’s upper chambers) are called premature
atrial contractions, or PACs. Premature beats that occur in the
ventricles (the heart’s lower chambers) are called premature
ventricular contractions or PVCs.

34.  SUPRAVENTRICULAR
ARRHYTHMIAS
 -are tachycardias (fast heart rates) that starts in the
atria or atrioventricular (AV) node. The AV node is
a group of cells located between the atria and the
ventricles.
Types of SV Arrhythmias
Atrial Fibrillation (AF)
Atrial Flutter
PSVT
Wolff-Parkinson-White

35.  VENTRICULAR ARRHYTHMIA
-Starts at the heart’s lower chambers, the ventricles.
They can be very dangerous and usually require
medical care right away.
Includes:
Ventricular Tachycardia
is a fast, regular beating of the ventricles that may
last for only a few seconds or much longer.
Ventricular Fibrillation
is disorganized electrical signals make the
ventricles quiver instead of pump normally. Without
the ventricles pumping blood to the body, sudden
cardiac arrest and death can occur within a few
minutes.

36.  BRADYARRHYTHMIAS
-Occur if the heart rate is slower than normal. If the heart rate is
too slow, not enough blood reaches the brain. This can cause
you to pass out.
-in adults, a heart rate is slower than 60 beats per minute is
considered bradyarrhythmia. Some people normally have
slower heart rates, especially people who are very physically fit.
For them, a heart beat slower than 60 beats per minute isn’t
dangerous and doesn’t cause symptoms. But in other people,
serious diseases or other conditions may cause
bradyarrhythmias.
-can cause
 Heart attacks
 Conditions that harm or change the heart’s electrical activity,
such as an underactive thyroid gland or aging
 An imbalance chemicals or other substances in the blood,
such as potassium
 Medicines such as beta blockers, calcium channel blockers,
some antiarrhythmia medicines, and digoxin

37.  Arrhythmia in children
 Children’s heart rates normally decreases as they get older. A newborn’s
heart beats between 95-160 times a minute. A 1 year old heart beats
between 90- 150 times a minute, and a 6 to 8 year old heart beats
between 60 to 110 times a minute.
 A baby or child's heart can beat fast or slow for many reasons. Like
adults, when children are active, their hearts will beat faster. When
they're sleeping, their hearts will beat slower. Their heart rates can speed
up and slow down as they breathe in and out. All of these changes are
normal.
 Some children are born with heart defects that cause arrhythmias. In
other children, arrhythmias can develop later in childhood. Doctors use
the same tests to diagnose arrhythmias in children and adults.
 Treatments for children who have arrhythmias include medicines,
defibrillation (electric shock), surgically implanted devices that control
the heartbeat, and other procedures that fix abnormal electrical signals
in the heart.

38. ARRHYTHMIAS
NON SHOCKABLE
PEA (Pulseless Electrical Activity)
Asystole (Silent Heart)
SHOCKABLE
VF (Ventricular Fibrillation)
VT(Ventricular Tach Pulseless)
TORSADES de Pointes
Perfusing Rhythms
(non-arrest rhythms)
BRADYCARDIA
Sinus Bradycardia
Junctional rhythym
Idioventricular Rhythym
Artioventricular Block:
1st degree
2nd degree: Mobitz Type I
Mobitz Type II
3rd degree (Complete Heart Block)
TACHYCARDIAS: NARROW QRS
Regular Rhythym:
Sinus tacycardia
Atrial flutter
Supraventricular Tachycardia
Junctional Tachycardia
Irreguar Rhythyms:
Atrial flutter
Atrial Fibrillation
Multifocal Atrial Tachycardia
TACHYCARDIAS : WIDE QRS
Regular Rhythym:
Ventricular tachycardia: monomorphic
Irregular Rhythym:
Ventricular Tachycardia: polymorphic
Torsades de Pointes

40. Thank you!!!