Crash cart overview part 1 https://www.youtube.com/watch?v=6MeHlKVc7fE

Soheir ElBanna
Demonstrator BUE Faculty of Nursing
AHA FA & BLS Instructor
Soheirelbanna89@gmail.com
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quote

Intended Learning outcomes ILOs
After completion of this presentation you will be able to:
1. Delineate the crash cart & its purposes
2. Classify the Competent of the crash cart
3. Distinguish between the various emergency
drugs Indication, Precautions /contraindication
,dosage & injection technique.
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Introduction
Crash Cart:
Is a cabinet contains lifesaving equipment and drugs. The cart is designed
to be easily movable , multi drawer &readily accessible into all sides of the
cart for rapidly presentation &removing equipment and drugs during a
critical situations.
Crash Cart other Names :
Emergency Cart / Emergency response Cart/ Code Cart / Emergency trolley .
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Crash cart Purposes
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 To provide immediate access to emergency medication & equipment until arrival the
emergency response team in life threatening conditions Such as :
 Compromised Airway/Respiratory Distress /Respiratory Arrest
 Some times prearrest conditions
 Cardiac Arrest
 Drug Overdose/ Toxicity
 Hypoglycemia
 Anaphylactic Reaction
To provide organized & unified display of emergency medication & equipment in order to
save the valuable time .
To ensure properly stocked emergency cart will be readily available
with functioning defibrillator & other equipment
 To reduce time waste which capitalize the effectiveness life Saving Effort

Component Of Crash Cart
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1
• External Contents (out of drawers)
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• Drawer 1- Medications
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• Drawer 2-Breathing and Airway
4 • Drawer 3- Circulation: IV supplies
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• Drawer 4- Circulation: I.V. solutions and
tubing
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•Drawer 5- Cardiac, Chest
Procedures
•Drawer 6- Special Procedure Trays

Crash Cart External Contents
(out of drawers)
Soheirelbanna89@gmail.com 7
 Oxygen cylinder
 Defibrillator with Monitor
 Portable suction apparatus
 Laryngoscope
 CPR Board
 IV pole
 Shuttle forceps
 Sphygmomanometer
 Stethoscope
 ACLS algorithms
 Code blue recoding sheet
 Crash Cart Check Sheet
 Check List of cart contents.
 Emergency drug information
sheet

Drawer 1- Medications
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Drawer 1- Medications Chart /Lay out Example

Drawer 1- Medications (Adenosine )
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Adult dosagePrecautions
/contraindicationIndicationDrug
IV Rapid Push
Place patient in mild reverse
tendelenburg position before
administration of drug
Initial bolus of 6mg given rapidly
over 1 to3 seconds followed by NS
blouse of 20ml then elevate the
extremity
A second dose of (12 mg ) can be
given in 1 to 2 minutes if needed .
Record rhythm strip during
administration
Draw up adenosine dose & flush in 2
separate syringes
Attach both syringes to the IV
injection port closest to patient
Clamp IV tubing above injection port
Push adenosine as quickly as possible
(1 to 3 seconds)
While maintaining pressure on
adenosine plunger , push NS flush as
rapidly as possible after adenosine
Unclamp I V Tubing
Contraindicated in poison / drug
induced tachycardia or second –or third
degree heart block
Transient side effects including
flushing , chest pain or tightness ,brief
period of asystole or bradycardia
 less effective ( large dose may be
required ) in patients taking
theophylline or caffeine
Reduce initial dose to 3mgin patient
receiving dipyridamole or
carbamazepine in heart transplant
patient or if it given by central venous
line
If administered for irregular
polymorphic wide complex tachy cardia
/VT, may cause deterioration (including
Hypotension)
Transient period of sinus bradycardia
and ventricular ectopy are common after
termination of SVT
 Safe and effective in pregnancy
First drug for most of Stable
narrow complex SVT Effective in
terminating those due to reentry
involving AV node or sinus node
May consider for unstable
narrow complex reentry tachy-
cardia while preparation for are
made for cardioversion
 regular & monomorphic
Ventricular Tachy cardia thought to
be pervious defined as reentry SVT
Does not convert atrial
fibrillation , atrial flutter or VT
Diagnostic maneuver : stable
narrow complex SVT
Adenosine
Injection technique

Drawer 1- Medications (Amidarone)
VF/ pVT Cardiac Arrest
unresponsive to CPR, Shock &
vasopressor
First dose : 300 mg IV/IO
push
Second dose (If Needed): 150
mg IV/IO push
Life threatening arrhythmias
Maximum cumulative dose :
2.2g IV over 24 hrs May be
administer as follow :
Rapid infusion : 150 mg Iv
over first 10 minutes (15mg
per minutes)
Slow infusion :360 mg Iv
over 6 hours (1gm per
minute )
Maintenance infusion :
540mg iv over 18 hours
(0.5mg per minute)
Caution : multiple
complex drug interaction
 Rapid infusion may lead
to hypotension
With multiple dosing ,
cumulative dose ≥ 2.2gm
over 24hrs are associated
with significant
hypotension in clinical
trails
Do not administer with
other drugs that prolong
QT interval (eg,
procainamide)
Terminal elimination is
extremely long ( half –life
up to 40 days)
Because its use is associated
with toxicity
Amidarone is indicated for use
in patients with life
threatening arrhythmias when
administrated with appropriate
Monitoring :
 VF/ pulseless VT
unresponsive to shock
delivery ,CPR& vasopressor
Recurrent hemodynamically
unstable
With expert consultation ,
amidarone may be used for
treatment of some atrial and
ventricular arrhythmias
Amidarone

