pediatric crash cart nightmare...
- 0OK, not a long story... I just need some new ideas hopefully. I am trying to re-figure my current peds crash cart for our 18 bed ER. Currently i have a Breslow style cart. Color coded drawers with all the equipment but no meds kept in our cart. We pull ours from the pyxis. Our current cart is to small for all the equiptment so the drawers are packed to the gills and are messy and unorganized. When you open the individual drawers the ett's and ng's fall out the back and get stuck. I've been told that i will not get another actual cart and that i need to make this one work....grrrrr.
So my thought is why cant the drawers be individualized for their needs? ie: an airway, iv, ng, and foley drawer. I have found that with our color coded system more than one drawer gets opened anyways when digging for the correct equiptment.
Has anyone seen a peds crash cart done this way before?? Thanks rnbecky ed 9yrs in a 45,000pop town
- 1Feb 10, '11 by XB9S GuideI have always worked with emergency trolleys that are categorised into the following
Top of Trolley: Basic Airway management
1st Drawer: Advanced Airway and Breathing
2nd Drawer Circulation equipment, IV access, blood work and monitoring
3rd Drawer: Gloves, fluids and drugs
Have a look at the following set up:
Page 12 of the link
- 0Feb 10, '11 by back2bRNWe use the Broselow Cart where I am, ours is fairly streamlined so don't often have things fall out the back and get stuck. However, our blades and scope are in the first drawer(pink/red). Maybe you need to re-evaluate the quantities and supplies in each drawer? Are your iv supplies in each drawer/fluids?
- 0The quantity of things may be an issue..usually 2 different sizes of ett, suction caths, and iv needles for each color drawer... i really think we just have a crap cart and thats why things fall out the back. it happens when you open the drawer things get caught and topple out the back side. we dont keep fluids in our cart at all.
- 2Feb 10, '11 by FlyingScotIf you have more than one size ETT/NG then your cart isn't set up correctly. Each color should only have one size of each. The beauty of the Broselow system is you grab one drawer for each size of patient. Once you divide it out the way you are thinking then you are forced to dig thru multiple drawers. In my experience this is not very efficient in an emergency. We utilized the Broselow system but not the actual cart. Ours were labeled with the color. They had internal dividers or trays. We set up each drawer exactly the same. Airway to the left then breathing (masks, etc) and finally circulation (leads, IV's) on the extreme right. One thing that helped keep the packages under control was we rubber-banded them (not tightly though). It seemed to help keep things from "jumping" from the drawer. Our meds were kept in a locked tackle box that was managed by pharmacy and kept on top of the cart. We needed it done this way because we responded to pedi codes throughout the hospital. I can probably get a picture of it if you PM me your e-mail address.
- 2Feb 10, '11 by Altra GuideI have not seen a peds crash cart set up as you propose, and quite frankly, unless your staff is very experienced with pediatric emergencies and you continue to see a lot of crashing kiddos -- I wonder if the lack of a color-coded size guide would add unnecessary stress to the situation.
The problem appears to be the cart itself. I sympathize -- I briefly worked in an ER where the "trauma cart" (I use the term loosely) looked like something that had been dropped from the top of a tall building and each & every drawer handle had a certain "trick" required to actually open it.
If your department absolutely cannot purchase a new cart, then re-evaluate the quantities of each item to see what can be pared down. Maybe some things can be moved out into a simple plastic tote (purchased at the dollar store if necessary) and stored on top of the cart.
And ... it will take just one situation with a crashing kid where the right size ETT is delayed because no one can find it to cure your problem ... a new cart will magically appear. 'Cause, ya know, reaction, not prevention, is the name of the game.
- 3Feb 10, '11 by FlyingScotQuote from AltraThat's what happened with us. Originally we stored the equipment in plastic bags and bins. All it took was an entire bin dumping onto the floor where we had to retrieve it's contents and use them on a 3 month old SIDS to get the cart we needed.And ... it will take just one situation with a crashing kid where the right size ETT is delayed because no one can find it to cure your problem ... a new cart will magically appear. 'Cause, ya know, reaction, not prevention, is the name of the game.
- 0Feb 11, '11 by back2bRNYou may in fact have a "crap cart", the Broselow I am familiar with does have two of all sort of tubes on it in each drawer(and no issues opening it up). However our peds iv supplies and our io supplies are both in different and distinct portable caddies. The other system that I have seen work well is the Broselow duffel bag with each color a velcro attached to the main bag which contained the supplies used for all peds. Ie scope/blades,ect. That also worked well.
- 0Feb 11, '11 by ImThatGuyJust a random thought as I watch tv here....
Can you get color coded stickers or tape and mark the item with its corrsponding color on the Broselow tape?
Make the top drawer airway for example and throw in a lot of color coded junk. That does nothing for me since I'm red-green color blind, lol. I have to read my crayons.
Other than that...thin out the cart maybe?? We used a bag on the ambulance that corresponded to Broselow. I think we could service to pedi's out of the bag without refilling.