Version control: This document is current with respect to drug indications in the 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document.

New! We now sell laminated 8.5"x11" crash cart/code cart algorithm cards ($60 $40 set of 8).

Equipment

  • 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)
  • Gauze
  • 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)

Drugs

  • 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 antiarrhtyhmics – 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.

Follow is a maintenance routine that should be completed at least monthly:

Region-Specific Information

State/provincial departments of health may amend these requirements. We are aware of the following local requirements.

Illinois

Retail Suppliers

Mainline Medical

Supplier for anesthesia and respitory equipment with name brand products and wide selection. This is a small women-owned business with particular attention to customer support and they can help you pick the products you need.

Mention ACLS Training Center for special pricing on your first order.

Call 800-366-2084 and ask for Nancy or see https://www.mainlinemedical.com/

Cardinal Health

Provides all drugs listed here. Minimum account spend is $50,000 per month to create an account. (If your practice is part of a hospital network, they may already have an account.)

Call 866-551-0531 or http://www.cardinal.com/

Boundtree Medical

All drug items listed here are available from Boundtree with no account minimums.

Mention ACLS Training Center for 10% off your first order.

https://www.boundtree.com


Frequent Questions

Where are the NRP cart guidelines?
Please see this page.
I had a question regarding crash carts. Every facility that I have gone to has a red tag that locks the cart and has a serial number. Is there any requirement for the red tag and for documenting the number?
The tag documentation assures that nothing in the cart has been removed or changed. So you know of the number is the same as the last one recorded that is all you have to check. If the tag is missing or not the same then someone was in the cart and you have to check all of the contents to be certain nothing was used.
My ED was just told that we are not allowed to have suction set up with the tubing out of the package as it is not sterile. Our argument is that the tubing does not need to be sterile, and really needs to be pre-connected to save time when urgently needed. We do keep the suction tips/catheters in sterile packaging until used. * I read the question and response below. What is the reference document for the response?
We just received new crash carts that have a portable suction attached to the top of the machine. An unsterile suction tubing is attached and left on the suction. Our OR director is concerned about this and thinks the suction tubing should be removed and a sterile suction tubing pack should be placed next to the suction instead. She is concerned the exposed tubing will be cited during inspections. Is this a concern? The disposable suction liner comes with the tubing already connected. What is the standard for this?
I don't know what to say except look at the packaging. Unless specifically packed for OR use, it is not packaged sterile.
Yes I agree they are on the cart. But, I think they should be listed in the checklist to make sure they are full. They should be checked just like everything else on the cart. If your O2 is low and you run out during a code you could possibly be in a very unsafe predicament for the patient.
You can add them to your list for your facility. Hospitals almost always utilize the wall oxygen source as a tank running at 15 Liters via Ambu bag will only last several minutes. You can add the oxygen to your checklist to your facility. The checklist is just a suggestion, and not in any means appropriate to every facility and every situation.
I work at a VA hospital in North Carolina. The unit is a 20 bed substance abuse inpatient rehab unit. The patients have already detoxed when they are admitted. These patients are full codes and most have multiple co-morbities. The unit does not have a crash cart. Is there a requirement /law/guideline that requires one to be on the unit?
It would depend upon how the unit is classified with the State. My guess is that it is classified as a rehabilitation facility in which case the answer is no. If that is not the case then it would be governed by the North Carolina DOH.
I work at a VA hospital in North Carolina. The unit is a 20 bed substance abuse inpatient rehab unit. The patients have already detoxed when they are admitted. These patients are full codes and most have multiple co-morbities. The unit does not have a crash cart. Is there a requirement /law/guideline that requires one to be on the unit?
It would depend upon how the unit is classified with the State. My guess is that it is classified as a rehabilitation facility in which case the answer is no. If that is not the case then it would be governed by the North Carolina DOH.
Do you have any information on how long we are required to keep the QC checklists for the crash carts and defibrillators?
Most hospitals that I am familiar with keep them for a year, but that is a matter of individual hospital policy not regulation.
I would like to know if you need a crash cart on both floors of our facility. The first floor has an MRI machine and the second floor has pain management, orthopedics and physical therapy.
The need for a crash cart is defined by your state governing authority (usually department of health) or your certifying authority such as JACHO for hospitals. This differs from state to state. It is dependent upon your patient population (risk status) and the procedures (potential for deterioration) that your company does.
Should our hospital defibrillator be plugged into the charger 24/7 or we can just keep record of the battery condition and charging time?
