Version control: This document is current with respect to the latest drug indications in the 2016 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 21, 2020. If you are reading this page after October 21, 2020, please contact ACLS Training Center at firstname.lastname@example.org for an updated document.
New! We now sell a laminated checklist that you can keep on the crash cart for reference.
- Airway (oral and nasal) all sizes
- McGill forceps, large and small
- King Airway set (3) eliminates the need for laryngoscope and endotracheal tubes
- Bag valve mask (adult and pediatric)
- Nasal cannula
- Non rebreather oxygen face masks (3 sizes)
- IV start packs
- Normal saline solution (1000ml bags)
- IV tubing
- Angiocaths (various sizes)
- 10ml normal saline flush syringes (3)
- Alcohol preps
- Monitor with defibrillator (preferred) or AED
- Syringe nasal adaptor (nasal narcan atomizer)
- A checklist confirming everything that should be on the cart
(print this page, or buy our laminated checklist)
- Aspirin 81mg Tablets
- Nitroglycerin spray or 0.4mg tablets
- Dextrose 50% (dextrose 25% if treating pediatrics)
- Narcan 1mg/ml (6)
- Epinephrine 1:10,000 Abboject™ (3)
- Atropine Sulfate 1mg Abboject™ (3)
- Amiodarone 150mg Vial (4)
- EpiPen® (2)
- EpiPen Jr® (2)
- Solumedrol 125mg vial
- Benadryl 50mg vial (2)
- Adenosine 6mg (4)
- Lopressor 10mg (2)
- Cardiazem 20mg vial (2)
- Pronestyl (procainamide) 1g in 10 ml 100mg/ml Vial (1)
Why a Crash Cart?
Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts can differ somewhat depending upon their location, the basic crash cart will contain similar equipment.
Who needs a crash cart? Any facility that treats patients who have the potential to have a sudden deterioration in their condition should have a crash cart available. State regulatory agencies require certain facilities to have a crash cart, but they are recommended for many more. This would include hospitals, outpatient surgery centers, urgent care centers, and all centers where conscious sedation is performed. Nursing homes who provide treatment for patients in cardiac arrest until EMS arrives would also have a need for a crash cart. Physician offices who perform certain diagnostic testing such as cardiac stress testing or stress echocardiogram also must have a crash cart available.
What is in a crash cart? There is a basic list that all crash carts contain. All carts contain:
- Basic airway equipment including bag valve masks, oral and nasal airways, oxygen masks and nasal cannulas, Magill forceps
- Intravenous access equipment (or intraosseous) including angiocaths, IV tubing and IV fluid. If the facility elects to utilize intraosseous access for emergency medications, then a drill and needles must be included.
- Medications utilized in the treatment of cardiac arrest including epinephrine and amiodarone.
- Medications utilized to treat cardiac dysrhythmias including adenosine, cardiazem, a beta blocker (usually Lopressor®), and Atropine.
- Monitor equipment with a defibrillator or an AED
- Medications to treat allergic reactions such as EpiPens®, Solu-medrol® and Benadryl®
- Aspirin 81mg PO
- Nitroglycerin spray or 0.4mg tablets
Additionally, carts being utilized for specialized areas may add or subtract from the basic list. Depending upon the specialty of the facility, the following may be added:
- Endotracheal intubation equipment if anesthesia personnel are present in the facility
- King Airways – in facilities without anesthesia personnel or as a bail out airway for the patient with a difficult airway
- Narcan – to reverse the effects of narcotics in facilities where narcotics or sedation is used
- Additional antiarrhythmics – particularly in physician offices who do cardiac stress testing
Maintenance of Crash Cart
The worst thing ever is to reach for a piece of emergency equipment or an emergency medication and find it inoperable or expired. It is important that the crash cart be checked regularly and maintained so that its contents are there when needed.
