CRASH CART

Nursing Education Dept.

King Fahd Specialist Hospital
 What is a CRASH CART?
• Crash Cart is an emergency cart that
facilitates coordination of equipments and
supplies used for cardiopulmonary
resuscitation
 of CRASH CART
• To provide immediate access to supplies
and medications.
• To facilitate coordination of emergency
equipment.
• To ensure a properly stocked crash carts
will be readily available.
• To ensures a properly functioning
defibrillator will be readily available.
• To save the valuable time at the time of
emergency
WHEN DO YOU
CHECK CRASHCARTS?
1. Daily (every shift)
2. Monthly
3. Every after use

Every
After Use
WHO WILL CHECK
THE CRASHCARTS?
1. Nurse Manager(Morning shift)
2. Charge Nurses (Evening, Night
and during weekend)
 WHAT TO CHECK IN
THE CRASHCARTS?

1. Expiry dates
2. Completeness
3. Checking for equipments
if working properly and
ready for use
 WHEN TO RETURN
TO PHARMACY THE “NEAR
TO EXPIRE”DRUGS?

1 (one) WEEK prior

to expiry date.
Crash cart is
ALWAYS
plugged to
AC supply.
 OUTSIDE/EXTERNAL
parts of the crash cart
are cleaned with
SODIUM HYPOCHLORITE
solution in
OR/RR, IVF and AKU
A 1-in-5 dilution of household bleach with water
(1 part bleach to 4 parts water)

1 in 10 dilution
OUTSIDE/EXTERNAL
parts in other Units
are cleaned with Surfa
Safe by the HEAD
NURSE/
CHARGE NURSES
 DEFIBRILLATOR
Cleaned with
Surfa Safe solution
in the units
______
LARYNGOSCOPE
HANDLE

wiped
 Send to CSSD
LARYNGOSCOPE
BLADES
 CSSD
with reservoir

Sterilization
Spray Medisol,
leave for
1 minute
then wipe
OR/RR, IVF & AKU

OTHER UNITS
OR/RR, IVF & AKU
Washed with
soap & water.
Disinfect with
sodium
Hypochlorite.
OTHER UNITS

Wash with soap and water

and send to CSSD
for sterilization if
INFECTED.
 Laryngoscope holder
and blades will be placed
in stainless steel
medication tray with
cover, and to be placed
on top of crash cart.
MILLER MACINTOSH
 MAGILS FORCEP

SCISSORS
 Checklist
& test load
strips to be
maintained in
the Unit for
“one year”
 9/3/2021 0700H
Belen Suarez

ECG print out

should be signed, timed and
dated in FRONT of the print out
by the staff who checked the
defibrillator
 Any staff nurse on
duty as requested
by the HN/CN
will bring down the
request to the
pharmacy.

Refilling of the drugs

is the responsibility
of the HN/CN and the
Nursing Supervisor
within 1 (one) hour
 The Unit Supervisor during
administrative hours or
General Supervisor during
non-administrative hours
will counter check/ sign the
refilled crash cart and make
sure it is ready for use.

Upon
her GO SIGNAL the
crash cart will be
locked.
 CONTENTS OF THE
CRASH CART
TOP OF CART: EQUIPMENTS
TOP DRAWER- Emergency Medications
FIRST DRAWER- AIRWAY
SECOND DRAWER CONTRAPTIONS
THIRD DRAWER-CIRCULATION
FOURTH DRAWER- CIRCULATION (IVF)
 FRONT OF THE CART
Compression board/back board
 ON STAND
Ambubag
(Pedia/adult)
Stethoscope
(Pedia/adult)
Emergency
Pediatric Dose
Stopwatch
AMBUBAG (pedia/adult)
 RIGHT SIDE OF THE CART

Oxygen cylinder
with gauge
Portable suction
machine
Sharp container
RIGHT SIDE OF THE CART
• Portable suction machine
• Sharps Container
LEFT SIDE OF THE
CART
Syringes-different volumes
Extra endotracheal tubes
Extra IV Cannula
NASOPHARYNGEAL AIRWAY

