CRASH CART Prepared by FARIDA KHOGLI, BSN, RN` MEEQAT GENERAL HOSPITAL MADINA MUNAWARH KINGDOM OF SAUDI ARABIA

1. CRASH CART
Prepared by
FARIDA KHOGLI, BSN, RN`
MEEQAT GENERAL HOSPITAL
MADINA MUNAWARH
KINGDOM OF SAUDI ARABIA

2. Objectives
 To identify what is the crash cart consist of.
 To identify how to arrange crash cart contents
according to policy listed from CBAHI
 To determine the role of nurse during checking crash cart
 To know the maintenance of crash cart

3. Definition
 A crash cart - is a special cart (with drawers) containing
emergency drugs and equipment needed when a cardiac
pulmonary arrest occurs.
 It provides an easily accessible position which is
central to the patient care area.

4.  Function
 Is to provide mobile station with in the
hospital that contains every thing
needed to treat a life threatening
situation .The advantage of mobility is
that it allows the treatment to come to
the patient when needed .

5.  Policy :
 Crash cart must be checked by head nurse/staff
nurse every shift and document in checklist.
 Standardization must be maintained .
 Defibrillator will be checked by biomed
department regularly or as necessary .
 crash cart item must be checked monthly for
expiry dates .
 Each unit will have crash cart placed in an easily
place accessible location

6. Maintenance:
 Follow is a maintenance routine that should be completed at
least monthly:
 Expiration dates on medications should be checked on the first
day of the month
 Expired medications should be removed and replaced
 The defibrillation pads on the AED or the defibrillator should
be checked for expiration date
 The battery charge on the monitor and/or AED should be
checked and documented

7. Arrangement
Top shelf
 Defibrillator
 Spo2 probe
 ECG Strips
 Ultrasound jelly for DC shock
 Ambu bag adult with mask
 Ambu bag pedia with mask

8. Procedure: 1. The cart is inspected for the following External
contents:
1.1. Portable suction apparatus with connecting tubing if not available
in each patient’s room.
1.2. Portable monitor/defibrillator unit with charged batteries, multi-
function cable, multifunction pads (pedi, adult or both as appropriate),
pacer cable (if pacer capable machine), ECG electrodes, appropriate
sized paddles (adult, pediatric), defibrillation gel, monitor paper,
blood pressure cuff (adult carts), SpO2 probe.

9. Procedure:
 1.3. Sharps container.
 1.4. Cardiopulmonary Resuscitation records
 1.5. Emergency Crash Cart Check Sheet.
 1.6. List of cart contents.
 1.7. Emergency drug information sheets as appropriate
for unit

10.  Defibrillator
 chest leads
 Chest electrodes
 Conductive jell
 ECG recoding paper
 Defibrillator paddles
 To know rhythm and delivering shock

14. Second Drawer
 Dextrose 50%
 Lidocaine 1%
 Plasil
 Potassium chloride KCL
 Sodium bicarbonate


15. Third drawer:
 Laryngoscopy( various sizes of blade)
 electrodes
 Xylocaine jelly
 Stylet
 Oropharyngeal airway
 Gauze bandage
 Plaster

17. Fourth drawer:
 ETT(various sizes )
 Tracheostomy tube
 Airway
 Suction catheter (all sizes)
 Gloves

19. Intubation
 Laryngoscope with blades(curved
,straight)
 ETT of various sizes (adult , child )
 5&10ml syringe
 Lubricating gel
 Stylet

20.  Endotracheal Tube
 Is a catheter that is inserted into the trachea
for the primary purpose of establishing and
maintaining a patent airway and to ensure the
adequate exchange of oxygen and carbon
dioxide

21.  Introduction
 A list of the drugs kept in the crash carts.
 This list has been approved by the Pharmacy and Therapeutic
Committee.
 The most important indications, contraindications and dosage
and administration of these drugs are reviewed as a reminder for
the physicians, nurses and pharmacists who serve on cardiac
arrest (code) teams or who are involved in other emergency
situations.

22. Intraosseous (IO) Access
 In older children and adults:
• Distal radius and ulna
Proximal tibia

23. Trans -tracheal Administration TT
 1. Lipid-soluble drugs such as lidocaine, epinephrine,
atropine, and naloxone ("LEAN") can be given via the
endotracheal tube.
 2. Flush with a minimum of 5 mL normal saline
followed by 5 assisted manual ventilations.

24.  What is ?
1-Adrenergic blocker
A drug that blocks the secretion of epinephrine and norepinephrine . By
blocking these adrenergic substances, which cause constriction of blood
vessels and increased cardiac output, adrenergic blocking agents produce
a dilatation of the blood vessels and a decrease in cardiac output.
2-Anticholinergics
Drugs that block the action of acetylcholine. Acetylcholine is a
neurotransmitter, or a chemical messenger. It transfers signals between
certain cells to affect how your body functions
3-vasopressor
 Drugs cause vasoconstriction (contract blood vessels) and increase
blood pressure. They are used to treat hypotension, especially in
critically ill patients

25.  1- EPINEPHRINE
 Adrenergic agent, choice for cardiac arrest
_vasoconstrictor
 Uses :-
 In pulseless VF, VT, Asystole, and PEA:
 Dose:-1 mg IV or IO every 3 – 5 minutes. May be given
via endotracheal route.
 Stocked 1 mg/ 10ml 1:10,000

26. 2-Atropine sulfate
 Parasympatholytic
 Anticholinergic
 Antidote
 Agent used in symptomatic bradycardia
 PEA o.5- 1mg IV push
 Repeat at 3-5minute
 Total dose .o4mg/kg
 May be given endotracheal route

27. 3- verapamil :
Antianginal
Antiarrhythmic
Antihypertensive
Calcium channel blocker
Therapeutic action : inhibits the movement of
calcium ion across the membranes of cardiac and
arterial muscle cell

28. Indications :
 Treatment of SVT
 Essential hypertension
Adult dose :
 Initial IV initial dose 5-10mg over2min may
repeat dose 10 mg 30min after first dose
 Stocked 2.5mg/ml

29. Nursing consideration
 Monitor patient carefully (BP, Cardiac rhythm
and out put )
 Protect IV solution from light
 Monitor patient with renal or hepatic
impairment carefully for possible drug
accumulation and adverse reactions.

