NCM 119: The Emergency Cart • It is where patients who are critically ill are

being treated and prevented to have

WHAT IS AN EMERGENCY CART?
cardiac arrest
• A multi drawer wheeled cabinet with
• E-cart is a requirement
essential and lifesaving medications and
tools that are required in life- threatening USES OF EMERGENCY CART
situations: • A means of storing and transporting vital
• Other names: E-cart, emergency response equipment and drugs which may be
cart, code cart, emergency trolley, crash required during a code blue or a cardiac
cart. emergency to a location of the
• Can come in varied shapes, sizes, and emergency.
color (color usually in red or blue). • An integral component of emergency
• Contents of e-carts may not be the same patient care which allows medical
among hospitals. professionals to respond quickly to codes
and is more than merely a medication cart
SCENARIOS
because it contains everything that might
• Emergency rooms
be needed in terms of medication and
• Fast paced actions among healthcare
equipment in a lifesaving emergency.
team members.
• Although most emergency departments
• Heart to save lives is embedded.
use e-carts to treat cardiac arrest, they can
• Nurses along with other healthcare team
also treat other emergency conditions and
members act with patient’s safety as the
ensure that providers are able to promptly
highest priority.
attend to patients at a high risk or serious
• Nurses and doctors are the first in line to
morbidity and mortality.
provide life support to the patients.
PURPOSES OF E- CART
WHAT AREAS NEED AN E-CART?
• To provide immediate access to supplies
• It is a necessity for any facility that treat
and medications during life threatening
patients who have the potential to have
situations.
sudden deterioration in their condition.
• The advantage of mobility is that it allows
• Hospitals
treatment to come to the patients when
• Emergency rooms and urgent care centers
needed, thus saving valuable time at the
• Outpatient surgery centers
time of emergency.
• Diagnostic testing facilities, such as cardiac
stress testing centers. WHAT IS A MEDICAL EMERGENCY?
• Poses an immediate threat to health or life
Emergency Room
• A sudden injury or serious illness that if not
• A vital part of a hospital which is responsible
treated right away, could cause death or
for the provision of medical and surgical
serious harm to you or somebody.
care to patients in need of immediate
• Most emergencies require urgent
care.
intervention to prevent a worsening of the
situation.

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 • High probability of escalating to cause • All have casters with wheels that move in all
immediate danger to health or life. directions and can be locked into place. A
• Will cause health detriments or loss of life caster is an assemble that includes a wheel
and a mount.
EMERGENCY SCENARIOS
• The drawers also contain locking
• Compromised airway
mechanisms to secure cart contents.
• Respiratory distress/ respiratory arrest
• The arrangement of the equipment in the
• Cardiac arrest/ abnormal cardiac rhythm
e- carts should be standardized throughout
• Drug overdose
the institution.
• Hypoglycemia
• The specific layout of the hospital’s
• Anaphylactic reaction
emergency cart may not be the same but

⁃ These are some of the medical the arrangement and placement of

emergencies which has the tendency to medications and equipment in the e- carts

create uneasiness, anxiety, and a sense of should be the same in all the units in a given

chaos among healthcare providers during hospital. Dedicating specific drawers or

the event of a lifesaving situation. These surfaces for the storage of certain items

feelings may be magnified if the allows the hospital staff to memorize their

emergency equipment or supplies used to location and reach for them inside the

rescue the patient are not readily medical cart with drawers quickly at the

available. The intent of the e-cart is to time of emergency.

ensure that the correct emergency • Emergency readiness is paramount for

equipment, medications, and supplies are ensuring that the patients are provided

readily available to manage the with the best treatment possible.

emergency.
CONTENTS OF EMERGENCY CART
• External Contents
FEATURES OF E-CART
• Primary use is to transport supplies a doctor ⁃ Contents not inside the drawers

or a nurse may need to save a patient’s life. ⁃ Supplies and equipment on top shelf, sides,

However, it is critical how the cart is and at the back of crash cart.

thoughtfully organized. ⁃ Checklist/ sheets/ cards

• Should be kept in an easily accessible

position which is central to the patient care • Internal Contents
areas. ⁃ Supplies and equipment inside the drawers.
• Every drawer on the e-cart will be clearly
Take note: Arrangement of the contents of an E-
labeled with the type of contents it
cart may vary among hospitals/ facilities.
contains.
• Drawers can be customized to the needs
TOP OF EMERGENCY CART (COMMON
and desires of the doctors and nurses.
• Do not move the cart from this position EXTERNAL CONTENTS)
unless it is in use. • Defibrillator with monitor
• Conductive gel for direct current shock

