Thursday, July 6, 2017

Crash Cart - Circa 1921

Inventory of ancient crash cart: Tracheotomy set, solutions of H2O2, adrenalin, tannic acid, and gallic acid. Equipment to administer a stimulating enema and if that failed, how about some smelling salts?  Sterile supplies with the notation, "If carefully done up, these will not need to be frequently sterilized."

I should probably publish  this post without pontificating about crash carts, but like the oldfoolrn that I am, here I go shooting off my old wrinkled up mouth. Mouth flapping and jaw jacking at it's finest about a subject I have no current experience with.

There is something almost talismanic, I think, about having an assemblage of lifesaving equipment and pharmaceuticals gathered together in a  mobile crash cart or trolley. The individual components assume a far greater reverence and respect than they would on their own and the ability to move them throughout the hospital is indeed  magical.  If a patient is circling the drain, it's always prudent to park that crash cart right outside the door to chase away that bad juju.

Whippersnapperns were quick to admonish oldfoolrns like me for failing to respect the supernatural  powers  of  collective resuscitation equipment, "Hey you need to have the crash cart at the bedside when you do that," was their frequent outburst. They were just shocked, and awed by my magical power to convert tachy arrhythmias to normal sinus by slight of hand vagal tricks  like applying gentle ocular pressure, a trick old nurses learned from watching the 3 stooges. There were no crash carts in the stooge era and I never converted anyone into cardiac stand still, but the youngsters had a good point and I became more concerned about access to a crash cart later in my nursing life..

Whippersnapperrns were always flabbergasted to learn there were no crash carts in the OR and we never called a code for a patient that was on the table. The rationale for this practice was the notion that anesthesia was on the ready with all  equipment at hand for resuscitation. I was explaining this in my usual blowhard, know-it-all tone of voice to a young whippersnappern and she piped up with the question, "Where is the defibrillator, fool?"  I did not have an answer as all that we had available were defibrillators with  internal paddles. "Well..I guess we could run over to ICU and borrow their defibrillatoer," was my lame reply.

Old nurses knew and practiced resuscitation without new fangled devices like ambu bags using mouth to mouth. I once performed mouth to mouth on a chap with about a weeks worth of whiskers and it felt like trying to blow up a water ballon studded with porcupine quills. Ambu bags were one of the greatest inventions for lips-off resuscitation.

This cart is so important that a nurse is obligated to check on it every shift. I knew a nurse that accrued big time trouble because an amp of bicarb was a month out of date and her initials were last on the checklist when a supervisor went through a crash cart. Nurses can get into trouble for the most inconsequential of misdeeds. It never paid to worry about supervisor admonishments because trouble always accrued from something totally unforeseen. Don't happy and carefully check that crash cart was always good advice.



  1. Hello,
    I once did mouth to mouth on a fellow in ICU while someone else did the compressions. At one point i looked at him and noticed his mouth was covered in blood. Turns out it was my blood as i'd split my lip on his teeth as he bounced up and down from the compressions. Yes, thank goodness for the ambu bag.

  2. Even with the advent of Ambu bags, many old nurses were skeptical about using them, claiming mouth-to-mouth was a superior way to ventilate. "How can you assess pulmonary compliance with a bag?" was a frequent question.

    After practicing mouth to mouth on a Resci-Annie with about 20 other people, I came down with Mono. The incubation period jived exactly with my mouth-to-mouth session with Annie. That was enough to convince me of the importance of Ambu bags.

    Thanks, Doc, for reading my foolishness and taking the time to comment.

  3. Early crash carts were usually followed by a harried orderly pushing a dolly containing a gigantic "H" cylinder of oxygen. Crash cart pioneers were more concerned with capacity than portability. Interesting post.