CRASH CART, AN EFFICIENT WAY TO EMERGENCY HEALTH SERVICES
*
SOLUTION-ORIENTED TO OUR EMERGENCY SERVICES THROUGH STANDARD PRACTICES*.
*CRASH CART SYSTEM*
Have you heard of “crash cart/ MAX cart/ code cart/ crash trolley” before?
You might know it but do not know that it is called that.
KBTH as well as other big hospitals normally have the crash cart at the theatres used by anaesthestists during surgeries.
*A crash cart/MAX cart/code cart/crash trolley* is a movable set of trays or drawers or shelves with wheels used in hospitals for transportation and dispensing emergency medication/equipment at site of medical/surgical emergency for life support protocols to potentially save someone's life for the first thirty (30) minutes.
*BRIEF HISTORY*
It was originally invented by a Registered Nurse by name, Anita Dorr who worked in Emergency department at Meyer Memorial hospital in Buffalo, New York. She got tired of having to carry all the supplies that were needed and the delayed response anytime there was an emergency case. With her husband's carpentry skills, she invented what she called *“Emergency nursing crisis cart”* in *1967* now known as *Crash cart*.
Joel Judovich Nobel, an American Anaesthesiologist & patient safety advocate also invented the new form of the crash cart known as *MAX cart* in *1968* when a four (4) year-old patient died at the hospital where he worked (Presbytarian hospital at University of Pittsburgh Medical centre) as a result of a faulty bag valve mask which he had alerted other staffs several times that it was not working properly but was not given attention. This made him to set up a research unit and published an article titled *“Anger is a great source of energy”*.
*IMPORTANCE OF CRASH CART*
It helps enhance hospital's efficiency in emergencies by enabling doctors & nurses to save time, thereby increasing the chances of saving a life.
*CONTENT/COMPONENT OF CRASH CART*
The content of crash cart varies from hospital to hospital, and from department to department depending on the needs but typically contains the tools and drugs needed to treat a person in or near cardiac arrest. The content includes the following:
1. *Top view* includes items such as defibrillator, bag valve masks.
2. *Side view* includes items such as drip pole, suction machine, oxygen devices.
3. *Front view* includes the following;
~*drawer 1*: Breathing & airway items such as ambu bag with mask, oxygen nasal cannula, oxygen flow meter with adapter, laryngoscope handle, traheostomy tubes etc.
~*drawer 2*: medications such as epinephrine, atropine, tranexamic acid etc.
~*drawer 3* : Venous such as iv solutions (R/L, DNS, D5%, NS, 1/5NS in 4.3%Dextrose), tubings such as urethral cather,giving set, iv cannula etc
~*drawer 4*: circulation; iv supplies such as 2-3 way stop cocks, blood tubes, heparimised aspirators, needles, alcohol swab, tape, butterflies, syringes etc
~*drawer 5*: Surgical (procedure tray) such as cardiac or chest procedures; sterile glooves, scapels with blades, chest tubes, cutdown trays etc.
*MAINTENANCE OF CRASH CART*
1. Check expiry date on medications on the first day of every month.
Rationale: To help make it easier to replace expired drugs.
2. Check the defibrillation pads on the AED or the defibrillator for expiry dates.
Rationale: To make it easier to replace expired ones to ehance effective, and quality care.
3.Check the state of the chargeable battery of the monitor or the defibrillator and document.
Rationale: To make it easier to know when to charge the battery by the next user(healthcare provider) for efficient delivery of emergency services.
*WHY CRASH CART?*
Any environment in which a patient may suddenly experience a medical emergency needs to have the equipment to deal with that emergency efficiently.
*WHO NEEDS A CRASH CART?*
Any facility that treats patients who have the potential to have a sudden deterioration in their condition. In this case, units like *Surgical medical emergency, accident centre, ENT unit, Cardiothoracic unit, paediatric emergency, obstetric and gyanaecological emergency etc* and not only the theatres!
*NB* : Physicians, nurses, pharmacists, and respiratory therapists must become familiar with the contents of this crash cart.
Source: Medscape.com, wikipedia,acls.net,ucdmc.ucdavis.edu,Journal of Emergency: jenonline.org/article
Credit: Mahmoud Isahaku, Nursing Officer, ENT, KBTH.
