13MS9148 Crash Cart SOP web_Layout 1 11/7/13 9:27 AM Page 1

“The CMS ASC Conditions for Coverage mandate Most allergic reactions that occur during anesthesia Patients with atopic diseases such as asthma, eczema, specific requirements for emergency management.” are caused by antibiotics, though many reactions or allergic rhinitis are at high risk of anaphylaxis Typically, these policies include code blue response, do not have a clear cause. from food, latex, and radiocontrast. emergency transfer, and crash cart. Source: Anesthesia and Allergy, Sept. 2011 Source: Annals of Allergy, Asthma & Immunology Source – CMS

A compliant crash cart is characterized by ToP of THE CART storing lifesaving equipment that is easily movable and readily accessible into all sides of defibrillator Real CPR Help™ for ALS the cart for quickly viewing and removing ® The first and only Code-Ready ® SOP equipment and drugs during a crisis situation. monitor defibrillator Stat Kit Z-1000 crash cart CRASH CART BEST PRACTICES: R-Series ALS Each 120-7737 When time is critical, your • Design a standardized crash cart that meets the needs Thermal Paper 5/Box 106-5906 ability to get the appropriate of your facility, the patient population you treat, and Spectra Gel 8.5 oz. 727-6353 medications, devices, and Stat Pads 1 Pair 119-1441 procedures you perform oxygen to the patient may • Review and modify crash cart inventory as required by be the difference between the anesthesia and medical staff at your facility a life saved and • Document necessary approvals for inventory list and Suction a life lost. 449-0032 emergency management protocols by your Medical Executive Committee and Governing Board The Vario 18 is a medical suction pump, offering dependability, low • Establish protocols for emergency response and noise and mobility. transfer. Download A Sample Emergency Crash Cart • Lightweight and portable Checklist from www.henryschein.com/crashcart • For small surgical interventions • Designate licensed personnel to perform scheduled • Ideal for airway suctioning inventories of your crash cart supplies for expiration Vario 18 AC 240-0021 foR EnHAnCEd foR dIffICulT and availability while registering compliance on an Vario 18 AC/DC 240-0022 vASCulAR ACCESS InTuBATIonS approved checklist. Download A Sample Inventory List Suction – Drive Portable Suction AC/DC Pump Each 119-6164 from www.henryschein.com/crashcart Suction – V-Vac™ Manual Starter Kit Each 220-6305 • Ensure functionality, accessibility, and security of all Tubing ¼" x 100” Each 153-3560 equipment and crash cart supply inventory Suction Canister – 800cc Each 645-5651 AED – Zoll AED Pro® Each 108-8563 • Implement ongoing educational trainings and quarterly Portable Ventilator – AutoVent3000® Each 782-8048 drills, while documenting each event For patients over 44 pounds, features state-of-the-art START WITH pneumatics to assure reliable, time-cycled, constant