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Veterinarian Technician March 2013 (Vol 34, No 3)

Crash Carts: Preparation and Maintenance

by Paula Plummer, RVT, VTS (ECC)

    Many different types of emergencies can present at veterinary practices at any time of day. Having a centrally located 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 is 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) or can be prepared using a large or a small toolbox (FIGURE 2AFIGURE 2B). The same equipment is 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 near oxygen and suction sources. Hospitals that have separate wards or treatment areas should consider maintaining multiple crash carts to cover all areas.

    Crash carts should include emergency medications, intravenous catheters and fluids, and a defibrillator. Carts should be fully stocked 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 set up and use all the equipment in a crash cart. Staff training can be essential for saving a patient’s life. Scenario-based training should be conducted regularly to train new employees and refresh the skills of the 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 five to nine drawers. In veterinary medicine, most crash carts can be organized into five drawers. A system for organizing crash carts follows.

    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 could be covered in the owner’s blood or have bite wounds from a rabid animal. Blood-borne 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 debatable. Ideally, only drugs used in emergencies should be included; suggestions include epinephrine, atropine, naloxone, calcium gluconate, dexamethasone, dextrose 50%, diphenhydramine, vasopressin, aminophylline, and atipamezole. 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 (Abbott Laboratories), lactated Ringer 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, sterile thoracocentesis packs, 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.

    Maintenance

    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.

    Conclusion

    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.

    Suggested Reading

    Devey J. CPCR: how to set up a ready area. Proc Latin Am Vet Emerg Crit Care Soc2010. Available at www.ivis.org. Accessed November 2012.

    Fletcher D. Advances in CPR: guidelines & simulations for educational and clinical training. Proc Int Vet Emerg Crit Care Soc 2011.

    Quintana A. What’s new in CPCR? Proc World Small Anim Vet Assoc 2009. Available at www.ivis.org. Accessed November 2012.

    NEXT: Equine Essentials: Understanding the Equine Pain Score

    didyouknow

    Did you know... Lidocaine is the only emergency drug with different doses for feline and canine patients.Read More

    These Care Guides are written to help your clients understand common conditions. They are formatted to print and give to your clients for their information.

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