Yes, defibrillators should remain plugged in when not in use.
Regarding crash carts, do you have any evidence of the efficacy of equipment when monitored by RNs versus other healthcare professionals (i.e., unit secretaries performing equipment checks on defibrillators).
That data does not exist to my knowledge, but data to the contrary also doesn't exist. Many, particularly smaller practices cross train non-medical personnel. Testing a defibrillator requires no medical knowledge. It is simply following a very distinct set of directions and writing down the results, as such requires no medical decision making and places no person at risk.
We are a maternal fetal medicine clinic located in Texas. We administer Rhogam ®, progesterone injections, and occasionally fast acting insulin. Are we required to keep a crash cart?
You would have to get this answer from the Texas state guidelines.
Regarding crash carts, what is the standard for checking a crash cart in a hospital de-fib check, cart meds locked (not the monthly in depth check)? Is it daily, every shift? This is in a California Acute Care Hospital.
The standard is for the presence of the lock to be checked each shift and the defibrillator to be fired with a test load (according to manufacturer's guidelines). If the lock is intact then you document the test and move on. If it is not, the entire cart must be checked (or replaced depending on your policy). The cart must be replaced each time it is used. I hope this is helpful.
I am a pharmacy student, practicing at a hospital and I am conducting a crash cart update. I was wondering whether you recommend using the standard crash cart checklist or the neonatal crash cart for pediatric wards?
The Neonatal checklist is only appropriate in a NEONATAL unit which has different needs than a pediatric unit. However, there are different needs in a pediatric unit than in the adult crash cart. There should be a pediatric crash cart standard for the hospital. (Usually utilizes Browslow labelling).
Where can I find information/proof that in Oklahoma it is MANDATORY to have and upkeep a crash cart for a nuclear cardiology lab that performs treadmill/chemical stress tests (MPI's).
Oklahoma Department of Health, JACHO, but that question is quite strange. You are inducing ischemia during a stress test. The indication for stress testing is the suspicion of coronary artery disease. It would be ludicrous to perform stress tests without being able to resuscitate the patient. So although I am sure it is in Oklahoma regulations, it is first and foremost to please use common sense.
I was looking for a crash cart list for an internal medicine physician. It will be great if you can help me.
Crash carts are not unique by physician or practice type. They are generic because every cardiac arrest is treated via the same algorithms so the medications and the equipment is identical. The only differences are adult vs pediatric carts.
I am a physiotherapist soon will be working in a private physio clinic in Oman and I would like to ask regarding, crash carts, if it's really necessary to have one. We are not dealing with emergency cases and life threatening conditions but we are trained in BLS just in case of an unexpected event. Most of the conditions that we are expecting to handle are sports related injuries, muskuloskeletal conditions, exercise conditioning, child developmental delay and manual treatments. Please enlighten us and any input will be much appreciated.
I don't know what your specific state regulations are, but I know in PA few if any physic clinics have full crash carts.
Hi I just started working at a surgi center's PACU and the code cart does not have most of the meds needed for 2015 ACLS GUIDELINES and some of the supplies CO 2 detector, OPA, also wrong kind of Epi (1:1000) concentration. Since we are not in a hospital ER and would call 911 in case of cardiac or respiratory arrest and we have basic intubation equipment and AED, is it necessary? I live in Maryland.
EMS average response time is longer than ten minutes. You should have the medication necessary to deal with an arrest in the first 10. Minutes. I think you will find that your state regulations require this. What good does it do to have Epinephrine 1:1000 IF IT IS NOT USABLE because it is not indicated? You need Epinephrine 1:10000 to treat cardiac arrest. If you need a crash cart, you need one with the correct medications and equipment.
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.
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.
Is it a requirement to have Cardiazem in our crash cart? The facility I work for is a cardiac radiology facility where stress perfusion tests are performed. The medications we have in our crash cart are Metoprolol, Amiodarone, Adenosine, Epinephrine, and Atropine among other medications not heart related.
There should be some calcium channel blocker. It can be Cardiazem or Verapamil, but there should be one as that is first line after Adenosine for narrow complex tachycardia.
Are the requirements different in MY STATE?
There really are no requirements for crash carts other than the ability to respond to cardiac and respiratory emergencies so most facilities base the contents on AHA and a little common sense.
What is the standard time limit for removing medications from Crash cart? As far as I aware to remove medications before 90days of expiry. If this answer is correct then what is reason for removing before 90 days? Why cant we remove before 30 days?
Medications are acceptable up until the day of expiration (normally the last day of the month in which they expire) The habit of removing them 90 days ahead came from when facilities would move medications before they expired to units that were more likely to utilize them before expiration. ... (see more below)

Newer questions are being answered and posted to this page.

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