Drawer 1- Medications (Atropine Sulfate )
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Bradycardia (With or
without ACS)
O.5 mg IV every 3 to 5
minutes as needed , not
exceed total dose of 0.04
mg/kg (total 3mg)
Use shorter dosing
interval (3 minutes ) and
higher doses in sever
clinical condition
Organophosphate
poisoning :
extremely large dose (2
to 4 mg or higher) May be
needed
Use in caution in presence
of myocardial ischemia and
hypoxia .increase
myocardial oxygen
demand
Avoid in hypothermic
Bradycardia
May be not effective for
infranodal (type 5) AV
block and new third
degree block with wide
QRS complexes (in these
patient ,may cause
paradoxical slowing . Be
prepared to pace or give
catecholamine)
Doses of atropine ≤ 0.5
mg may result in
paradoxical slowing
First drug for symptomatic
sinus bradycardia
May beneficial in
presence of AV nodal block .
Not likely to be effective for
type 2 second degree or
third degree AV block or a
block in nonnodal tissue
 routine use during PEA or
Asystole is unlikely to have
a therapeutic benefit
Does not convert atrial
fibrillation , atrial flutter or
VT
Organophosphate (eg.
Nerve agent) poisoning :
extremely large dose May
be needed
Atropine
Sulfate
Can be given
Via
endotracheal
tube

Drawer 1- Medications (Dopamine)
IV Administration
Usual infusion rate
is 2to20 mcg/kg per
minute
Titrate to patient
response : taper slowly
Correct Hypovolemia
with volume
replacement before
Initiation dopamine
Use with caution in
cardiogenic shock with
accompanying CHF
May cause tachy
arrhythmias , excessive
vasoconstriction
Do not mix with
sodium bicarbonate
Second –line
drug for
symptomatic
bradycardia (
after atropine )
Use for
hypotension
(SBP ≤70to 100
mmHg) with
signs and
symptoms of
shock
Dopamine
IV infusion

Drawer 1- Medications (Epinephrine)
IV /IO dose: 1mg(10ml of
1:10000solution ) administrated
every 3to5 minutes during
resuscitation . Follow each dose
with 20 ml flush elevate arm to 10
to 20 seconds after dose .
Higher dose: up to (0.2 mg/kg) may
be used for specific indications (β-
blockers or calcium channel blocker
over dose )
Continous infusion : initial rate
:0.1to0.5 mcg/kg per minutes (
eg,70 kg pt :7 to 35 mcg per minute)
Titrate to response
Endotracheal route : 2to 2.5 mg
diluted in 10 ml NS
Profound bradycardia or
hypotension : 2 to10mcg per
minute infusion titrate to patient
response
Raise blood pressure
and increasing heart
rate may cause
myocardial ischemia
,angina and increase
myocardial oxygen
demand
 High dose do not
improve survival or
neurologic outcome
contribute to post-
resuscitation
myocardial
dysfunction
Higher doses may
be required to treat
poison/ drug induced
shock
Cardiac arrest: VF ,
pulseless VT, Asystole , PEA
Symptomatic Bradycardia :
Can be consider after atropine
as an alternative infusion to
dopamine
Sever hypotension:
Can be used when pacing and
atropine fail, when
hypotension accompanies with
Bradycardia or with
phosphodiesterase enzyme
inhibitor
Anaphylaxis , sever allergic
reactions :
Combine with large fluid
volume ,corticosteroids ,
antihistamines
Epinephrine/Ad
renalin
Can be given
endotracheal
Available in
1:1000
&1:1000concent
ation

Drawer 1- Medications (lidocaine)
Cardiac Arrest :
•Initial dose :1to 1.5 mg/kg IV Io
•For refractory VF ,may give
additional 0.5 to 0.75 mg /kg iv
push ,repeat in 5 to10
minutes
Perfusing Arrhythmia:
•For Stable VT ,Wide –complex
Tachycardia Of uncertain type
Significant Ectopy:
•Dose ranging from 0.5 to 0.75
mg/k and up to 1to1.5mg/kg may be
used
•Repeat 05 to 0.75 Mg/kg every 5 to
10 minutes :maximum total dose :3
mg/Kg
•Maintenance Infusion :
•1to 4 mg per Minutes (30to 50
mcg/kg per minutes)
Contraindication :
Prophylactic use in AMI is
contraindicated
Reduced Maintenance
dose (not loading dose) in
presence of impaired liver
or LV dysfunction
Disconnect infusion
immediate if signs of
toxicity develop
Alternative of
amidarone in cardiac
arrest from VT/ PVT
Stable polymorphic
VT with normal base
line QT and preserved
LV function when
ischemia is treated and
electrolyte balance is
corrected
Can be used for
Stable polymorphic VT
with normal base
QT – interval
prolongations
Lidocaine
Can be given
endotracheal