Written by Kwasi Omaro, Registered Nurse, ENT, KBTH.
Omaromusah@gmail.com
29/08/2018.
*CRASH CART SYSTEM*
Have you heard of “crash cart/ MAX cart/ code cart/ crash trolley” before?
You might know it but do not know that it is called that.
KBTH as well as other big hospitals normally have the crash cart at the theatres used by anaesthestists during surgeries.
*A crash cart/MAX cart/code cart/crash trolley* is a movable set of trays or drawers or shelves with wheels used in hospitals for transportation and dispensing emergency medication/equipment at site of medical/surgical emergency for life support protocols to potentially save someone's life for the first thirty (30) minutes.
*BRIEF HISTORY*
It was originally invented by a Registered Nurse by name, Anita Dorr who worked in Emergency department at Meyer Memorial hospital in Buffalo, New York. She got tired of having to carry all the supplies that were needed and the delayed response anytime there was an emergency case. With her husband's carpentry skills, she invented what she called *“Emergency nursing crisis cart”* in *1967* now known as *Crash cart*.
Joel Judovich Nobel, an American Anaesthesiologist & patient safety advocate also invented the new form of the crash cart known as *MAX cart* in *1968* when a four (4) year-old patient died at the hospital where he worked (Presbytarian hospital at University of Pittsburgh Medical centre) as a result of a faulty bag valve mask which he had alerted other staffs several times that it was not working properly but was not given attention. This made him to set up a research unit and published an article titled *“Anger is a great source of energy”*.
*IMPORTANCE OF CRASH CART*
It helps enhance hospital's efficiency in emergencies by enabling doctors & nurses to save time, thereby increasing the chances of saving a life.
*CONTENT/COMPONENT OF CRASH CART*
The content of crash cart varies from hospital to hospital, and from department to department depending on the needs but typically contains the tools and drugs needed to treat a person in or near cardiac arrest. The content includes the following:
1. *Top view* includes items such as defibrillator, bag valve masks.
2. *Side view* includes items such as drip pole, suction machine, oxygen devices.
3. *Front view* includes the following;
~*drawer 1*: Breathing & airway items such as ambu bag with mask, oxygen nasal cannula, oxygen flow meter with adapter, laryngoscope handle, traheostomy tubes etc.
~*drawer 2*: medications such as epinephrine, atropine, tranexamic acid etc.
~*drawer 3* : Venous such as iv solutions (R/L, DNS, D5%, NS, 1/5NS in 4.3%Dextrose), tubings such as urethral cather,giving set, iv cannula etc
~*drawer 4*: circulation; iv supplies such as 2-3 way stop cocks, blood tubes, heparimised aspirators, needles, alcohol swab, tape, butterflies, syringes etc
~*drawer 5*: Surgical (procedure tray) such as cardiac or chest procedures; sterile glooves, scapels with blades, chest tubes, cutdown trays etc.
*MAINTENANCE OF CRASH CART*
1. Check expiry date on medications on the first day of every month.
Rationale: To help make it easier to replace expired drugs.
2. Check the defibrillation pads on the AED or the defibrillator for expiry dates.
Rationale: To make it easier to replace expired ones to ehance effective, and quality care.
3.Check the state of the chargeable battery of the monitor or the defibrillator and document.
Rationale: To make it easier to know when to charge the battery by the next user(healthcare provider) for efficient delivery of emergency services.
*WHY CRASH CART?*
Any environment in which a patient may suddenly experience a medical emergency needs to have the equipment to deal with that emergency efficiently.
*WHO NEEDS A CRASH CART?*
Any facility that treats patients who have the potential to have a sudden deterioration in their condition. In this case, units like *Surgical medical emergency, accident centre, ENT unit, Cardiothoracic unit, paediatric emergency, obstetric and gyanaecological emergency etc* and not only the theatres!
*NB* : Physicians, nurses, pharmacists, and respiratory therapists must become familiar with the contents of this crash cart.
Source: Medscape.com, wikipedia,acls.net,ucdmc.ucdavis.edu,Journal of Emergency: jenonline.org/article
Credit: Mahmoud Isahaku, Nursing Officer, ENT, KBTH.
Written by Kwasi Omaro, Registered Nurse, ENT, KBTH.
Omaromusah@gmail.com
29/08/2018.
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