What’s an Emergency department?

An emergency department essentially is an area in the

hospital that’s responsible for the provision of medical and surgical care to patients arriving at
the hospital in need of immediate care. Every day, around the world millions of people need
emergency care. People seek care for infections and injuries, heart attacks and strokes, asthma or
complications during pregnancy. An organized integrated emergency care system gets care to
people and people to care, timely emergency saves lives when an emergency occurs bystanders
are essential to provide first aid until professional care is available bystanders need to be able to
call for help ideally through a universal access number, To know the basics of first-aid to safely
assist the ill and injured, and lastly to be protected by a good Samaritan law.
Universal access numbers allow bystanders to activate the system so that trained pre-
hospital can be dispatched. Once at the scene these can rapidly assess and stabilize the patient for
transports using specific protocols, they identify the destination hospital that can best provide the
needed care during transport the patient’s condition is continuously monitored and interventions
are performed. Ambulances always need at least two personnel one to monitor and manage the
patient during the transport and another to drive an ambulance personnel should be able to
communicate with the hospital prior to arrival if needed.
At the hospital during handover, the ambulance provider quickly gives critical
information to hospital personnel as patients arrived. They are triage to different areas to ensure
the life-threatening conditions are recognized and that all patients receive the care they need
when they need it.
Triage is done by assigning patients to categories based on accuracy of their conditions.
Some patients need to be seen immediately while other patients may safely wait. Trained
personnel use clear protocols and specific equipment to assess and manage patients. After initial
care is provided in the emergency unit patients might be admitted to other hospital units for
further inpatient care, transfer to another facility or discharged home after the treatment.

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 swab stick
 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
 Angio-catheters 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
 Blue top
 Purple top
 Green top
 Red top
 Spinal needles of various sizes
  Regular needles of various sizes
 3-Way stopcock
 Tape
 Arm boards
 ABG syringes and sampling kits
 Catheter tips
 Tubing
 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