PROCEDURE:
CRASH CART
Section:
CLINICAL/PATIENT CARE
CHIEF MEDICAL
PROCEDURES
OFFICER
Effective Date: 11/81; Revised: 6/03: 5/05
CPCP1
Reviewed: 4/05; 12/06
CPCP11; RM12
Responsibility:
Procedure Number:
Related: APP9;
Purpose:
TO ESTABLISH A POLICY OF PREPAREDNESS
FOR PATIENT EMERGENCIES IN THE HEALTH
CENTERS.
Scope:
Medical Providers, Other Health Providers, Administration,
Nursing, Medical Assistants, Specialist Registration Services
Exceptions:
NONE
Description:
1.
The crash cart should be locked at all times. The integrity of the lock
should be checked daily. Any time the crash cart is opened for any reason,
nursing must check all contents prior to attaching a new lock. Crash cart
locks should be stored separately from the crash cart. Locks should be
breakaway and numbered or initialed.
2.
Once each quarter, all personnel who may be involved in the use of the
crash cart equipment will be given in-service training to review the use of
the equipment. The Clinic Manager or designee will coordinate training
and document appropriately.
3.
A Code Blue/Patient Emergency Procedure exists and outlines the
responsibility of each HealthNet associate in the event of a patient code.
All clinic associates are to be familiar with this procedure. Code Blue
Drills to test the emergency procedure will be held quarterly overseen by
the Health Center Manager or designee.
4.
All MA’s, LPN’s, RN’s, physicians and midlevel providers who are
involved in direct patient care will be required to take the Basic Life
Support for Healthcare Providers course offered by Clarian Health. It is a
policy of HealthNet that all appropriate associates take the course and be
certified, unless medically excused. This course includes CPR, as well as
upper abdominal thrust instruction (formerly Heimlich Maneuver) and
other emergency life support procedures.
5.
CPR-certified associates will receive training every 2 years as a refresher
in emergency life support.
6.
All medications will be checked monthly for expiration date. Supplies
will be checked (monthly also) to verify they are present and in sufficient
quantity. Each center manager will designate a nurse to review the crash
cart contents. S/he will note exceptions and ensure that deficiencies are
addressed. (See form below.)
HealthNet Life Support: Medications and Guidelines for Use
Medications
How
Supplied
Typical
Indication
Warning
Adverse
Reactions
Dose/Route
Dextrose
D50
Epinephrine
1:1000
Racemic
Epinephrine
DiphenhydrAMINE
50mg
50 ml
bristojet
HypoGlycemia
assoc. with
coma or
seizure
HyperGlycemia
1ml vial
(1mg/ml)
Anaphylaxis
2.25% solut.
(7.5 ml)
Severe croup
laryngeal
edema
50mg/ml
syringe
Severe allergic
reactions
Tachycardia,
hypertension
Tachycardia
Adult:
1 ampule
IV
0.01ml/kg
per dose
0.05ml/kg
per dose
nebulized
(max 0.5 ml)
dilute
to 3 ml with
Normal
Saline
subcutaneous
(max 0.5ml)
Nitroglycerin
Sublingual
tablet
0.4mg tablet
Aspirin
Anginal chest
pain
Possible
or confirmed
myocardial
infarction
Sedation,
nausea,
vomiting
Hypotension
tachycardia,
headache
1-2mg/kg
per dose
IV or IM
(max dose
50 mg)
1 tablet
dissolve SL,
may repeat
Q5 minutes x
3 doses
Bleeding,
gastric
irritation,
allergy
1 tablet,
chew and
swallow
81 mg tablet
Quick Reference Dosing
Medications
Dextrose
D50
Epinephrine
1:1000
Racemic
Epinephrine
DiphenhydrAMINE
50mg
Nitroglycerin
Sublingual
tablet
Aspirin
1 ampule
IV
0.3-0.5 ml
subcutaneous
0.5ml with 2.5ml
NS
1ml IV or IM
1 tablet SL
1 tablet
0.1ml
0.5ml with 2.5ml
NS
0.5ml with 2.5ml
NS
0.4ml IV or IM
Adult
Pediatric
1yr/old
subcutaneous
3yr/old
0.l5ml
subcutaneous
0.6ml IV or IM
5yr/old
8yr/old
12yr/old
0.2ml
subcutaneous
0.25ml
subcutaneous
0.3ml
subcutaneous
0.5ml with 2.5ml
NS
0.5ml with 2.5ml
NS
0.5ml with 2.5ml
NS
0.75ml IV or IM
1mlIV or IM
1ml IV or IM
CRASH CART CHECK-OFF
Instructions: Each center manager will designate a nurse to review crash cart contents every
month. The nurse will check the minimum quantity of each item is present and (when applicable)
the expiration date has not passed.
