Emergency Cart

Definition of an Emergency Cart 

An emergency cart or most commonly knowna s   “ c r a s h   c a r t ”

i s   a   w h e e l e d   c a b i n e t   o r c h e s t   o f   drawers which contains all of the equipment
necessary  f o r   e m e r g e n c y   r e s u s c i t a t i o n ,   f r o m   l a t e x gloves to a defibrillator. Crash carts are
conveniently positioned throughout hospitals and some other medical facilities so that they can be quickly
accessed in an emergency. It includes medication as well as the equipment for
defibrillation,intubation,intravenous medication, and passage of central lines.

Purposes of Emergency Cart 

To ensure availability of all drugs, equipment, and supplies necessary to initiate
advanced life-support measures.To have the emergency cart and Defibrillator constantly ready for use
in caseof life threatening condition such as cardiopulmonary arrest.

Indications of Emergency Cart 

This emergency equipment is used only if the patient's heart or lungs stop working. The cart is
brought to the patient's bedside when the patient's heart or lungs are failing or have failed. Using the tools
on a crash cart requires advanced medical skills and certification in Advanced CardiacLife
Support(ACLS), a medical protocol  which  dictates  which  medical  interventions  should  be  used  in
an emergency, and when.

Uses of Emergency Cart 

It is used in hospitalemergency roomsfor transportation and dispensing
of emergency medication/equipment at site of medical/surgical emergency for life support
protocols (ACLS/ALS) to potentially save someone's life.

Contents of Emergency Cart

Top of trolley:

1. Defibrillator & cardiac monitor

2.  Adult paddles
3. Pedi-paddles
4. Conducting Gel
5. ECG cable
6.  ECG paper
7.  ECG electrode
8. Sphygmomanometer
9.  Clock
10. Pediatric & adult stethoscope
11. Resuscitation bag with O2 tubing & reservoir (Infant, Pediatric, Adult)
 12. Resuscitation mask (sizes: 0, 1,2,3,4 & 5)
13. Drip stand
14. Sharps container
15. Tape of securing EET
16. Razor

Side of cart:

1. Portable suction machine

2. Suction machine

3.  Pediatric & adult yankauer sucker

4. Oxygen cylinder with:

 Pressure reducing valve

 Pressure gauge

 Nipple adaptor

 Cylinder key

 Flow meter

5. Oxygen tubing connected to the flow meter

6. Code blue performance quality sheet

7. Code blue attendance sheet

Back of cart:

1. Adult & pediatric algorhythms

2. Cardiac board

3.  Crash cart checklist
4. Resuscitation form

Drawer 1 - Medications:

Drugs:

1. Adenosine

2. Amiodarone

3. Epinephrine

4. Flumazenil

5. Ketamine

6. Magnesium sulfate

7.  Naloxone

8.  Norepinephrine

9. Normal saline solution

10. Vasopression

11. Verapamil

Pre – mixed medications:

