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A crash cart, commonly called a code cart, is found in many healthcare settings; specifically, those in which patients are at the most risk for a cardiac or respiratory event. Some of the areas in which you will find a crash cart include hospitals, emergency rooms, urgent care centers, outpatient surgery centers, and cardiac stress testing centers.
Crash carts are often made up as a set of drawers, trays, or shelves on a mobile cart that can be easily transported to different locations during emergencies for life support protocols to assist in saving a person’s life. Crash carts contain various medical supplies and medications needed during an emergency situation. These carts are used by the patient's medical team, and it is important that the items inside them be easy to locate. The contents of each drawer are well thought out, organized and labeled. Each cart has a locking device on it to ensure that all items that need to be in the cart are there and to protect against theft.
As stated above, crash carts contain many medical supplies such as a heart monitor and defibrillator, oxygen tank, stethoscope, endotracheal tubes which are often used to keep the airway open in order to administer oxygen, medicine, or anesthesia. Crash carts also include IV fluids and supplies used to start and maintain an IV, blood pressure cuffs, flashlights, anesthesia bags, and a cricothyrotomy kit. A cricothyrotomy kit is an emergency airway device that allows quick and safe ventilation in the presence of acute respiratory distress with upper airway obstruction.
Below are 7 common medications found in crash carts:
Epinephrine - In a lot of cases, epinephrine is the main medication used and can be used every 3-5 minutes during a code. Epinephrine is a vasopressor. Vasopressors are a group of medications that contract, or tighten blood vessels and raise blood pressure.
Amiodarone - Amiodarone is an antiarrhythmic drug. Antiarrhythmic drugs are used to prevent and treat heart rhythms that are too fast or irregular.
Atropine - Atropine is used to keep heart rates stable after a heart attack.
Calcium Gluconate - Calcium gluconate is a medication used to manage hypocalcemia (a deficiency of calcium in the bloodstream), cardiac arrest (sudden, unexpected loss of heart function, breathing, and consciousness), and cardiotoxicity (damage to the heart muscle) due to hyperkalemia (a medical problem in which you have too much potassium in your blood) and hypermagnesemia (a rare condition in which there is too much magnesium in your blood). Calcium gluconate can also be used for calcium channel blocker overdoses. Calcium channel blockers are a group of medications that are used as antihypertensive drugs, or drugs used to decrease blood pressure in patients with hypertension.
Sodium Bicarbonate - Sodium bicarbonate is commonly used during CPR (cardiopulmonary resuscitation) during cardiac arrest to correct metabolic acidosis, which is a condition in which too much acid accumulates in the body due to a variety of reasons which include a buildup of toxins in the body, kidney failure, ingestion of certain drugs or toxins, such as methanol or large doses of aspirin and can also be a rare complication of diabetes. Sodium bicarb can also be used in patients with hyperkalemia (high potassium levels).
Dopamine - Dopamine is often used to treat low blood pressure, low heart rate, and cardiac arrest and during a code can act as a vasodilator, which assists in bringing better circulation to the brain, myocardium (muscular tissue of the heart), and kidneys.
Naloxone - Naloxone, more commonly known to most of us as Narcan is a very important part of a crash cart. This medication works as an antidote to specific opioid medications such as oxycodone, morphine, and fentanyl. What this means is that should a person overdose on one of these medications, Naloxone will help to reverse any effects that an opioid overdose could potentially cause, including CNS (central nervous system) and respiratory depression, altered levels of consciousness, and coma.
The list above is not an extensive list of what is found in a crash cart. It is important that technicians know and understand their roles involved with crash carts. Technicians are generally responsible for restocking crash carts through a medication verification system after they are used and/or when there are medications inside them that are near their expiration date. Technicians are often also responsible for ensuring that these carts are located in the correct locations and sometimes for stocking these in Omnicell or Pyxis machines for easier access in some areas. Always check with your company's policy and procedure manual and refer to your pharmacist for questions regarding crash carts.