Exceptions noted should be documented in the third column, plus what was done to fix the
problem. Example: Nurse finds only one pocket mask. She should write, “Missing one.
Submitted written request to Office Coordinator on 9/1/6 for one pocket mask. “ Nurse will note
his/her initials and the check-off date in the last column.
Medications
50% Dextrose e.g. Bristojet
Nitroglycerin 0.4 mg SL
ASA enteric coated 81mg tablet
Racemic Epinephrine 2.25% ( 7.5ml)
Smelling Salts
DiphenhydrAMINE Syringes 50mg/ml
DiphenhydrAMINE capsules 25 mg
DiphenhydrAMINE syrup 12.5mg/5ml
Epinephrine ampules 1:1000 1mg/ml
Airways Supplies
Masks:
Adult
Pediatric
Infant
Nasal Cannula:
Adult
Pediatric
Infant
Extension Tubing
Ambu:
Adult size with mask
Pediatric size with peds and infant
Mask
CPR Mask:
Pocket Mask
Microshield
Oral airways
Size 2
Size 3
Size 5
O2 bottles with regulator
Suction Euipment:
Pediatric
Quantity
Note Exception/
Action Taken
Staff Initials and
Date
Note Exception/
Action Taken
Staff Initials and
Date
2
2
1 bottle ( 36 )
1
2
6
1 bottle
6
Quantity
1
1
1
1
1
1
2
1
1
2
2
2
2
2
1
2
Adult
2
CRASH CART CHECK-OFF
IV Supplies
Syringes:
3 ml
5 ml
1 ml
Bulb
Angiocaths:
18
20
22
Arm Boards:
Pediatric
Adult
Buretrol
IV Start Kits
Test Tubes
Red Top
Lavendar Top
Butterfly 22 G
IV Tubing:
Microgtt
Macrogtt
IVF:
1000 ml NS
500 ml NS
250 ml NS
Miscellaneous
Latex Free Gloves:
Medium
Low
XL
Code Form
Tape:
1”
Quantity
Exceptions Noted/
Action Taken
Staff Initials and
Date
Exceptions Note/
Action Taken
Staff Initials and
Date
2
2
2
2
2
2
2
1
1
1
2
2
2
4
2
2
1
2
2
Quantity
1 box
1 box
1 box
1
2”
Coban-3”
Scissors
Razor
Needles
18 g 1 ½”
21 g ¾”
23 g ¾”
1
1
1
3
3
3
CRASH CART CHECK-0FF
Miscellaneous
25 g 3/4”
25 g 5/8”
Sharp Container
Lancets-safety flow
Tourniquet-latex free
Blood Pressure Cuff
Adult
Adult Large
Child
Stethoscope
Latex Safe Blood Draw Kit
Band-Aids
K-Y Jelly
Cotton balls
2” Gauze
Yankauers
Portable Suction
Alcohol Pads
Code Form
Epinephrine Dose Card
Quantity
3
3
1
1
1
1
1
1
Assorted
1 tube
Assorted
Assorted
3
1
1 box
1
1
Exceptions Note/
Action Taken
Staff Initials and
Date