A crash cart is a locked metal cabinet on wheels that contains equipment, medications and supplies needed to handle medical emergencies in a hospital setting. While there may be some variation in contents from one facility to another, the crash cart essentially has all items needed to handle respiratory and cardiac emergencies.
A cardiac monitor/defibrillator normally sits on top of the cart for easy access. There are many types and brands of monitors; the important thing to know is what type of monitor your facility uses, and to be familiar with how to operate it. The monitor shows the patient's heart rhythm and rate and allows real-time assessment of how the patient is responding to treatment.
Newer monitors have very simple, numbered controls, making it easy to operate quickly in an emergency. The old-fashioned paddles for shocking have given way to foam-like pads that have a sticky surface to quickly adhere to the patient's skin, allowing shocks to be delivered hands-free and maximize safety for personnel.
The backboard is hung on the back of the crash cart, and is placed under the patient to provide a firm surface upon which to perform chest compressions. Chest compressions on a hospital bed without the backboard are largely ineffective, because of the soft mattress. An oxygen tank is located on the outside of the crash cart.
Airway Management Devices
A variety of face masks for oxygen delivery are available in the respiratory section of the cart. The most important oxygenation device is the ambu bag, which is placed over the patient's mouth and nose and squeezed to deliver respirations until an advanced airway can be placed. For a patient breathing on his own, nasal cannulas, non-rebreathers, and venturi masks are stocked.
An intubation tray contains endotracheal tubes of various sizes, lighted laryngoscopes to visualize placement, and tube holders to secure the airway in place. Should intubation attempts be unsuccessful, alternative airway devices placed in the nasal cavity or mouth are also available.
IV Access Devices
Most patients in the hospital setting will already have IV access for delivery of drugs. However, IV supplies are available if needed. If IV access is unobtainable, an intraosseous needle that delivers medication directly into the tibia bone of the leg may be used by IO certified providers. IV tubing and saline bags are also found with IV supplies.
ACLS and emergency drugs are included for immediate access. Prior to intubation by anesthesia, the patient may receive etomidate and succinylcholine for sedation and paralyzation. Drugs are packaged in single-dose vials saving time by not having to draw up each drug. Typical drugs include atropine, epinephrine, amiodarone, nitroglycerin, sodium bicarb, morphine and lidocaine. Infusion bags of medications to sustain blood pressure such as dopamine and vasopressin may also be available. Medications to treat hypoglycemia, oversedation and allergic reactions are also included.
Pediatric Crash Carts
In areas that treat children, a special pediatric crash cart is available. It is easily recognizable as being a different color from the adult carts, which are usually red. The pediatric crash cart has drugs bundled in color-coded packs based on weight ranges. A special tape measure is used to measure the child's length/height and gives a weight range, allowing for the correct drug dosages to be used.