flow THE CART! capabilities driven by a minimum of source gas. • Quality construction Our Team of over 600 Sales Consultants • Multiple configurations Electrodes–Monitoring 50/Pack 900-7028 and Equipment Specialists are your • 12-year warranty on Adult Ambu Bags–Disposable Each 624-2443 reliable network of trusted advisors as Infant Ambu Bags–Disposable Each 499-9928 you make the best investments to manufactured parts! Pedi Ambu Bags–Disposable Each 102-2685 generate revenue and deliver Finger Sensor Probes for SpO2–Reusable Adult 103-0696 Stethoscope–22” Black 900-4815 optimal outcomes. Aneroid Sphyg Black Adult 112-6070 CPR Lifesaver Board, m 23¼” x 17¼” Each 120-8283 116-9650 Call us to schedule a complementary 389-8699 Oxygen Tanks w/one Regulator–Banyan filled Each 321-0069 External Mount Sharp Container 3 Gallon 106-7885 in-office consultation. 1.800.772.4346 www.henryschein.com/crashcart Don’t Forget Clipboard, Stopwatch or Timer, www.henryschein.com/crashcart

STANDARD OPERATING PROCEDURE Code Blue Worksheets, and ACLS Algorithms 13MS9148 13MS9148 Crash Cart SOP web_Layout 1 11/7/13 9:27 AM Page 2

Emergency Crash Cart Essentials for Physician Office and Healthcare Facilities

FIRST DRAWER-Medications: FIFTH DRAWER–Intubation: CRASH CART DRUGS clo–mag CRASH CART DRUGS met–wat CC Qty. Inventory Component Order# CC Qty. Inventory Component Order# Clonidine HCl (Catapres®) 0.1mg 1 tablet 248‐7968 Methylene Blue 1% (10mg/mL) 10mL SDV 258‐0112 2 3mg 2mL CC Drugs 36 Dantrium 20mg – Each CC Drugs Dantrolene Sodium/Dantrium® IV 20mg/mL 70mL SDV (6/Box) 115‐7589 Metoclopromide HCl (Reglan®) 5mg/mL 2mL FTV 114‐8940 1 HCl 50mg 3mL CC Drugs 1 Laryngoscope – Welch-Allyn Handle Each 566-6530 Dantrolene Sodium/Revonto® IV 20mg/mL 60mL SDV (6/Box) 118-3633 Metoprolol (Lopressor®) 1mg/mL 5mL SDV Ampule 248‐8794 1 Sulfate 10mL CC Drugs 1 Miller Blade #2 – Disposable Each 857-5266 Dexamethasone (Decadron®) 4mg/mL 5mL MDV 258‐0122 Midazolam HCl (Versed®) – CIV 2mg/mL 2mL Prefilled 116-9386 1 Calcium Gluconate 10% 10mL CC Drugs 1 Miller Blade #3 – Disposable Each 857-3605 Dexamethasone (Decadron®) 4mg/mL 30mL MDV 102‐4486 Midazolam HCl (Versed®) – CIV 5mg/mL 1mL SDV 248‐0299 1 Dobutamine 250mg 20mL CC Drugs 1 Miller Blade #2 – Fiber Optic Each 203-0680 Dextrose 25% (infant) 10mL Syringe 248‐6407 Midazolam HCl (Versed®) – CIV 5mg/mL 2mL SDV 248-0514 4 Epinephrine 1:1000 1mL CC Drugs 1 Miller Blade #3 – Fiber Optic Each 203-3868 Dextrose 50% 50mL Syringe 248‐0724 Midazolam HCl (Versed®) ‐ CIV 2mg/mL 118mL bottle 408‐0210 2 Epinephrine 1:10,000 10mL CC Drugs 1 Macintosh Blade #2 – Fiber Optic Each 772-0856 Dextrose 50% 50mL SDV 248‐6614 Nalbuphine (Nubain®) 10mg/mL 1mL SDV 248‐0314 1 Dexamethasone 4mg 1mL CC Drugs 1 Macintosh Blade #3 – Fiber Optic Each 566-8513 ® 3 Diltiazem – CC Drugs Dextrose 5 in Water (D5W) 5% 100mL IV Bag 153‐9754 Naloxone HCl (Narcan ) 0.4mg/mL 1mL Carpuject LL 248‐9357 1 ET