pediatric crash cart nightmare...

allnurses Guide · Feb 10, 2011

I 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

http://www.ruh.nhs.uk/about/policies/documents/clinical_policies/blue_clinical/Blue_774.pdf

back2bRN · Feb 10, 2011

We 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?

rnbecky8085 · Feb 11, 2011

The 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.

FlyingScot, RN · Feb 11, 2011

If 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.

Altra, BSN, RN · Feb 11, 2011

I 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. :uhoh3:

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.

FlyingScot, RN · Feb 11, 2011

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.

That'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.

rnbecky8085 · Feb 11, 2011

lol I guess I haven't responded enough...I don't have pm privileges. ha I would really like the photo you offered tho...just send it to [email protected] thanks bunches

back2bRN · Feb 12, 2011

You 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.

ImThatGuy, BSN, RN · Feb 12, 2011

Just 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.

rnbecky8085 · Feb 12, 2011

I do like the idea of the meds in a separate locked box, filled by pharmacy. I also like the idea of the io and iv supplies taken out of the cart and placed in a separate caddy...that's how we do peds iv already and the pca's can continue to stock that. I also like the idea of putting all the ett and blades together and just color coded them.....wonderful ideas everyone....thank you so much!

MesaRN · Feb 17, 2011

We use separate bins that are color coded to the Braslow. The bins contain larger items like ET tubes and OG/NG tubes, ect. that are appropriate for the weight group. The core cart itself holds the larygoscope blades, IO kit, IV kit and meds.