The following is a maintenance routine that should be completed at least monthly:
- Expiration dates on medications should be checked on the first day of the month
- Expired medications should be promptly removed and replaced
- The defibrillation pads on the AED or the defibrillator should be checked for expiration date
- The battery charge on the monitor and/or AED should be checked and documented
State/provincial departments of health may amend these requirements. We are aware of the following local requirements.
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- Could you please help with this medical question? Hi. My inquiry is about the Defibrillator monitor. Is there any specific time within the shift that the defibrillator machine use for crash cart should be checked?
- There is not, but most do their checks at the beginning of each shift.
- Hi. I am a RN working in a cardiology office. Was wondering what medications I should keep on hand? And what supplies? Not all of the RNs in the office are acls certified and it is not a requirement to work here. Thanks
- Regulators dictate that you should be able to deal with emergencies arising from your practice. Most offices stock those medications necessary to deal with cardiac arrest, allergic reaction, SVT and respiratory emergencies in the first 15 minutes (assuming EMS arrival in that time frame)
- I used to be a RN and taught ACLS at the last hospital I worked at. I have since surrendered my license and have considered taking up teaching ACLS as a new career. My question is; do I have to have a medical license in order to teach the class, or just as I did before with BLS certification along with ACLS certification for teaching?
- You have to be practicing in a an area that using the expertise taught in the course. You could certainly teach BLS but it would be difficult to remain current with ACLS if you are not practicing.
- Is there a standard for how long we should hold onto the log record book for the crash cart? We log whats in the cart along with expiration dates and when something is replaced. Right now it has records dating back 8 years.
- That's a little over kill. The purpose of the list of expiration dates is just to make it easier to replace them each month. There is no "requirement" for keeping those checklists. The hospital that I am affiliated with keeps theirs for a year.
- Hi there, I'm trying to get information regarding any requirements or regulations for what needs to be stocked in an ambulatory surgical center's crash cart. We are strictly ophthalmology and our patients only receive conscious sedation. We recently inventoried our crash cart and had to throw away a lot of expired medications so we just want to know what exactly is required and if there is any specific regulation.
- Although there are no explicit requirements, you are required to stock equipment and medications required for all possible scenarios in your practice. For conscious sedation that includes ventilation equipment, reversal agents, medications for allergic reactions and medications required in first 20 minutes (unless your EMS has a longer response time) of cardiac arrest. In addition, you must have the ability to defibrillate and monitor your patient appropriately.
- I am a medical director at a health clinic and was told that we are unable to stock anything on our crash cart that are considered "ACLS supplies" because we have no one that is ACLS certified. I wanted to make sure this was true.
- ACLS does not change the practice of medicine. A physician with prescribing privileges can certainly prescribe and administer any medication. ACLS simply reviews the skills to do so. It is not a CERTIFICATION but an educational course
- Epinephrine 1:10000 is not available from the manufacturer. What is a suitable replacement for Crash Cart purposes?
- There is no suitable replacement, but many hospitals are diluting 1:1000 as a substitute
- I have a quick question. Does it matter where the crash cart will be located, hospital vs nursing home, whether or not Narcan should be on the cart? I don't know if the regulations are different? I can't seem to find anything that states there is a difference, so I figured I'd ask you. Thank you for your time. for the state of Illinois.
- Each crash card must have the requirements to respond to possible emergencies within that practice. Because many patients in nursing homes receive opiods for chronic pain, the presence of Narcan would be a requirement.
- I was told that ACLS standards are what governed requirements for Code cart drawers and their contents. I am looking for information regarding the requirements for McGill Forceps needing to be sterilized, disinfected etc. Can you please share with me where I can find this information please?
- Unfortunately, that had nothing to do wi5 AHA guidelines. Sterility of instruments etc are a function of hospital policy I believe. With that said, EMS does NOT sterilize them and I have worked at three different Hospital and have never seen them sterilized. They are not utilized in the lower airway.
- Do you have regulatory standards for an Endoscopy and office setting for medication in code cart and what to do when emergency drugs are on back order?