First Drawer- Airway

 OROPHARYNGEAL AIRWAY

First Drawer- Airway

LARYNGEAL MASK
ENDOTRACHEAL TUBE
TRACHEOSTOMY TUBE
Cuff inflator
Second Drawer
MANUAL EXTERNAL MANUAL INTERNAL
DEFIBRILLATOR DEFIBRILLATOR

AUTOMATED EXTERNAL DEFIBRILLATOR

 BIPHASIC DEFIBRILLATOR
Delivering a single current of electricity that travels in
two direction between the two paddles on the patient’s
chest.
 MONOPHASIC

MONOPHASIC DEFIBRILLATOR
Delivering a single current of electricity that travels in
one direction between the two paddles on the patient’s
chest.
 Biphasic Monophasic

Current delivered Current delivered

in two directions in one direction
 DEFIBRILLATION
Defibrillation is a common treatment for life-
threatening cardiac dysrhythmias, ventricular fibrillation and
pulseless ventricular tachycardia. It consists of delivering a
therapeutic dose of electrical energy to the heart with a
device called a defibrillator. 
 CARDIOVERSION
Cardioversion may be a necessary procedure when drugs
alone have not been able to convert an arrhythmia to a
normal heart rhythm. It restores the normal heart rate and
rhythm, allowing the heart to pump more effectively.
Marker indicates each
detected R wave
during synchronization
 PHILIPS HEART START

TEST JOULES = 200J

INNOMED CARDIO AID-200

TEST JOULES = 200J

 WELCH ALLYN

TEST JOULES = 200J

 LIFE PAK 15

TEST JOULES = 10J

 LIFE PAK 20/20E

TEST JOULES = 50J

 ZOLL

TEST LOAD= 30 J
 LT. RT.
hand hand
STERNUM
APEX
Can I use to Pediatric
patients the adult
paddles?
 Adult paddles can be used
to Pediatric patients but
pediatric paddles can not be
used to adult patients…
(ensure enough spacing, no overlapping of paddles)
 RT. hand

