Crash Carts

The crash cart is the commonly used term to describe a self-contained, mobile unit
that contains virtually all of the materials, drugs, and devices necessary to perform a
code. The configuration of crash carts may vary, but most will be a waist high or
chest high wheeled cart with many drawers. Many hospitals will also keep a
defibrillator and heart monitor on top of the crash cart since these devices are also
needed in most codes. Since the contents and organization of crash carts may vary, it
is a good idea for you to make yourself aware of the crash cart that you are most
likely going to encounter during a code.
What is in a crash cart?
The size, shape, and contents of a crash cart may be different between hospitals
and between different departments within the same hospital. For example, an
adult crash cart is set up differently than a pediatric crash cart or crash cart on the
medical service may be different than the one on a surgical service.
Medications
Medications are usually kept in the top drawer of most crash carts. These need to be
accessed and delivered as quickly as possible in emergent situations. Therefore, they
need to be available to providers very easily. The medications are usually provided in
a way that makes them easy to measure and dispense quickly.
The common set of first drawer medications might be:
 Alcohol swabs
 Amiodarone 150 mg/3ml vial
 Atropine 1mg/10 ml syringe
 Sodium bicarbonate 50mEq/50 ml syringe
 Calcium chloride 1gm/10 ml syringe
 Sodium chloride 0.9% 10 ml vial Inj. 20 ml vial
 Dextrose 50% 0.5 mg/ml 50 ml syringe
 Dopamine 400 mg/250 ml IV bag
 Epinephrine 1 mg/10 ml (1:10,000) syringe
 Sterile water
 Lidocaine 100 mg 5ml syringes
 Lidocaine 2 gm/250 ml IV bag
 Povidone-Iodine swabstick
 Vasopressin 20 units/ml 1 ml vial
If the crash cart also contains pediatric medications these may be contained in the
second drawer. Often these would include:
 Atropine 0.5 mg/ 5 ml syringe
 Sodium bicarbonate 10 mEq/10 ml syringe
 Saline flush syringes
 Sodium chloride 0.9% 10 ml flush syringe
The second drawer of the crash cart might also contain saline solution of various
sizes like 100 mL or 1 L bags. A crash cart in the surgery department may include
Ringer’s lactate solution.
 Intubation
Many crash carts will also include most of the materials necessary to perform
intubation. These may be contained in the third or fourth drawers depending on the
setup of the particular crash cart.
The adult intubation drawer will contain:
 Endotracheal tubes of various sizes
 Nasopharyngeal and perhaps oropharyngeal airways
 Laryngoscope handle and blades of different sizes
 A flashlight with extra batteries
 A syringe of sufficient size to inflate the cuff on it endotracheal tube
 Stylets
 Bite block
 Tongue depressors
 Newer setups may also include the materials needed to start quantitative
waveform capnography like a nasal filter line
Pediatric intubation materials may be in a separate cart or if they are included in the
adult crash cart they may occupy their own drawer. The pediatric intubation supply
drawer may contain the following:
 2.5 mm uncuffed endotracheal tube
 3.0 mm – 5.5 mm microcuff endotracheal tubes
 Pediatric Stylet (8 Fr)
 Neonatal Stylet (6 Fr)
 Nasopharyngeal and perhaps oropharyngeal airways,
 Laryngoscope blades
 Disposable Miller blades
 Disposable Macintosh blades
 Armboards of various sizes
 Vacutainers for blood collection
 Spinal needles
 Suction catheters of various sizes
 Bone marrow needles of various sizes
 Feeding tubes
 Umbilical vessel catheter
 Disinfectants (swab sticks)
 Pediatric IV kits
Intravenous lines
It is usually the case that the equipment necessarily to start an IV is in a separate
drawer from materials needed to maintain an IV, such as the fluids in the tubing. The
IV drawer(s) usually contain the following:
 IV Start Kit
 Angiocatheters 14 Ga and/or 16 Ga
 Disinfectants (Chloraprep, Betadine, povidone-iodine)
 Luer lock syringes of various sizes
 Tourniquet tubing
 Insyte autoguards of various sizes
 Vacutainers
o Blue top
o Purple top
o Green top
o Red top
o Spinal needles of various sizes
o Regular needles of various sizes
o 3-Way stopcock
o Tape
o Armboards
o ABG syringes and sampling kits
o Catheter tips
o Tubing
o IV solutions may also be kept in this drawer
Procedure drawer
The bottom drawer on crash carts is usually devoted to keeping prepackaged kits
available for various urgent and emergent procedures (or it is where the IV solutions
are kept). In any case, the following kits may be found in the procedure drawer:
 ECG electrodes
 Sterile gloves of various sizes
 Sutures of various sizes and materials
 Suction supplies
 Salem pump
 Cricothyroidotomy kit
 Adult and pediatric cut down pack
 Yankauer suction
 Drapes to create a sterile field
 Large bore needle and syringe (for tension pneumothorax)
 Suction Cath Kit 14 Fr & 18 Fr
 Lumbar puncture kit
What are the most important things you must have on and in your cart?
 

