A crash cart, code cart, crash trolley or "MAX cart" is a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency for life support protocols ( ACLS/

ALS Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or—in the United States—Lou Gehrig's disease (LGD), is a rare, terminal neurodegenerative disorder that results in the progressive loss of both upper and low ...

) to potentially save someone's life. The cart carries instruments for cardiopulmonary resuscitation and other medical supplies while also functioning as a support litter for the patient. The crash cart was originally designed and patented by ECRI Institute founder, Joel J. Nobel, M.D., while a surgical resident at Philadelphia's

Pennsylvania Hospital Pennsylvania Hospital is a Private hospital, private, non-profit, 515-bed teaching hospital located at 800 Spruce Street (Philadelphia), Spruce Street in Center City, Philadelphia, Center City Philadelphia, The hospital was founded on May 11, 17 ...

in 1965. MAX helped enhance hospital's efficiency in emergencies by enabling doctors and nurses to save time, thereby increasing the chances of saving a life. The contents and organization of a crash cart vary from hospital to hospital, country to country, and specialty to specialty, but typically contain the tools and drugs needed to treat a person in or near

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

or another life-threatening condition. These include but are not limited to: * Monitor/

defibrillator Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...

s, suction devices, and

bag valve mask A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide Modes of mechanical ventilation, positive pressure ventilation ...

s (BVMs) of different sizes * Advanced cardiac life support (ACLS) drugs such as

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically give ...

amiodarone Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, atrial fibrillation, and paroxys ...

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia and ventricular fibrillation. When used for local anae ...

sodium bicarbonate Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda (or simply “bicarb” especially in the UK) is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cat ...

dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...

, and

vasopressin Mammalian vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the ''AVP'' gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It ...

* First line drugs for treatment of common problems such as:

adenosine Adenosine (symbol A) is an organic compound that occurs widely in nature in the form of diverse derivatives. The molecule consists of an adenine attached to a ribose via a β-N9- glycosidic bond. Adenosine is one of the four nucleoside build ...

dextrose Glucose is a sugar with the molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae during photosynthesis from water an ...

, epinephrine for IM use,

naloxone Naloxone, sold under the brand name Narcan among others, is an opioid antagonist, a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. Effects begin within two ...

nitroglycerin Nitroglycerin (NG) (alternative spelling nitroglycerine), also known as trinitroglycerol (TNG), nitro, glyceryl trinitrate (GTN), or 1,2,3-trinitroxypropane, is a dense, colorless or pale yellow, oily, explosive liquid most commonly produced by ...

, and others * Drugs for rapid sequence intubation: succinylcholine or another

paralytic Paralysis (: paralyses; also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, ...

, and a

sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are central nervous system (CNS) Depressant, depressants and interact with brain activity, causing its decelera ...

such as

etomidate Etomidate (United States Adopted Name, USAN, International Nonproprietary Name, INN, British Approved Name, BAN; marketed as Amidate) is a short-acting intravenous anaesthetic agent used for the induction of general anaesthesia and sedation for ...

propofol Propofol is the active component of an intravenous anesthetic formulation used for induction and maintenance of general anesthesia. It is chemically termed 2,6-diisopropylphenol. The formulation was approved under the brand name Diprivan. Nu ...

midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia, premedication before surgical anesthesia, and procedural sedation, and to treat psychomotor agitation, severe agitation. It induces ...

; endotracheal tubes and other intubating equipment * Drugs for peripheral and central venous access * Electronic

metronome A metronome () is a device that produces an audible click or other sound at a uniform interval that can be set by the user, typically in beats per minute (BPM). Metronomes may also include synchronized visual motion, such as a swinging pendulum ...

to provide standardized auditory cadence cues during CPR * Pediatric equipment (common pediatric drugs, intubation equipment, etc.) * Other drugs and equipment as chosen by the facility Hospitals typically have internal

intercom An intercom, also called an intercommunication device, intercommunicator, or interphone, is a stand-alone voice communications system for use within a building, small collection of buildings or portably within a small coverage area, which funct ...

codes used for situations when someone has suffered a

or a similar potentially fatal condition outside of the

emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the Acute (medicine), ...

or intensive care unit (where such conditions already happen frequently and do not require special announcements). When such codes are given, hospital staff and volunteers are expected to clear the corridors, and to direct visitors to stand aside as the crash cart and a team of physicians, pharmacists and nurses may come through at any moment. (''See'' Code Blue.)

History in the United States

Another version of the cardiac crash cart was created in 1962 at Bethany Medical Center in

Kansas City, Kansas Kansas City (commonly known as KCK) is the third-most populous city in the U.S. state of Kansas and the county seat of Wyandotte County. It is an inner suburb of the older and more populous Kansas City, Missouri, after which it is named. As ...

, home to the first cardiac care unit in the country.Colby, William H. ''Unplugged: Reclaiming Our Right to Die in America'' The version of the crash cart was designed by a nurse and fabricated by the father of one of the doctors. It contained an Ambu bag, defibrillator paddles, a bed board and endotracheal tubes. An emergency department nurse, Anita Dorr, developed a prototype of a crash cart in 1967 that looked and worked like crash carts used today. Dorr was supervising the Emergency Department of Meyer Memorial Hospital (now Erie County Medical Center) in Buffalo, New York. She found it took too long to gather supplies for cardiac and respiratory arrests. Dorr, with her fellow nurses, put together a list of emergency response supplies, meds and equipment, and built an "Emergency Nursing Crisis Cart" with her spouse in their garage in 1967. Dorr was not able to patent her cart design but she went on to co-found the Emergency Department Nurses Association (now the Emergency Nurses Association) in 1968. Before Dorr invented her crash cart prototype there was a doctor, Joel Noble MD, who invented a cart called the Max cart which was actually a table for patients to lie on. The Max crash cart had drawers for medical supplies and other equipment such as a cardiac compressor and an electrocardiograph machine. The table had equipment to record ECG readouts. Dorr's crash cart looked and functioned like the crash carts that we use today. Dr Nobel's version was more of a table for patients to lie on with drawers of supplies and equipment.

In computing

In the computer industry, the term crash cart is used, by analogy to its original meaning in medicine, to mean a cart that can be connected to a server that is malfunctioning so badly that remote access to it is impossible, the intention being to "resuscitate" the server to the point where remote administration works again. Crash carts most commonly include a keyboard, mouse, and monitor, because most servers in a modern high-density environment do not have user input/output devices. Crash carts are a method of last resort in data centers which employ various forms of

out-of-band management In systems management, out-of-band management (OOB; also lights-out management or LOM) is a process for accessing and managing devices and infrastructure at remote locations through a separate management plane from the production network. OOB all ...

. In those cases it is used for equipment which does not support the requisite out-of-band infrastructure (OOBI) features or in cases where the OOBI devices (concentrators, switches, terminal servers, etc.) or services themselves have failed. The term "crash cart" can also refer to a bootable removable medium containing an operating system and any relevant software used to recover computer equipment (such as a server or PC) from a state of failure. This is done when such recovery is not possible using the computer's existing operating system and software. Crash carts in this sense are historically tape cartridges ("carts") or more recently, external or removable hard drives.

References

;Notes

External links

360-degree view of a crash cart and all its contentsCrash Cart Inventory Checklist
(PDF)
Max, The Lifesaver; Life
{{DEFAULTSORT:Crash Cart Medical equipment Out-of-band management