LT. hand
LT. hand

PRESSED WITH FINGERS

Planned Preventive Maintenance
1400 psi
10000 KPa
Oxygen Tank Checklist- Separate File
1100 psi
80 bar
 CHECKLISTS:
1. Daily Crash Cart Checklist
2. Daily Crash Cart Checklist for
Cleaning
3. Crash Cart Checklist for
Cleaning Every After Use
4. Monthly Crash Cart Equipment Checklist
5. Monthly Crash Cart Emergency
Drugs Expiry Checklist
6. Monthly Crash Cart Consumable
Expiry Checklist
7. PPM checklist
8. CPR Forms
9. Crash Cart Emergency Drug Request Form
10. ECG Strips (ongoing month)
 REFERENCE
• CRASH CART APP-GNR-284-08
• Advanced Cardiovascular Life
Support (ACLS) Provider
Manual, AHA, 2016
KFSHB-Nursing Education Department- MVL-01/28/2018
EMERGENCY
DRUGS
-Ensure proper labeling
-Familiarize with the placement on
the top drawer
 ADENOSINE
• Primary Uses:
– SVT/PSVT
–  Wide QRS Tachycardia
•  Dose:
–  First Dose: 6 mg RAPID IV Push (1-3 seconds)
– Second Dose: 12 mg IV Push
• Cautions/Notes
– Must be given as a bolus, followed by a flush
–  Can cause bronchospasm – use caution in asthmatics
–  Flushing / chest tightness are common
 AMIODARONE
• Primary Uses:
– Pulseless VT
–  Ventricular Fibrillation (V-Fib)
–  Recurrent Hemodynamically Unstable Ventricular Tachycardia
–  Hypertrophic Cardiomyopathy
–  Supraventricular Tachyarrhythmias
•  Dose:
– VT / V-Fib: 300 mg IV/IO. May give 150 mg after initial dose
– Tachy / VT: 150 mg IV/IO over 10 minutes. Continuous infusion of 1 mg/min IV for 6 hours, 0.5
mg/min IV for next 18 hours
• Cautions/Notes
– Atrial fibrillation, hypertrophic cardiomyopathy and supraventricular arrhythmias are often
treated with oral form of amiodarone
–  Rapid infusion causes hypotension
– If cumulative dosing exceeds 2.2 grams in 24 hours, significant hypotension can occur. Avoid
administration with any drug that may prolong QT interval
 ATROPINE SULFATE
• - Primary Uses:
– Symptomatic Bradycardia
– Organophosphate poisoning
• Dose:
– 0.5 mg IV (Repeat every 3 – 5 minutes
– Max dose: 3 mg
•  Cautions/Notes
– Dose less than 0.5 mg may cause paradoxical
bradycardia
 DOPAMINE HCl
• - Primary Uses:
–  Bradycardia
–  Hypotension
•  Dose:
–  2 – 20 mcg/kg/min infusion
– Titrated based on clinical response; tapered on/off slowly
• Cautions/Notes
– Extravasation causes tissue damage and necrosis
– Use caution if giving high doses through peripheral IV site
– May cause excessive vasoconstriction / tachyarrhythmias
–  Adequate volume resuscitation required before initiating dopamine
therapy
 EPINEPHRINE
•  Primary Uses:
– Cardiac Arrest
– Symptomatic Bradycardia
–  Anaphylaxis / Severe Allergic Reactions
– Severe Hypotension
• Dose:
– 1 mg (10 mL of 1:10,000 solution)
–  Repeat every 3 – 5 minutes
–  IV fluid Flush following each dose
– Endotracheal route: 2-2.5 mg diluted in 10 mL NS
•  Cautions/Notes
–  Higher doses often needed in cases of beta-blocker or calcium channel blocker
overdoses. A continuous infusion may be required
– High dose does not improve survival / neurological outcome
– High dose ceases myocardial dysfunction in post-resuscitation period
 LIDOCAINE
•  Primary Uses:
–  Ventricular Tachycardia
–  Ventricular Fibrillation
•  Dose:
–  Cardiac Arrest from VT / VT: 1 – 1.5 mg/kg IV/IO
– Refractory VF: Additional 0.5 – 0.75 mg/kg IV/IO; Repeat every 5 – 10 minutes for max of
3 doses, or 3 mg/kg
– Stable VT: 0.5 – 0.75 mg/kg up to 1.5 mg/kg; Repeat in 0.5 – 0.75 mg/kg doses to max of
3 mg/kg
– Maintenance Infusion: 1 – 4 mg/min
• Cautions/Notes:
–  Not recommended routinely after Cardiac Arrest, but can be used following ROSC
–  Can also be used for stable polymorphic ventricular tachycardia with normal baseline
QT AND torsades
–  Decrease maintenance doses if left ventricular dysfunction or if impaired liver function
– Not used prophylactically after myocardial infarction
 MAGNESIUM SULFATE
• - Primary Uses:
– Torsades de Pointes
– Hypomagnesemia (low magnesium)
–  Digitalis Toxicity
•  Dose:
–  Initial Dose: 1 – 2 g IV/IO diluted in 10 mL D5W
– Infusion Dose: 0.5 – 1 g/hour
•  Cautions/Notes:
– Rapid administration may drop blood pressure
– Very high doses can cause respiratory distress (calcium is antidote)
– Use with caution for patients with renal failure
 AMINOPHYLLINE
• Primary Uses:
– Vasodilator
– Bronchodilator
– Diuretic,
– Cardiac stimulant 
•  Cautions/Notes:
– If a patient has received theophylline the previous 24
hours, the serum concentration should be measured
before administering an intravenous loading dose to
make sure that it is safe to do so
CALCIUM CHLORIDE 10%
• Primary Uses:
– Hypocalcemia , hyperkalemia (with ECG changes)
hypermagnesemia