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 • Portable suction apparatus emergencies, shock, or cardiopulmonary
• Sphygmomanometer arrest.
• Stethoscope ⁃ Will serve as a helpful reference for them
• Pulse oximeter during cardiac resuscitation.
• ECG strips ⁃ ACLS: Advanced Cardiovascular Life
• Sharps bin Support
• Disposable gloves ⁃ PALS: Pediatric Advanced Life Support
• Check list of cart contents ⁃ CPR: Cardiopulmonary Resuscitation
• Emergency drug information sheet • Recording Sheet
• ACLS (Advanced Cardiovascular Life
⁃ Patient profile/ vital signs/ medication
Support), PALS (Pediatric Advanced Life
⁃ Patient’s time of arrival in the ER, mode of
Support), and CPR algorithm cards
arrival (ambulatory, wheelchair,
• ER record sheet
ambulance/ stretcher), complaints of
DEFIBRILLATOR client, status, treatments, doctor’s orders.
⁃ Should be ready to use as soon as needed
and should be checked daily to ensure it is SIDE/ BACK CONTENTS OF E- CART
in good working order.
(EXTERNAL CONTENTS)
⁃ The defibrillation pad should be ready for
• The portable O2 tank located on the side of the
use as well. There should be separate infant
e- cart, should be securely fastened.
pads to use also.
⁃ The pressure or oxygen level on the tank
• Chest leads
should be checked regularly (dated and
• Chest electrodes
initialed by the staff member who is
• Conductive gel- provides a high
checking it).
conductive effect for clear and accurate
• The backboard for CPR- located on the back/
recording and lowers the chance of
side of the E- cart, either back or side.
electrical artifacts or errors.
⁃ A backboard can be made of wood,
• ECG recording paper
plastic, or other materials. This is inserted
• Defibrillator paddles
under the torso of the patient who is to
receive CPR in order to provide a firm
EMERGENCY CART CHECKLIST/ ALGORITHM
surface during the chest compression.
CARDS (ON TOP OF E- CART)
• E- cart checklist- for the nurses to verify that DRAWER CONTENTS (INTERNAL CONTENTS)
all items in the checklist are on the e- cart. ⁃ Equipment that are placed inside the
• Algorithm cards drawers.
⁃ Each drawer has an assignment which can
⁃ The algorithm card is a systematic or a step-
vary among hospitals but should be
by- step protocol for managing healthcare
standardized among the e- cart in a single
problems. It is designed for health care
hospital.
providers to effectively recognize and
• Drawer 1- Medications
intervene in patients with respiratory
• Drawer 2- Breathing and Airway

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 • Drawer 3- Circulation: IV supplies
• Drawer 4- Circulation: IV solutions and
tubing
• Drawer 5- Procedure kits and supplies
• Drawer 6- Miscellaneous supplies
DRAWER 1
⁃ Medications are kept in the top drawer
⁃ Need to be accessed and delivered as
quickly as possible in emergent situations.
⁃ Need to be available
⁃ Provided in a way that makes it easy to
measure.
⁃ Medications for cardiac arrest are typically
kept in the front for faster access.
DRAWER 2
- Most of the materials necessary for
intubation
1. Laryngoscope – rigid device to expose the
laryngeal inlet under direct vision to
facilitate placement of tracheal tube and
comes in various styles and sizes with and
without fiber optic light source.
2. Endotracheal tube – open passage
through upper airway, permit air to pass
freely to and from the lungs.
3. Oropharyngeal and Nasopharyngeal
Airway – adjunct or supplementary
measure to obtain and maintain an open
airway. OPA for unconscious and is at risk of
airway obstruction due to relaxed airway
muscles or blockage or airway by the
tongue. These are common for pts who are
anesthetized. NPA is used to keep airway
open and can be used in conscious or
semi-conscious pt. OPA can’t be used in
conscious or semi-conscious patients
because of their gag reflex.
4. Bag valve mask (BVM) or AMBU (artificial
manual breathing unit) bag or Manual
resuscitator – AMBU bag is self-inflating bag
to provide ventilation to the person not
breathing normally. A BVM consist of a
non-rebreathing face mask and opposite
end of bag is attached to an O2 source.
DRAWER 3
DRAWER 4
⁃ IV solutions and tubing
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DRAWER 5

DRAWER 6

⁃ Devoted to keeping pre-packaged kits

⁃ For urgent and emergent cases WHERE ARE CRASH CARTS LOCATED AND HOW
⁃ Equipment required for a code MANY ARE REQUIRED?
⁃ Kits should be labeled - No concrete requirement
⁃ Sterile gloves and sutures should also be - The facility should assess their needs and
here determine where they should be located
and if they require more than one cart.
1. Chest tube insertion kit - is designed to - Place carts to where at risk patients may be
provide necessary equipment needed to (ER, Surgical room, ICU, PICU, Labor and
perform emergency chest tube delivery floor).
thoracotomy. - May vary depends on the patients the
2. Lumbar puncture kit - contains materials for hospital will care for.
lumbar puncture which include insertion of - Hospital should consider the likelihood of pt
needle to the spinal canal to examine CSF. needing resuscitation.
3. Cricothyroidotomy kit – incision made
FACTORS AFFECTING SAFETY
through the skin and cricothyroid
1. Medication errors and mix-ups
membrane to establish a patent airway
2. Missing, expired, damages, contaminated,
during life threating situation. Indicated for
and unavailable equipment or
pt with airway obstruction by a foreign
medications.
body, angioedema or massive facial
3. Empty oxygen tanks
trauma or when more routine procedures
4. Drained batteries on equipment
like laryngeal mask airway or ET intubation
5. Unsecured carts
are ineffective or contraindicated.
6. Incorrect size of equipment
4. Cut down kit - venous cut down is an
7. Staff unfamiliarity of e-cart location,
emergency procedure where a physician
storage, and procedures.
exposes a vein and inserts a canula under
direct vision mostly done in cases of SAFETY CONSIDERATIONS
emergency where rapid access is required 1. Attend to staff training and educational
for intravenous fluid therapy. This gives the needs
physician access to the saphenous or 2. Conduct regular and timely check of e-
antecubital vein and the physician carts supplies and equipment.
recommends that this procedure should be
done when other less invasive procedures
for IV insertion will fail.

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3. Ensure completeness and replacement of
used items in the e- cart (nurse who checks
the content must be identified).
4. Ensure check of defibrillator by a bio-
maintenance dept regularly or as
necessary.
5. Contents must be checked in terms of
expiration dates
6. Arrange drugs in the medication drawer
clearly labeled and visible
7. Maintain safe and accessible location of e-
cart in each unit.

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