Any facility that treats patients who have the potential to have a sudden deterioration in their condition should have a crash cart available. State regulatory agencies require certain facilities to have a crash cart, but they are recommended for many more. This would include hospitals, outpatient surgery centers, urgent care centers, and all centers where conscious sedation is performed. Nursing homes who provide treatment for patients in cardiac arrest until EMS arrives would also have a need for a crash cart. Physician offices who perform certain diagnostic testing such as cardiac stress testing or stress echocardiogram also must have a crash cart available.
What is in a crash cart? There is a basic list that all crash carts contain. All carts contain:
- Basic airway equipment including bag valve masks, oral and nasal airways, oxygen masks and nasal cannulas, Magill forceps
- Intravenous access equipment (or intraosseous) including angiocaths, IV tubing and IV fluid. If the facility elects to utilize intraosseous access for emergency medications, then a drill and needles must be included.
- Medications utilized in the treatment of cardiac arrest including epinephrine and amiodarone.
- Medications utilized to treat cardiac dysrhythmias including adenosine, cardiazem, a beta blocker (usually Lopressor®), and Atropine.
- Monitor equipment with a defibrillator or an AED
- Medications to treat allergic reactions such as EpiPens®, Solu-medrol® and Benadryl®
- Aspirin 81mg PO
- Nitroglycerin spray or 0.4mg tablets
Additionally, carts being utilized for specialized areas may add or subtract from the basic list. Depending upon the specialty of the facility, the following may be added:
- Endotracheal intubation equipment if anesthesia personnel are present in the facility
- King Airways – in facilities without anesthesia personnel or as a bail out airway for the patient with a difficult airway
- Narcan – to reverse the effects of narcotics in facilities where narcotics or sedation is used
- Additional antiarrhythmics – particularly in physician offices who do cardiac stress testing
Maintenance of Crash Cart
The worst thing ever is to reach for a piece of emergency equipment or an emergency medication and find it inoperable or expired. It is important that the crash cart be checked regularly and maintained so that its contents are there when needed.
The following 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 promptly 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