1. Atropine

2. Calcium chloride 10%

3. Dextrose 50%

4. Adrenaline

5. Lidocaine

6. Sodium bicarbonate

7. Dopamine 400mg/250ml
 Drawer 2 - Breathing and Airway

1. AMBUBAG

2. Artery forceps

3. Endotracheal tubes, each size: 6.0, 7.0, 7.5, 8.0, 8.5, 9.0 12

4. Oxygen non-breather mask (infant, pediatric & adult)

5. Pediatric & adult oxygen nasal canella

6. Oral airway (sizes: 0, 1, 2, 3, 4&5)

7. Minitrach

8. Pediatric & adult Magill's forceps

9. Scissors

10. Tongue depressors

11. Suction catheter

12. Nasogastric tube

13. Yankauer Suction Catheter

14. Lubricant

15. Tracheostomy tubes, each size: Adult shiley blue box: #4, #6, #8

16. Inner Cannulas, Each size: Adult shiley blue box: #4, #6, #8

Drawer 3 - IV Supplies

1. 3 ways stop-cocks

2. ABG syringes

3. Alcohol swabs

4. Angiocaths
5. Blood tube (red, blue & pink)

6. Butterflies (sizes: 21G, 23G & 25G)

7. Cardiac needle 20G

8. Needle (sizes: 18G, 21G & 25G)

9. Tourniquet

10. Transparent tape

11. Syringes (sizes: 1,3,5,10,20 & 50ml)

12. Intraosseous needle 18G

13. Scalpel with blade

14. Sterile gauze (size: 10×10)

15. Dressing (size: 10×10)

16. Skin disinfectant spray

17. Sutures (2.0 & 4.0 silk & cutting needle)

18.3 lumen central catheters

19. Chest tubes (sizes: 12, 14, 28 & 32fr)

20. Betadine solution

Drawer 4 - I.V. Solutions & Tubing

1. D5W 500cc

2. D5W 250cc

3. D5W 500cc WITH LIDOCAINE .4% PRE-MIXED

4. LACTATED RINGERS 1000cc

5. NORMAL SALINE 1000cc

6. NORMAL SALINE 250cc

7. MACRODRIP

8. MICRODRIP
9. HORIZON CASSETTES

10. EXTENSION TUBING

11. BURETROL

12. BLOOD TUBING

13. ARMBOARDS

Emergency Solutions / IVF

1. D5W 500cc/250cc (Dextrose in 50% water) - It is used to supply water andcalories to

the body. It is also used as a mixing solution (diluent) for other IV medications. Dextrose is a
natural sugar found in the body and serves as a major energy source. When used as
an energy source, dextrose allows thebody to preserve its muscle mass

2. LACTATED RINGERS 1000cc - is often used for fluid resuscitation after a blood loss due to
trauma,surgery, or a burn injury.

3. NORMAL SALINE SOLUTION 1000cc/250cc (NSS) - Normal saline can be used to cleanse,
irrigate, or moisturize wounds. It is also used in IV fluids for dehydration and in contact lens
solutions.
 EMERGENCY DRUGS

ACLS/ PALS/ NALS

Adenocard

adenosine

Adrenalin

amiodarone

atropine

Cardizem

diltiazem

dobutamine

dopamine

epinephrine

inamrinone

Levophed

lidocaine

Lopressor

magnesium sulfate

metoprolol

milrinone

Neo-Synephrine

norepinephrine

phenylephrine injection

Pitressin

Primacor

procainamide

vasopressin

verapamil
ACLS/ PALS/ NALS

Xylocaine

Anaphylaxis
Drug Names
Adrenaclick
Adrenalin
epinephrine
Epipen
Epipen Jr
glucagon
methylprednisolone sodium succinate
Solu-Medrol
Twinject

Toxicity 1: Drugs
Drug Names Codes
2-PAM (common name)
Acetadote
acetylcysteine
atropine
Colestid
colestipol
Digibind
DigiFab
Enlon
flumazenil
Fusilev
glucagon
glycopyrrolate
leucovorin
Levsin
Mephyton
methylene blue
Mucomyst
naloxone
Narcan
neostigmine
OraVerse
physostigmine
phytonadione
Prostigmin
protamine sulfate
Protopam
Toxicity 1: Drugs
Drug Names Codes
Robinul
Romazicon
vitamin K (common name)

Toxicity 2: Envenomations
Drug Names
Antivenin (Latrodectus mactans)
Antivenin (Micrurus fulvius)
CroFab

Toxicity 3: Metals
Drug Names Codes
BAL In Oil
Chemet
Cuprimine
deferoxamine
Desferal
Exjade
Syprine

Toxicity 4: Organophosphates
Drug Names Codes
2-PAM (common name)
AtroPen
atropine
DuoDote
NAPPS (common name)
Pralidoxime Auto-Injector
Protopam

Toxicity 5: Radiation
Drug Names Codes
Iosat
ThyroSafe
ThyroShield
Toxicity 6: Other
Drug Names Codes
Actidose with Sorbitol
Actidose-Aqua
Antizol
Cyanide Antidote Package
Cyanokit
ethyl alcohol
fomepizole
ipecac syrup

Common Emergency Drugs

Emergency Drug Initial Dose Indications
Adenosine 6 mg
Atropine sulfate 0.5 – 1 mg.q 3-5 min Bradycardia
Epinephrine 1 mg.q 3-5 min Cardiac arrest
Lasix 0.5-1 mg/kg Pulmonary edema
Lidocaine 1-1.5 mg/kg Ventricular fibrillation, Ventricular tachycardia
Magnesium sulfate 1-2 g Ventricular tachycardia r/t hypomagnesemia
Morphine Sulfate 1-3 mg Chest pain, pulmonary edema
Narcan 0.02-2mg Narcotic – respiratory depression
Nitroglycerine 0.4 mg SL Chest pain, pulmonary edema
Vasopressin 40 units Cardiac arrest
 EMERGENCY SITUATIONS

Myocardial Infarction

Diagnosis: Pain r/t tissue ischemia (coronary artery occlusion)

Nursing Responsibilities

Independent:

•Obtain full description of pain from patient including location, intensity (0–10), duration, characteristics
(dull/crushing), and radiation. Assist patient to quantify pain by comparing it to other experiences

•Instruct patient to report pain immediately.

