Crash Carts: Preparation and Maintenance
Updated from Veterinary Technician March 2013 (Vol 34, No 3) by the author and peer reviewed by Today’s Veterinary Nurse. Used with permission from VetFolio, LLC. Veterinary Technician articles published from January 2005 through August 2013 can be accessed without subscription at vetfolio.com/veterinary-technician-archives.
Many different types of emergencies can present at veterinary practices at any time of day. Having a centrally located station for emergencies with a crash cart that is stocked and ready to use is essential for saving time, which is crucial in emergencies and should not be wasted by scrambling to gather supplies. A crash cart can be designed to fit the needs of any hospital and can help stabilize critically ill or injured patients.
A crash cart can be as simple as a mobile, compact cart equipped with medical equipment and supplies for various emergencies. The size of the cart depends on the number and types of emergencies a hospital manages. Multiple-doctor, high-volume hospitals typically have larger, more complete crash carts than smaller, low-volume hospitals. Crash carts are commercially available (FIGURE 1), but hospitals can prepare their own using a large or a small toolbox (FIGURES 2 and 3) or even a cabinet drawer.
The same equipment can be used for canine and feline emergencies, so the same crash cart can be used for both species. Lidocaine is the only emergency drug with different doses for feline and canine patients. The different doses are noted in TABLE 1, which is an example of an emergency drug chart.
A hospital’s crash cart should be located in the central treatment area and in areas where patients are anesthetized. The station should be near oxygen and suction sources to increase cardiopulmonary resuscitation (CPR) success rates. Hospitals that have separate wards or treatment areas should consider maintaining multiple crash carts to cover all areas.
Studies have shown that environmental factors (e.g., location of the crash station); availability of up-to-date checklists, flow charts, and easy-to-follow aids; and maintenance of a well-stocked, organized cart can help improve the success rate of CPR. In human medicine, it has been proven that a pre-stocked station that includes the proper crash cart and CPR aids such as flow charts and algorithms improves the outcome of cardiopulmonary arrest.
Crash carts should include emergency medications, intravenous catheters and fluids, and a defibrillator. Carts should be fully stocked and in date at all times, and each drawer should be labeled. All staff members should know what is in the cart and where to find each item. BOX 1 lists common supplies in a crash cart.
All personnel should know how to use all the equipment in a crash cart. Staff training can be essential in saving a patient’s life. Scenario-based training should be conducted regularly to train new employees and refresh the skills of the established staff. Written emergency protocols and quick-reference guidelines on how to use the crash cart should be posted, and the team leader should ensure that all staff members understand them.
Organizing a Crash Cart
Organizing a crash cart requires understanding of how a life-threatening emergency progresses. In human medicine, most crash carts have 5 to 9 drawers. In veterinary medicine, most crash carts can be organized into 5 drawers. An example system for organizing crash carts follows.
Top of the Cart
The top of the crash cart could include an electrocardiograph, a defibrillator, a capnograph, a pulse oximeter, Ambu bags of various sizes, and a blood pressure unit. A multiparameter unit can be used instead of individual monitors. Keep examination gloves on top of the cart or nearby. All patients arriving as emergencies should be handled with gloves. In trauma cases, patients may be covered in their own or the owner’s blood or have undiagnosed infectious diseases. Bloodborne pathogens can be transmitted to staff members.
The top drawer could contain intubation supplies, including endotracheal tubes (at least one of each size), laryngoscope handles, blades of various sizes, and umbilical tape or something else for tying endotracheal tubes in place.
The second drawer could contain emergency drugs. Which drugs to include may be a matter of preference. Ideally, only drugs used in emergencies, such as those listed in BOX 2, should be included. All doctors in the hospital should agree on the drugs and doses to be used in an emergency. The drawer could also include a small supply of preassembled needles and syringes as well as a chart of drug doses per body weight. TABLE 1 is an example of a drug chart; alternatively, a chart can be purchased from the Veterinary Emergency and Critical Care Society.
The third drawer could contain intravenous catheters of various sizes and the supplies for placing them (e.g., T-ports, tape, surgical scrub, needles, syringes, scalpel blades). Every emergency patient requires placement of an intravenous catheter for administering medications and fluids, so it saves time to keep catheters centrally located in a crash cart.
The fourth drawer could contain intravenous fluids and administration sets. One or two bags of each type of intravenous fluid stocked by the hospital could be kept in the crash cart; suggestions include sodium chloride 0.9%, Normosol-R (Hospira, Lake Forest, IL), lactated Ringer’s solution, and hetastarch.
The fifth drawer could contain miscellaneous items to help treat cardiac arrest. All items could be organized in labeled bins to facilitate access. This drawer could also include anything that might be needed in an emergency. To decide what to include, each hospital should determine which types of emergencies it typically sees. Suggested supplies include suction catheters, internal and/or pediatric defibrillator paddles, conducting gel, intravenous pressure administration bags, chest tubes, and sterile thoracocentesis packs consisting of a butterfly catheter, a three-way stopcock, and a 60-mL syringe. Supplies for thoracocentesis can be sterilized and preassembled to save time in an emergency.
Crash carts should be checked daily and monthly against checklists to ensure that they are fully stocked at all times. When an item from the cart is used, it should be replaced immediately after the emergency. A daily check would include ensuring that the cart has all the necessary supplies in the proper place and that all its electronic equipment is fully charged. A monthly check would include checking drug expiration dates as well as sterilization dates for endotracheal tubes if they are reused.
A crash cart can be very helpful in saving lives, but staff members must be properly trained to successfully use a crash cart. It is very important for a crash cart to contain the appropriate equipment and supplies and to be centrally located. Being prepared and organized can make a significant difference in an emergency.