- The guidelines for crash carts do not specifically list medications or equipment. Regulatory agencies simply require "equipment to respond to any emergency within the practice" This will differ with each different type of practice.
- Is it recommended to check the paddles on a defibrillator that has pads? Our hospital recently started checking the paddles; however, we do not use them. Can you provide us with some insight on evidence based practice.
- Most hospitals do in fact check the paddles, just because they represent the backup if pads are dry, open or expired, or simply missing.
- Are there any AHA guidelines that specify whether to lock the wheels on the cart that contains the crash cart cards? Or is it a case of best practice applies?
- There are no guideines or best practices in this regard
- have worked in a hospital setting for 16 years. I was wondering why their is not a magnet in the crash cart for the pacer /defibrillator. If someone passes away during the code we should be able to turn it off.
- Generally the crash cart is for emergency use by all responders. Not all are trained in the use of a magnet to terminate an AICD. In addition, if the code is unsuccessful it is. It an emergency and a crash cart an an emergency response cart.
- I am a family medicine clinical lead RN for Variety Care in Oklahoma City. We have 11 metro OKC clinics. We are currently discussing the need for standardized crash carts in all the clinics. All clinics have family medicine, some with only 1 provider. A few clinics have dental and optometry. Two clinics have women's health. We are an FQHC (Federally-Qualified Health Center). My question is, do we need to have crash carts with emergency meds and intubation equipment, given that few of our FM physicians are ACLS trained and have not dealt with this type of treatment in many years, if not since their residency. We have a OKC metro EMS system which generally responds with 5 -10 minutes, if not faster. Your thoughts?
- I have tried doing some research into the requirments for FQHC. I have not found anything on the need for crash carts at the facilities. The question does ask our thoughts, not the requirements. My thoughts: The physicians should all be up to date on their ACLS certification (completed every 2 years, renewing) and there should be crash cart and emergency medications/intubation equipment on site that these VERY QUALIFIED healthcare providers can administer in an emergency situation. Time is everything, and many patients don't have 5–10 minutes when they are crashing (as stated, the time it would take for the EMS system to respond). I believe it is safest practice to have at least basic life-saving equipment on-site to stabilize the patient. As a healthcare provider myself, I would not work in any medical facility that did not have a crash cart available. I hope this helps!
- I had a question regarding crash carts, is the sterile processing department required to fill carts along with cleaning after every use? Or would that be something the floors could clean and restock to lessen the turn over time within the facilities? In your experience and opinion who should be accountable for restocking crash carts?
- There is no hard and fast rule. That decision is facility based. A cart does not require sterilization, therefore it would not be a requirement. In many facilities, the Pharmacy checks and restocks medications and the nursing floors maintain the cart.
- I had a question regarding crash carts, is there Glucagon in Crash cart? Are you going to use Glucagon or Epinephrine during prophylactic shock in a patient on Beta Blocker?
- It would depend upon your practice. If it is strictly a “crash cart “ for cardiac arrest, there is no indication for glucose or glucagon in cardiac arrest.
- On the Neonatal equipment page there is no mention of urinary drainage—ie 3 and 5 fr foley catheters. Can you explain how you intend to monitor urinary output in the critical infant? Feeding tubes are no longer acceptable practice. RN. Director, Supply Expense Management
- Urinary catheters may certainly be added. The equipment list, as stated, will change depending upon practice. Many of our customers are prehospital (they do not utilize urinary catheteris), outpatient facilities who would have the child transported prior to the need. The needs of a crash cart are not regulated for that reason. They are meant to meet the needs of practice and so any list is not comprehensive and everything on any list does not necessarily apply to an individual’s practice. Certainly a NICO or ED would stock urinary catheters. For example, there would be no need for an ED or NICU to stock coronary catheters in pediatric sizes, but a cardiac catheterization lab who does pediatrics would. There can never be an inclusive list of equipment for all practices.
