You are sitting at the nurse’s station catching up on some charting at the end of your shift. It has been a smooth 12-hours; all of your patients have been cooperative and everything has gone as planned. Suddenly, the daughter of one of your patients comes running out of the room, yelling that her mother just lost consciousness and doesn’t appear to be breathing. You grab the crash cart and call a Code Blue.
What are the most important things you must have on and in your cart?
This is a very important piece of equipment and will likely be used in most codes. If your patient is found to be in a lethal cardiac rhythm, your defibrillator will be necessary to “shock” the heart back into a normal rhythm. The monitor/defibrillator should be checked daily and must be properly charged when not in use.
Portable suction machine
If a code occurs somewhere other than the bedside, if in-wall suction is not available, or if the in-wall suction is not functioning, your portable suction machine will be necessary. Whether you need to clear the airway for intubation or to remove vomit or foreign materials from the oropharynx, this handy tool will get the job done. Just like the defibrillator it needs to be regularly checked and charged so that it is alway ready to go in an emergency.
You’ll want a range of airway equipment available for you to use, from basic to more advanced. Your cart should have bag valve masks, oral and nasal airways, oxygen masks and nasal cannulas. Intubation equipment should also be stocked, including various sized endotracheal tubes, laryngoscopes and stylets. If supraglottic airways are available, they can be very useful in the case of a difficult airway or when appropriate personnel are not available for intubation.
IV access equipment
Being able to secure IV access is needed during a code, so your cart must have all of the necessary supplies. This includes angiocaths of different sizes, syringes, tubing, and IV solutions. You’ll need tape, and perhaps transparent film dressings and arm boards to help secure the site. Blood draw equipment and blood gas syringes can also be stored here.
Your crash cart should include medications to treat a cardiac arrest, such as Epinephrine and Amiodorone. In the case of a cardiac dysrhythmia, you’ll need medications such as Cardiazem, Adenosine, and Atropine. Dopamine, Sodium Bicarbonate and Calcium Chloride are other commonly stocked medications. You’ll want to have syringe flushes of sodium chloride too.
There are a few different procedures that may occur during a code or shortly after, and your crash cart should include the necessary supplies. This includes central line procedure trays and cricothyroidotomy kits. Extra sterile gloves and sterile drapes should be stocked as well.
In the middle of a code, you want to have all your needed equipment and supplies right there at your fingertips. Your specific facility and types of patients that you treat may dictate some changes in the materials that you stock, but use this list as a starting point to make sure you have the basics covered.