•Provide quiet environment, calm activities, and comfort measures

•Assist/instruct in relaxation techniques, e.g., deep/slow breathing, distraction , behaviors, visualization,

guided imagery

Collaborative:

•Administer supplemental oxygen by means of nasal cannula or face mask, as indicated

Administer medications as indicated:

•Antianginals, e.g., nitroglycerin, isosorbide dinitrate (Isordil)

•Beta-blockers, e.g., atenolol (Tenormin), propranolol (Inderal), metoprolol (Lopressor)

•Analgesics, e.g., morphine, meperidine (Demerol)

CVA

Impaired verbal communication related to loss of facial or oral muscle tone control.

Nursing Responsibilities

•Provide alternative methods of communication, like pictures or visual cues, gestures or demonstration.

•Anticipate and provide for patient’s needs.

•Talk directly to patient. Speaking slowly and directly. Use yes or no question to begin with.

•Speak in normal tones and avoid talking too fast. Give patient ample time to respond.

•Encourage family members and visitors to persist efforts to communicate with the patient.
SEIZURES

Diagnosis: Risk for trauma related to loss of large muscle coordination

Nursing Responsibilities

Independent:

•Explore with the patient the various stimuli that may precipitate seizure activity.

•Discuss seizure warning signs and usual seizure pattern.

•Keep padded side rails up with bed in the lowest position.

•Evaluate need for protective head gear.

•Maintain strict bed rest if prodromal signs or aura experienced.

•Turn head to side or suction airway as indicated. Insert plastic bite block only if jaw are relaxed.

•Cradle head, place on soft area, or assist to floor if out of bed.

•Reorient patient following seizure activity.

Collaborative:

•Administer medications as indicated.

ANGINA PECTORIS

Diagnosis: Acute pain related to decreased myocardial blood flow

Nursing Responsibilities

 Assess for vital signs and symptoms of pain such as facial grimacing, rubbing of neck or jaw,
reluctance to move, increased blood pressure, and tachycardia. Note onset, duration, location, and
pattern of pain.
 Use a pain rating scale to assess the patient’s perception of the pain’s severity.
 Administer sublingual nitroglycerin as ordered.
 Instruct the patient to notify a nurse immediately when experiencing pain. Have the patient stop
current activity, and place him on bed rest in a semi -to high Fowler’s position.
 Administer oxygen as ordered.
 Obtain a 12-lead ECG immediately during acute chest pain.
 Stay with the patient during chest pain episodes.
BRONCHIAL ASTHMA

Diagnosis: Ineffective airway clearance related to increased production of secretions

Nursing responsibilities:

Independent:

•Auscultate breath sounds. Note adventitious breath sounds like wheezes, crackles and rhonchi.

• Elevate head of the bed, have patient lean on overbed table or sit on edge of the bed.

• Keep environmental pollution to a minimum like dust, smoke and feather pillows, according to
individual situation.

• Encourage or assist with abdominal or pursed lip breathing exercises.

• Assist with measures to improve effectiveness of cough effort.

•Increased fluid intake to 3000 ml/ day. Provide warm or tepid liquids.

Collaborative:

•Administer bronchodilators as prescribed.

FEVER

Diagnosis: Hyperthermia related to dehydration

Nursing Responsibilities

Independent:

•Monitor heart rate and rhythm.

•Record all sources of fluid loss such as urine, vomiting and diarrhea.

• Promote surface cooling by means of tepid sponge bath.

•Wrap extremities with cotton blankets.

• Provide supplemental oxygen.

• Administer replacement fluids and electrolytes.

•Maintain bed rest.

• Provide high calorie diet, tube feedings, or parenteral nutrition.

• Administer antipyretics orally or rectally as prescribed by the physician.