Tubes 4.0mm Each 118-4841 ® 1 Hydrocortisone 100mg 2mL – CC Drugs Dextrose 5 in Water (D5W) 5% 250mL IV Bag 153‐6161 Naloxone HCl (Narcan ) 0.4mg/mL 1mL SDV 248‐9568 1 ET Tubes 7.0mm – Murphy Each 826-5685 1 Lanoxin 0.5mg 2mL – CC Drugs Dextrose 5 in Water (D5W) 5% 500mL IV Bag 258‐0265 Naloxone HCl (Narcan®) 0.4mg/mL 10mL SDV 258‐7295 1 ET Tubes 8.0mm – Murphy 10/Box 499-9231 1 Levophed® 4mg 4mL CC Drugs Dextrose 5 in Water (D5W) 5% 1000mL IV Bag 104‐6850 Naloxone HCl (Narcan®) 1mg/mL 2mL Min‐I‐Jet (21Gx1.5") 248-0500 1 ET Stylet – Flexi-Slip™ 10 FR Each 826-8199 1 Narcan 0.4mg 1mL – CC Drugs Dextrose 5 in Water (D5W) 5% 250mL Bottle 295‐0035 Neostigmine Methylsulfate (Prostigmin®) 1:1000 10mL MDV 258-9609 1 ET Stylet – 14 FR 20/Box 652-5403 1 Neo-Synephrine 10mg 1 mL CC Drugs Dextrose 5% & Sodium Chloride 5%/0.9% 500mL Bag 153‐8920 Nitroglycerin 5mg/mL 10mL SDV 248‐5055 1 Nasal Cannula with Tubing – Adult 25/Case 283-3962 1 Benadryl 50mg 1mL– CC Drugs Diazepam (Valium®) – CIV 5mg/mL 2mL Carpuject LL 248‐0273 Nitroglycerin Spray (Nitrolingual®) 0.4mg/spray 4.9 Gm. 116‐5208 1 Airways 6; 60mm Long Black Each 857-0060 1 Romazicon 1mg 10mL – CC Drugs Diazepam (Valium®) – CIV 5mg/mL 10mL MDV 248‐0274 Nitroglycerin Spray (Nitrolingual®) 0.4mg/spray 12 Gm. 116‐5209 1 Airways 8; 80mm Long Green Each 295-8407 1 Verapamil 2.5mg 2mL CC Drugs Digoxin (Lanoxin®) 0.25mg/mL 2mL SDV 248‐1659 NitroMist® Aerosol Spray (Nitroglycerin) 0.4mg/spray 4.1 Gm. 248‐0473 5 Tongue Blades 500/Box 100-2416 Diltiazem (Cardizem®) 5mg/mL 5mL SDV (10/Box) 108-9027 Nitropress® (Sodium Nitroprusside) 50mg/2mL SDV 248‐2398 1 Oxygen Wrench 923-0010 1 Lubricating Jelly Sterile 4 oz. Each 112-5680 Diphenhydramine (Benadryl®) 50mg/mL 1mL Carpuject LL 248‐9358 NitroMist® Aerosol Spray (Nitroglycerin) 400mcg/spray 4.1 Gm. 248‐0473 Each Thermal Paper–Sony Hi-Goss 5/Box 106-5906 1 Oxygen Flow Meter 15 LPM Each 111-8057 Diphenhydramine (Benadryl®) 50mg/mL 1mL SDV 258‐5924 Nitrostat® (Nitroglycerin) 0.4mg (1/150gr) 25/Bottle 258‐0313 2 Batteries C – Procell® 12/Box 719-2949 SECOND DRAWER-Breathing and Airway: Dobutamine (Dobutrex®) 250mg/20mL SDV 248‐7964 Nitrostat® (Nitroglycerin) 0.4mg (1/150gr) 100/Bottle 321‐3802 CC Qty. Inventory Component Order# (Intropine®) 40mg/mL 5mL SDV 258‐4556 Phenylephrine HCl (Neo‐Synephrine®) 1% (10mg/mL) 1mL SDV 248-0442 SIXTH DRAWER: ® ® 1 Glucagon Diagnostic Emergency Kit CC Drugs Dopamine (Intropine ) 80mg/mL 5mL SDV 114‐7375 Phenytoin Sodium (Dilantin ) 50mg/mL 2mL SDV 248‐2309 CC Qty. Inventory Component Order# ® 2 20 units/cc CC Drugs Dopamine in 5% Dextrose 400mg/250mL (1.6mg/mL) 250mL 115‐5645 Phenytoin Sodium (Dilantin ) 50mg/mL 5mL SDV 248‐0845 1 Dextrose 50 Gm. 50mL CC Drugs 1 Cric Kit w/6.0mm ET Tube (Adult) Kit 753-2319 Epinephrine (Adrenalin® Chloride) 1:10,000 10mL (18Gx3.5") 248‐8166 Potassium Chloride 20mEq 10mL SDV APP Pharma 248‐0240 2 Amiodarone 150mg 3mL CC Drugs Epinephrine (Adrenalin® Chloride) 1:10,000 10mL 248‐8175 Procainamide HCl (Pronestyl®) 100mg/mL 10mL MDV 258‐7296 1 Nitroglycerine 50mg 10mL CC Drugs 1 D5½ NS 250cc CC Drugs Epinephrine (Adrenalin® Chloride) 1:1,000 1mL 258‐9483 Procainamide HCl (Pronestyl®) 500mg/mL 2mL SDV 113‐2836 1 Sodium Bicarbonate 8.4% 50mL CC Drugs 2 Lactated Ringers 500cc CC Drugs Epinephrine Auto‐injector (Adrenaclick®) 0.15mg Ped-2/Pk 120-2511 Promethazine HCl (Phenergan®) 25mg/mL 1mL SDV 258‐4249 1 Dopamine 400mg 10mL CC Drugs 2 NACL 0.9% – see Sodium Chloride 500cc CC Drugs Epinephrine Auto‐injector (Adrenaclick®) 0.3mg Adult-2/Pk) 345‐1926 Promethazine HCl (Phenergan®) 50mg/mL 1mL SDV 248‐4638 2 CPR Microshield Breather 372-9613 5 IV tubing – Safeline® 15 Drop/mL 50/Case 613-6922 Esmolol HCl (Brevibloc®) 10mg/mL 10mL SDV 248-0492 Propranolol HCl (Inderal®) 1mg/mL 1mL SDV 248‐0340 2 Yankauer Tip Each (Bulb Tip, without Vent) 788-2392 5 Povidone Swabsticks 50/Box 267-8499 Flumazenil (Romazicon®) 0.1mg/mL 5mL MDV 248-0538 Revonto® IV (Dantrolene Sodium) 20mg/mL 60mL SDV (6/Box) 118-3633 2 Suction Tubing-Sterile ¼” x 10’ Roll 520-9818 Flumazenil (Romazicon®) 0.1mg/mL 10mL MDV 248-0540 Sodium Bicarbonate (infant) 4.2% (5mEq) 10mL 248‐7957 THIRD DRAWER-Circulation: CRASH CART DRUGS act–chl Furosemide (Lasix®) 10mg/mL 2mL SDV 181‐3332 Sodium Bicarbonate (infant) 8.4% (10mEq) 10mL 248‐8473 ® CC Qty. Inventory Component Order# (Check Monthly For Expiry Dates) Furosemide (Lasix ) 10mg/mL 10mL 248‐9356 Sodium Bicarbonate 8.4% (50mEq) 50mL SDV 248‐1288 GlucaGen® Diagnostic Kit (glucagon) 1mg (1 unit) Kit 104‐2145 Sodium Bicarbonate 8.4% (50mEq) 50mL SDV 248‐8109 2 Lasix 40mg/10mL – CC Drugs Activated Charcoal Powder 1 oz. bottle 348‐1109 Heparin Sodium Porcine 1,000 U/mL 1mL MDV a 248-3940 Sodium Chloride (Bacteriostatic) 0.9% 10mL MDV Plastic 116‐2590 1 Magnesium Sulfate 5 Gm./10mL CC Drugs Adenocard® (adenosine) 3mg/mL 2mL Syringe 323‐0003 ® Adenocard® (adenosine) 3mg/mL 4mL Syringe 323‐0004 Hydralazine HCl (Apresoline ) 20mg/mL 1mL SDV 248-0407 Sodium Chloride (Bacteriostatic) 0.9% 30mL MDV Plastic 258‐0040 ® FOURTH DRAWER-Circulation (IV): Adenosine 3mg/mL 2mL SDV 248‐0408 Isuprel (Isoproterenol HCl) 1:5,000 (0.2mg/mL) 2mL SDV 248‐3658 Sodium Chloride for Inj (Normal Saline) 0.9% 250mL 295‐0041 ® CC Qty. Inventory Component Order# Adenosine (Adenocard®) 3mg/mL 4mL Syringe 112‐7804 Ketorolac Tromethamine (Toradol ) 30mg/mL 1mL SDV 258‐9639 Sodium Chloride for Inj (Normal Saline) 0.9% 500mL 258‐1455 ® 3 Gloves- Nitratex® Small Sterile PF 100 /Box 685-5866 Albuterol/Ventolin® HFA Inhaler 0.09mg/spray 18 Gm. 930‐9143 Labetalol HCl (Trandate ) 5mg/mL 20mL MDV 840‐8589 Sodium Chloride for Inj (Normal Saline) 0.9% 1000mL 104‐6816 3 Gloves- Nitratex® Med Sterile PF 100/Box 685-7913 Aminophylline 25mg/mL 10mL SDV 248‐2037 Lactated Ringers Solution 500mL Bag 258‐8050 Sodium Chloride Irrigation (Normal Saline) 0.9% 1000mL Plastic 118-0914 ® ® 3 Gloves- Nitratex Large Sterile PF 100/Box 685-4461 Amiodarone HCl (Cordarone®) 50mg/mL 3mL SDV 248‐5924 Lactated Ringers Solution 1000mL Bag 104‐8833 Solu‐Cortef (Hydrocortisone Sod Succ) 100mg 2mL SDV 908‐0011 ® ® Each Tape-Hypafix 2" x 2 Yds. Roll 925-4928 Amiodarone HCl/Nexterone® 150mg/100mL (12/case) 248‐0455 Levophed (Norepinephrine Bitartrate) 4mg/4mL SDV 248‐7963 Solu‐Cortef (Hydrocortisone Sod Succ) 250mg 2mL SDV 908‐0013 2 Introcan® Safety IV Catheter 22 Ga. x 1” Each 507-5531 ® ® Amiodarone HCl/Nexterone® 360mg/200mL (10/case) 248‐0458 HCl (Xylocaine ) 1% (10mg/mL) 5mL 248‐0238 Solu‐Medrol (Methylprednisolone Sod Succ) 40mg/1mL SDV 248‐0255 2 Introcan® Safety IV Catheter 20 Ga. x 1” Each 507-5995 ® ® Ammonia Inhalant 0.3mL Ampule 840‐8449 Lidocaine HCl (Xylocaine ) 1% (10mg/mL) 20mL MDV 258‐7008 Solu‐Medrol (Methylprednisolone Sod Succ) 125mg/2mL SDV 248‐0254 1 Arterial Blood Gas Kit 25 Ga. x ⅝" 100/Case 245-2041 ® ® Aspirin 325mg (5gr) Packet/2 tablets 295‐0031 Lidocaine HCl (Xylocaine ) 2% (20mg/mL) 5mL 248‐3812 Succinylcholine Chloride (Quelicin ) 20mg/mL 10mL MDV 295‐0043 1 Tourniquet Latex-Free, 18” x 1” 25/Box 270-3884 Lidocaine HCl (Xylocaine®) – Cardiac 2% (20mg/mL) 5mL 248‐8012 Terbutaline Sulfate (Brethine®) 1mg/mL 1mL SDV 248‐0423 5 Alcohol Swabs- BD Swabsticks 100/Box 987-5706 Atropine Sulfate 0.05mg/mL (infant) 5mL Syringe 248‐7959 Lidocaine HCl (Xylocaine®) 2% (20mg/mL) 5mL SDV 248‐0235 Tigan® (Trimethobenzamine HCl) 100mg/mL 2mL SDV 248‐0294 2 Syringes 60mL 50/Box 112-6152 Atropine Sulfate 0.1mg/mL 5mL Syringe 248‐7960 Lidocaine HCl (Xylocaine®) 2% (20mg/mL) 20mL MDV 258‐0603 Vasopressin (Pitressin®) 20U/mL 1mL MDV 258‐2742 2 Syringes 20mL 50/Box 112-6151 Atropine Sulfate 0.1mg/mL 10mL Syringe 248‐4141 ® 5 Syringes 10mL 100/Box 900-4476 Atropine Sulfate 0.4mg/mL 1mL SDV 258-0069 Lidocaine HCl & Dextrose 5% 0.4%/5% 500mL 153‐6016 Vasopressin (Pitressin ) 20U/mL 10mL MDV 248‐7969 ® ® ® 5 Syringes 5mL 100/Box 900-4477 Atropine Sulfate 1mg/mL 1mL SDV 258-6261 Lidocaine HCl w/Epi (Xylocaine w/Epi) 1% 20mL MDV 258‐0672 Verapamil (Calan , Isoptin ) 2.5mg/mL 2mL SDV 248‐0352 ® ® ® 5 Syringes 3mL 100/Box 900-4475 Calcium Chloride 10% (100mg/mL) 10mL SDV 248-2310 Lidocaine HCl w/Epi (Xylocaine w/Epi) 2% 20mL MDV 248‐0237 Verapamil (Calan , Isoptin ) 2.5mg/mL 4mL 248‐9359 10 Needles 18 Ga. x 1” 100/Box 900-4469 Calcium Gluconate 10% (100mg/mL) 10mL SDV 248‐9765 Magnesium Sulfate 50% (1 Gm./2mL) 2mL SDV 258‐2820 (Sterile) Water for Injection Preservative-Free 10mL FTV 258‐0622 2 Injectable Saline 30mL CC Drugs Chloroprocaine HCl (Nesacaine®) 2% 400mg/20mL SDV 104‐5383 Magnesium Sulfate 50% (10 Gm./20mL) 20mL SDV 258‐0220 (Sterile) Water for Injection Preservative-Free 50mL FTV 181‐9911 Each Conductivity Gel-Spectra™ 360 8.5 oz. 727-6353

If you don’t see what you need for your practice, call your Henry Schein Sales Consultant or visit: www.henryschein.com/crashcart