Last updated: December 29, 2020
2020 updated guidelines have been published by American Heart Association®, by enrolling in our courses you will receive the current learning materials (2016 guidelines) now and also AUTOMATICALLY have free access to the 2021 guidelines when available. Please note that our company typically implements new training guidelines up to a year before AHA releases their updates.
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.
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.
There is a basic list that all crash carts contain. All carts contain:
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:
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:
New! We now sell a laminated checklist that you can keep on the crash cart for reference.
State/provincial departments of health may amend these requirements. We are aware of the following local requirements.
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There is not, but most do their checks at the beginning of each shift.
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)
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.
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.
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
There is no suitable replacement, but many hospitals are diluting 1:1000 as a substitute
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.
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.
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.
Most hospitals do in fact check the paddles, just because they represent the backup if pads are dry, open or expired, or simply missing.
There are no guideines or best practices in this regard
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 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!
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.
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.
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.
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.
There is no such list. It would differ depending upon what type of practice, etc...
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.
No you cannot. It depends upon the standing riders within your hospital.
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.
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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