- I am ASC coordinator at a cataract surgery center in California. We are in the process of updating & revising our crash cart, which hasn't been done in 4 yrs. Actually, since I've taken over the position. We are constantly discarding medications that expire that are never opened. I would like a more cost effective crash cart for our facility. I can not find anything definitive anywhere that tells me what we HAVE to have in our crash cart for our type of facility. Can you help me? Can you please tell me or point me in the right direction to find this information so that I can customize our crash cart to our needs but stay within state requirements? RNASC coordinator, Valley Eye Institute.
- No certifying agency (that I am aware of) defines an exact list of what you need. What they say is that “you need to respond to emergencies that may arise in your practice with the appropriate equipment and medications”. That will differ depending upon your type of practice. There are also statements about your staff being “educated to respond to complications of sedation, including respiratory arrest.” But you will not find a list required by an agency.
- Is there a List of Items that should be in a Pediatric Crash cart. Not an Adult one and not a Neo-Natal crash cart. Is that something you might have OR know. where we can get that? Laurie W
- There is no such list. It would differ depending upon what type of practice, etc...
- Hello Judy, Thank you, but may I ask ... It would differ depending upon what type of practice... when you state that, what practices are you referring to? Please advise.
- There would be a different list for a surgery center who does pediatric procedures vs a hospital OPerating room or a physician practice. A pediatric specials PT practice would have different requirements than an adult surgery center who also places ear tubes for pediatrics. An Emergency department that sees pediatrics would have different needs than a mEd/surf floor who has occasional pediatrics for observation.
- Good Day Just for clarification I am ACLS provider my ACLS still valid till November 2019 and I am working in ICU as RN if the patient asystol and there's no Doctor available can I give the medication as ACLS protocol without Dr order. Thanks !
- No you cannot. It depends upon the standing riders within your hospital.
- Greetings from central Pennsylvania. I was taking a look at your website and decided to attempt one of your quizzes. The one I chose was the ST Elevation Myocardial Infarction quiz. Unfortunately, I believe I found an error. Question # 2 states: The ST depression noted in Leads V1, V2 and V3 represents - Reciprocal changes - A normal finding on the EKG - An anterior wall infarct - A secondary infarct With you showing reciprocal changes to be the correct answer. I believe this is in error. Although I believe the EKG is showing an inferior wall myocardial infarction, IWMI's do not reciprocate to the anterior leads. However, the presence of depressions in the anterior leads along with elevations in II, III, & aVF would indicate posterior wall involvement. This would lead me to choose that a secondary infarct is occurring (PWMI) along with inferior involvement.
- Here is the response from the medical department: "He is correct. The reciprocal leads for the inferior wall are I and a VL. His diagnosis of posterior wall involvement is correct. This most likely is a proximal, dominant RCA occlusion. I will make sure this gets fixed.
- I work as 1 out of 6 sole RNs in a Urgent Care. All the RNs ,except for a few who reapplied, were replaced with MAs a few years ago. RNs were required to have BLS,ACLS,TNCC and ENPC (PALS included in ENPC). The Urgent care clinics have the usual crash carts and we do have many MIs,SVTs and PSVTs present to the clinics. 911 is called, but IVs are started (by the RN or provider) and treatment is begun. My ACLS is up for renewal soon, unfortunately I am on leave, so money is extremely tight. I emailed my manager for the company to assist in paying for this, but was informed "ACLS is not a part of my job description, so we will not pay for the class". The manager is non medical, so its difficult to get "medical related" questions answered. My question for you is, Shouldn't a RN be required to have ACLS to give ACLS meds and be able to provide ACLS measures with the Provider? Why even have a crash cart with ACLS meds?
- JCAHO dictates that in hospitals if sedation or anesthesia is given someone must have airway training. The hospitals use ACLS certification for that. Whether or not ACLS is required is a function of whatever state licensure you fall under. Although, in my experience with many surgery centers, all RN's are ACLS certified and PALS if they do children. I hope this helps.
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