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
  • Blue top
  • Purple top
  • Green top
  • Red top
  • Spinal needles of various sizes
  • Regular needles of various sizes
  • 3-Way stopcock
  • Tape
  • Armboards
  • 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