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 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 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:
- 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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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/
All drug items listed here are available from Boundtree with no account minimums.
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- 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.
- was reviewing what the emergency medications we have, if we have to have an ACLS trained individual give them (particularly Amiodarone and Lidocaine IV). We are wanting to revamp/bring our crash cart to the modern day and wondering exactly what we want to continue to carry in our clinic. RN BSN OCN Safety Officer.
- ACLS does not certify anyone to give medication. That is done by your licensure (RN, etc). The guidelines as to what needs to be in your cart are defined by your type of patients.
- 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? Pioneer memorial Hospital
- It would differ depending upon what type of practice. 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.
- I am at a Texas vein and interventional radiology practice. We were wondering, considering we do not accept pediatric cases, are we required to still have pediatric sizes of oral/nasal airways and medications? If so, could we get a list of exactly what sizes are needed for the crash cart to be compliant. CMA, NCRT, CPT Flower Mound Vein Center
- If you do not treat pediatric patients you have no pediatric equipment or medication requirement in any state.
- 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.
- Narcan should be on the cart anywhere there is narcotic use. Overdoses are very common in nursing care facilities and so they must be equipped to respond.
- Hi I have a question regarding neonatal crash carts and equipment. My understanding is the Broselow crash cart is for Pediatric patients, wherein we can have less than 3 kg neonates. Is there a new development on it’s content ? Appreciate your feedback. Faye C.
There is a new Broslow tape.
You are dealing with neonates, totally different issue.
- I am the nurse manager for Marklund Community Day Services in Geneva, Illinois. I am trying to update our crash cart and make sure we have all the necessary equipment and supplies that are legally required. Our facility provides care for community clients with developmental disabilities as well as our long term clients. Are the requirements the same as what is needed in a hospital setting or is there a difference? What is required for our facility? RN.
- Requirements are defined by each individual states. Most do not list individual equipment but rather require that equipment be available to respond to potential emergencies for your practice.
- Hello, I have a question, I work in a geriatric clinic as a certified medical assistant along with five RN’s and one LPN and just recently my director of nursing decided to delegate the responsibility of the crash cart to me and another MA. Is this ethical and following state regulations? I do not have the credentials, training nor ever seen a crash cart before coming to the clinic. Could you send me regulations or some guidelines stating who’s responsibility it is to manage the crash cart in the state of Oklahoma, please? I want to share this information with the clinic and director.
- Checking the crash cart (I assume that is what you mean) is simply checking expiration dates and assuring that the contents are complete. This can be done by anyone. It does not require any type of license or certification.
- We are going to have Jhaco in our facility soon. The list that you have on your website. about the medication and equipment needed in the ACLS(Crash Cart)Cart ,are they approved Nationwide? If not how can I know what are the approved meds and equipment needed for our crash cart in our center which we are base in Michigan. Lead Nurse Pre Post.
- There are no "requirements" for crash carts. They differ depending upon the inspecting body and are generally done by the State DOH. However most simply state that the "facility must be equipped to adequately respond to emergencies that may arise according to the practice of the facility.
- I work at a family practice office in ga.
We are trying to update our crash cart I got the check list off your site
but I have a few questions.
1. does it have to be in a locked box
2. what are the legal state requirements
3. how often does it need to be checked
- Dee B.
- It only needs to be locked to secure narcotics. There are no LEGAL requirements for crash carts. Just that you must be equipped to deal with emergencies that may reasonably be encountered in your practice. I.e, respiratory arrest with sedation, etc. if you utilize a plastic seal the standard practice is to check the cart when the seal is broken and to break that seal at the end of each month to check for each spiration dates on medications. Your practice could differ, but that is pretty standard.
- I had a question regarding crash carts. I was reading the information from your link below. Can you provide me with any billing guidelines or direct me on how to bill for crash cart services in an urgent care or office setting? Your assistance is greatly appreciated.
- The level of care would increase. I am not aware of any direct billing for “crash cart services”.
Hi I have a few questions. I’m a dialysis nurse working in a clinic providing dialysis for patients. Our crash cart has an AED, oxygen and suction. It also has some ACLS drugs on the cart. I’m new in this setting as my previous experience is hospital settings. I have my ACLS certification. What would be the barriers to providing ACLS in a clinic setting like this.
My concern is that we do not have a way to see rhythms, no way to intubate or any nurse with actual experience in intubation (respiratory or physicians have done this in past codes I’ve participated in) so we should not use the drugs in the cart? I’m just trying to find the legal answer to this situation and make recommendations regarding the epi and other drugs in the cart.
If you could help or tell me who to contact for this information.
Lastly, does a physician need to be present or at least contacted if ACLS drugs are needed?
Thank you in advance for any help or direction you can guide me in.
- There is no legal answer. Intubation is a non issue as it is not even recommended during arrest, but post arrest. There are no laws that govern ACLS. It is a recommended certification but is not necessary to administer any medication. That is based upon your nursing scope of practice and the policies and procedures at your place of employment. An AED will only defibrillate VT or VF so rhythm recognition is not an issue. Epinephrine is indicated in ALL arrested rhythms so recognition is not an issue. The only place you would need to "see" the rhythm would be bradycardia with a pulse and tachycardia with a pulse; but not for cardiac arrest,, at least initially.
- I've been reviewing your responses to questions on your Recently Asked Questions page (https://www.acls.net/acls-crash-cart-faq.htm) and it is very helpful. I was wondering if you could answer a question of my own.
I noticed you say that if an office is performing conscious sedation they are required to have a crash cart. I was just wondering where these requirements can be found? In other words, what authority states an office performing conscious sedation is required to have a crash cart? I'm in California. All the best and thanks for your great work.
- The requirements are different in each State. However universally all licensing bureaus require the office/hospital/medical center who performs sedation to be equipped to deal with any and all possible complications arising frim that sedation. Although you could equip your office with appropriate medications, defibrillator and equipment and no store it technically in a “crash cart” this is the most accessible and standard way to do it. Our liability as medical professionals lies with Meeting and be compared to the “standard of care” within our speciality and so it is safer from a liability standpoint to conform to the mean. I hope this helps.
- I would like to know, are infusion centers required to have full crash carts? Also, are there any regulations on what types of infusion medications require full crash carts? Regulatory Specialist.
- There are no specific requirements for “crash carts”. What most State guidelines require is that you are capable of responding to any emergencies “that can reasonably be expected in your delivery of care within your practice.” So that will differ depending upon the type of care that you render.
- 1. Why aren’t interosseous devices a crash cart requirement when they are potentially so crucial to delivering meds? 2. The use of the term “drill” with regard to interosseous makes it sound like a battery operated/ electric type drill is needed for interosseous needles. However, manual type devices are just as effective and don’t run risk of batteries being depleted. Is there a requirement that IO needles be accompanied by a “drilll” that is battery powered? Or are manual IO placement devices acceptable?
- There are NO requirements for crash carts as the needs depend upon the the facility. Manual IO devices have not been used for ten plus years. The old Cooks and Jamshudes could be put in manually. The new IO needles are completely different and can only be put in with a drill. They can be put in shoulders, legs and a number of ither sites. The manual ones were way more traumatic then the newer drills which is why no one uses them any longer.
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