•  Cautions/Notes:
– Chalky taste ,hot flushness vomitting
constipation,kidney stone, irregular HR
 CALCIUM GLUCONATE
10%
• Primary Uses:
– Hyperkalemia, hypocalcemia
•  Cautions/Notes:
– Nausea, vomiting, constipation, increased
urination, dry mouth
 DEXTROSE 50%
• Primary Uses:
• Hypoglycemia, altered level of consciousness
•  Cautions/Notes:
– May cause phlebitis ,thrombosis of vein , pain
 DILTIAZEM
• Primary Uses:
− Controls rapid ventricular rates
•  Cautions/Notes:
– Voice changes, congestion, trouble in
swallowing, body ache
 DIGOXIN
• Primary Uses:
– Cardiogenic shock, CHF
•  Cautions/Notes:
– Tachydysrhythmias, severe hypotension
 FUROSEMIDE
• Primary Uses:
– Causes increased
urine output
– CHF, pulmonary edema, hypertensive crisis

•  Cautions/Notes:
– Hypovolemia, anuria, hypotension
 HYDROCORTISONE
• Primary Uses:
– Shock due to acute adrenocortical insufficiency,
anaphylaxis, asthma, and COPD

•  Cautions/Notes:
• Corticosteroids should be used cautiously in patients with ocular herpes
simplex because of possible corneal perforation.
 ISOPROTERENOL
• Primary Uses:
– Bronchospasm during anesthesia; adjunctive treatment for
shock.
•  Cautions/Notes:
• Contraindicated with cardiac arrhythmias associated with tachycardia; tachycardia
or heart block caused by digitalis intoxication; angina; ventricular arrhythmias
requiring inotropic therapy
 NITROGLYCERINE
• Primary Uses:
– Acute angina pectoris, ischemic chest pain
•  Cautions/Notes:
– May causeBloating or swelling of
face ,numbness ,wheezing
Rapid weight gain,dyspnoea
 NOREPINEPHRINE
• Primary Uses:
– Cardiogenic shock, unresponsive to fluid resuscitation
•  Cautions/Notes:
– May cause Headache weakness,
dizziness,tremorpallor,precardial pain
 PROPANOLOL
• Primary Uses:
– Cardiogenic shock, unresponsive to fluid resuscitation
•  Cautions/Notes:
– May cause Headache weakness,
dizziness,tremorpallor,precardial pain
 SODIUM BICARBONATE
• Primary Uses:
– Metabolic acidosis during cardiac arrest, tricyclic
antidepressant.
•  Cautions/Notes:
– Repeat as needed in tricyclic antidepressant overdose until QRS
narrows
 VASOPRESSIN
• Primary Uses:
– Alternative vasopressor
to the first or second
dose of epinephrine
in cardiac arrest
•  Cautions/Notes:
– Use with caution in patients with coronary artery
disease, epilepsy, or heart failure.
 VERAPAMIL
• Primary Uses:
– Paroxysmal supraventricular tachycardia, atrial flutter, and
atrial fibrillation with rapid ventricular response
•  Cautions/Notes:
– Contraindicated with Wolff-Parkinson-White
syndrome,Lown-GanonLevine syndrome
 DRUGS THAT CAN BE
GIVEN VIA ETT
• Oxygen
• Naloxone
• Atropine
• Vasopressin
• Epinephrine
• Lidocaine
 ETT ROUTE
• AHA Guidelines1 suggest that in the ADULT the
tracheal administered drug should be in 10 mL
of solution and;
• (PEDS) in pediatric patients the drug should
be diluted up to 5 mL.
• The volume of solution (and the optimal drug
doses) to give to neonates is unclear,10 but a
reasonable volume to use is 2 mL.
 ETT ROUTE
• FOR ADULTS, the recommendation is to give
all ET drugs at 2 to 2.5 times the
recommended IV dose.
• PEDS: The recommended ET dose of
epinephrine for pediatric patients is
approximately 10 times the dose given via an
IV route (Class IIb)