Cardiac monitor/defibrillator

This is a very important piece of equipment and will likely be used in most codes. If
your patient is found to be in a lethal cardiac rhythm, your defibrillator will be
necessary to “shock” the heart back into a normal rhythm. The monitor/defibrillator
should be checked daily and must be properly charged when not in use.
 

Portable suction machine

If a code occurs somewhere other than the bedside, if in-wall suction is not available,
or if the in-wall suction is not functioning, your portable suction machine will be
necessary. Whether you need to clear the airway for intubation or to remove vomit
or foreign materials from the oropharynx, this handy tool will get the job done. Just
like the defibrillator it needs to be regularly checked and charged so that it is alway
ready to go in an emergency.
 

Airway equipment

You’ll want a range of airway equipment available for you to use, from basic to more
advanced. Your cart should have bag valve masks, oral and nasal airways, oxygen
masks and nasal cannulas. Intubation equipment should also be stocked, including
various sized endotracheal tubes, laryngoscopes and stylets. If supraglottic airways
are available, they can be very useful in the case of a difficult airway or when
appropriate personnel are not available for intubation.
 

IV access equipment

Being able to secure IV access is needed during a code, so your cart must have all of
the necessary supplies. This includes angiocaths of different sizes, syringes, tubing,
and IV solutions. You’ll need tape, and perhaps transparent film dressings and arm
boards to help secure the site. Blood draw equipment and blood gas syringes can
also be stored here.
 

Medications

Your crash cart should include medications to treat a cardiac arrest, such as
Epinephrine and Amiodorone. In the case of a cardiac dysrhythmia, you’ll need
medications such as Cardiazem, Adenosine, and Atropine. Dopamine, Sodium
Bicarbonate and Calcium Chloride are other commonly stocked medications. You’ll
want to have syringe flushes of sodium chloride too.
 
Procedure equipment

There are a few different procedures that may occur during a code or shortly after,
and your crash cart should include the necessary supplies. This includes central line
procedure trays and cricothyroidotomy kits. Extra sterile gloves and sterile drapes
should be stocked as well.

In the middle of a code, you want to have all your needed equipment and supplies
right there at your fingertips. Your specific facility and types of patients that you
treat may dictate some changes in the materials that you stock, but use this list as a
starting point to make sure you have the basics covered.
A crash cart is an integral component of emergency patient care. Although most
emergency departments use these carts to treat cardiac arrest, they can also treat
other emergency conditions and ensure that providers are able to promptly attend
to patients at a high risk of serious morbidities and mortality. 

What You Need in Your Crash Cart 

A basic crash cart must include all of the items necessary to meet the American
Heart Association’s guidelines for CPR and emergency cardiovascular care. The
needed items are as follows:
 
1. Resuscitation equipment, including: 

 Defibrillator
 Adult and infant paddles
 CPR backboard
 Bag valve masks
 Oxygen tube connector
 Pediatric bag valve masks and oxygen tube connectors
 
1. Personal protective equipment and disinfecting supplies, including:

 N95 masks
 Sanitizing wipes
 Disposal bags
 Alcohol-based hand sanitizer
 
1. Materials for establishing peripheral venous access, including:

 Angiocatheters
 Spinal needles
 Syringes and needles
 Sutures
 Nasal packs and balloons
 Femoral and arterial line catheters
 
1. Airway management equipment, such as:

 A suction machine and catheters
 An oral airway
 An endotracheal tube
 A nasogastric tube
 A stylet
 
1. Supplies for special procedures, such as:

 A delivery kit
  A pericardiocentesis kit
 A thoracostomy kit
 A cut down tray
 
1. There are also a number of medications you should include in your kit.
Organize these medications according to their intended use, and put the
medications your patient population uses the most in easily accessible locations.
These medications include:

 Resuscitation medication
 Antihypotensives
 Rapid sequence induction medication
 Antihypertensives, such as norepinephrine, adenosine,
hydrocortisone, magnesium, epinephrine, sodium bicarbonate, atropine,
ketamine, vecuronium, etomidate, labetalol, thiamine, glucagon, thyroxine,
narcan, and calcium chloride