Drawer 1- Medications (Magnesium sulfate )
Cardiac Arrest :due to
hypomagnesaemia or
Torsades de pointes:
•1to2 g(2to4ml of a50%
solution diluted in 10
ml (eg, D5W,Normal
saline ) given IV/IO
Torsades de pointes with
a pulse or AMI with
hypomagnesaemia :
• loading dose of 1 to 2
g mixed in 50 to 100 of
diluent ( eg, D5W , NS)
over 5to 60minutes IV
•Follow with 05 to 1 g
per hour iv (titrate to
control tosades)
•Occasional fall in blood
pressure with rapid
administration
•Use With caution if renal
failure is present
Recommended use in
cardiac arrest only if
Torsades de pointes or
suspected
hypomagnesaemia is
present
 life threatening
ventricular arrhythmia
due to digitalis toxicity
Routine
administration for
hospital patient is NOT
recommended
Magnesium
sulfate

Drawer 1- Medications (Naloxone)
•Opioid
Overdose
•0.4-2 mg
IV/IM/SC; repeat
2-3min PRN
Not to exceed 10
mg (0.01 mg/kg
•Consider other
causes of respiratory
depression if desired
response not
achieved after
administering 10 mg
cumulative total
Opioid Overdose
Indicated for the
complete or
partial reversal of
opioid depression
(including
respiratory
depression)
induced by
natural and
synthetic opioids
Naloxone

Drawer 1- Medications
ActionDrug
Used primarily to combat acidosis, although it's the treatment of
choice in certain cases of overdose
Sodium bicarbonate
Emetics (produce vomiting)Apomorphine
treatment of unstable anginaTridil (nitroglycerin)
For sever bronchospasmHydrocortisone
BronchodilatorAminophylline
SedativeValium (Diazepam )
an anti-epileptic (anticonvulsant)Dilantin/ phenytoin
Antihistamine drugBenadryl
Correct hyperkalemiaCalcium gluconate
Correct Hypokalemiapotassium chloride
(having the opposite effect of insulin)Glucagon
Anticoagulant (Inhibits blood coagulation)Heparin

Drawer 2- Breathing and Airway

Drawer 2- Breathing and Airway
 Oropharyngeal Airways sizes
 Nasopharyngeal Airways sizes
 Endotracheal tubes sizes
 Tracheostomy tubes sizes
 Yankauer suction
 viscous xylocaine
 Face mask
 Pocket mask
 Suction tube/ Kit
 Tracheostomy mask
 Nasal cannula
 Laryngoscope
 Laryngoscope batteries
 Suction catheter

Drawer 3- Circulation: IV supplies

Drawer 3- Chart /Lay out Example

Drawer 3- Circulation: IV supplies
 Needles different sizes
 Syringes different sizes
 Butterflies
 Sterile water vials
 IV cannula sizes
 Tourniquet
 Alcohol swabs
 Cotton balls
 Blood tubes
 Tape
 Saline locks
 Electrode kit
 3 way stopcock
 Radial artery catheterization set

Drawer 4- I.V. solutions and tubing
 0.9% sodium chloride 500ml
 100 ml NS
 Dextrose (500ml)
 10% dextrose (500ml)
 Hase-steril 6% (500ml)
 Ringer lactate (500ml)
 Blood pump tubing
 I.V. Tubing
 extension sets/lines
 500 ml Lidocaine 2 grams

Drawer 5- Cardiac&Chest Procedures
 Sterile gloves
 Sutures
 Cardiac needle
 Sterile towels
 Cut down tray
 Catheter kit
 Chest tubes
 Scalpels with blades
 Dressings

Drawer 6- Special Procedure Trays

References:
• Neumar RW, Eigel B, Callaway CW, et al. The American Heart Association
response to the 2015 Institute of Medicine report on Strategies to Improve
Cardiac Arrest Survival [published online ahead of print June 30, 2015].
Circulation. doi:10.1161/CIR.0000000000000233.
• McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB.Medical
education featuring mastery learning with deliberatepractice can lead to
better health for individuals and populations.Acad Med. 2011;86(11):e8-e9.
• 2010 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care (November 2010).
"Part 8: Adult Advanced Cardiovascular Life Support". Circulation122:
S729–S767

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Soheir ElBanna
https://www.linkedin.com/in/soheir-elbanna-b7141b98/

Crash cart overview part 1 https://www.youtube.com/watch?v=6MeHlKVc7fE

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Crash cart overview part 1 https://www.youtube.com/watch?v=6MeHlKVc7fE