30. 4. Amiodarone :
For refractory pulseless VT/VF
- 5 mg/Kg rapid
- 300 mg IV/IO; over 3 min. (dilute in 20-30ml).
Monitor ECG and BP
- For per fusing tachycardia
- Loading 5 mg/kg over 20-60 min
- Max 15 mg/kg/day IV
- (Should be diluted by D5W)

31. 4. Amiodarone
 Slows AV conduction, prolongs QT interval, and slows
ventricular conduction (widens the QRS).
 Amiodarone causes hypotension. The severity of the
hypotension is related to the infusion rate and is less
common with the aqueous form of amiodarone:
 1. It should be administered slowly to a patient with
pulse.
 2. May be given rapidly to a patient with cardiac arrest
or ventricular fibrillation (VF).

32. 4. Amiodarone
 • Monitor the ECG because complications may
include: 1. Bradycardia,
 2. Heart block,
 3. Torsades de pointes ventricular tachycardia (VT).
 Use extreme caution when administering with
another drug causing QT prolongation, such as
procainamide.
 Adverse effects may be long lasting because the half
life is up to 40 days.

33. 5-Adenosine :
For symptomatic SVT
 6 mg over 1-3 sec.
 Monitor ECG If no response within 1-2 min Repeat:
12 mg, Rapid IV/IO bolus
 Remarks: Rapid IV push
 Max dose 12 mg

34. 6-Dobutamine
7-Dopamine
2-20 mg/kg/min
adrenergic effect at higher doses
Dopamine 200mg, 40mg/ml 5ml vial (2)
Dobutamine 250 mg/ml 20ml Vials (2)

35. 8. Glucose
 0.5-1 g/kg IV/IO
 D10W: 5–10 mL/kg
 D25W: 2–4 mL/kg
 D50W: 1–2 mL/kg
 • Check blood glucose concentrations during and after arrest.

36.  9-lidocaine Anti-arrhythmic
 -For treatment of ventricular ectopy, VT, and VF.
 Initial dose: 0.5-1.5 mg/kg, repeat 0.5-0.75 mg/kg every 5 to 10
minutes as necessary, up to a maximum
 total dose of 3 mg/kg.

37.  10-MAGNESIUM
 Recommended for treatment of torsade's de pointes VT with or
without cardiac arrest. May be effective for rate control in patients
with atrial fibrillation with rapid ventricular response. Not helpful
for treatment of nontorsades pulseless arrest. Give 1 to 2 Gm
diluted in D5W over 5 to 60 minutes. Slower rates are
 preferable in the stable patient. Stocked in 1 Gm/2ml vials
 (torsades de pointes abnormal heart rhythm that can lead to
 sudden cardiac death
 Torsade's de pointes :is a specific type of abnormal heart
rhythm that can lead to sudden cardiac death

38. 11-NALOXONE (NARCAN) IS a narcotic
antagonist
 Initial dose of 0.4 to 2 mg IV/IM/SQ, repeat at
2 to 3 minute intervals. Use smaller doses (0.1-
0.2 mg) in postoperative patients to avoid large
cardiovascular changes

39. 12-NOREPINEPHRINE (LEVOPHED) Vasopressor
 To support blood pressure after return to spontaneous circulation.
Prepare IV infusion of 4 mg/250ml. Initial dose 2 to 12
mcg/minute (7.5 to 45 ml/hr) and titrate to adequate blood
pressure.
 Monitor urine output. Adequate hydration is imperative.

40. 13-SODIUM BICARBONATE:
 Used in metabolic acidosis: bicarbonate therapy should be
guided by the bicarbonate concentration of calculated base
deficit obtained from blood gas analysis or laboratory
measurement.. Usual initial dose 1 mEq/kg IV push.
Incompatible with dopamine, norepinephrine, and amiodarone.

41. 14-VASOPRESSIN : Non-adrenergic peripheral
vasoconstrictor.
 40 units IV push may replace first or second dose of
epinephrine to produce vasoconstriction and increased
blood flow to the brain during CPR for VF or pulseless
VT. Use epinephrine
 to follow up in 3 to 5 minutes if there is no response to
vasopressin. Stocked in 20 unit/1ml vials

42. 15. Calcium (10%, 1 g/10 mL)
 20 mg/kg
 500mg – 1 gm IV slowly
 For symptomatic hypocalcemia, hyperkalemia and Ca channel
blockers overdose.
 Preferably administer calcium chloride via a central venous
catheter because of the risk of sclerosis or infiltration with a
peripheral venous line .
Calcium
Chloride
10% 10ml 100mg/ml single dose vial (2)
Calcium
Gluconate
10% 10ml 100mg/ml single dose vial (2)

43.  Thank you