When a patient arrests, every second counts. The crash cart — also called a code cart or emergency cart — is the wheeled cabinet that makes rapid resuscitation possible. It holds every medication, airway device, and piece of equipment needed to run an ACLS algorithm from the moment the first nurse arrives at the bedside.
Knowing what is on a crash cart, where each item lives, how to verify the cart is ready before a code, and what your responsibilities are during and after resuscitation is not optional knowledge for nurses. Hospitals assess nurses on crash cart familiarity during annual competencies. NCLEX tests it directly. And in a real code, uncertainty at the cart costs lives.
This guide covers every drawer, every medication, every piece of equipment, and all three phases of your crash cart role — before the code, during the code, and after. For the code blue algorithm and team roles, see rapid response and code blue nursing. For defibrillation technique, see cardioversion and defibrillation nursing.
What is a crash cart
A crash cart is a standardized, wheeled metal or polymer cabinet stocked with the medications, equipment, and supplies needed to respond to a cardiac arrest or other life-threatening emergency. In most US hospitals, it is positioned in a designated location on every patient care unit — typically near the nurses’ station or in a hallway alcove with clear line of sight.
The terms crash cart, code cart, and emergency cart refer to the same thing. “Crash cart” is the most common clinical shorthand. “Code cart” is used interchangeably in many institutions. “Emergency cart” appears more often in administrative and policy documents.
Every crash cart is sealed with a numbered tamper-evident lock or plastic breakaway seal. This seal is the first thing you check. An intact seal means the cart has not been opened since the last full inventory check. A broken or missing seal means the cart must be fully inventoried before it can be cleared for use.
The defibrillator or AED sits on top of the cart. It is not inside a drawer — it must be the first thing visible and accessible when someone approaches the cart.
Responsibility for the crash cart rests with nursing. The nurse on shift checks the cart, documents the check, and ensures the cart is restocked and re-sealed after any use.
Crash cart layout: drawer-by-drawer guide
Crash cart organization is standardized across most institutions, though minor variations exist. NCLEX and hospital competency exams use a 5-drawer model. Learn this layout cold — during a code, you do not have time to search.
| Drawer / location | Contents | Clinical purpose |
|---|---|---|
| Top of cart | Defibrillator / AED, cardiac monitor, O₂ source | Immediate defibrillation and rhythm monitoring — always accessible, never inside a drawer |
| Drawer 1 (top) | BVM (adult and pediatric), ETT (sizes 6.0–8.0), laryngoscope handles + blades (Miller 2–3, Macintosh 3–4), stylet, OPA (sizes 80–100 mm), NPA (sizes 6–8 Fr), 10 mL syringe for cuff inflation, tape, CO₂ detector | Airway management — topmost drawer for the fastest access when a patent airway is the first priority |
| Drawer 2 | IV catheters (14, 16, 18, 20 gauge), tourniquet, alcohol swabs, tegaderm/tape, 10 mL NS flushes, IV tubing, extension sets, IO (intraosseous) needle kit, 60 mL syringes | Vascular access — peripheral IV and IO for medication administration |
| Drawer 3 | Epinephrine 1:10,000, amiodarone, atropine, adenosine, sodium bicarbonate, vasopressin, dopamine; syringes (1, 3, 5, 10, 20 mL); needles; medication labels | Primary cardiac medications — core ACLS pharmacology in one dedicated drawer |
| Drawer 4 | D50W (dextrose 50%), naloxone, calcium gluconate, magnesium sulfate, lidocaine, normal saline 0.9% (250 mL bags), IV tubing, blood draw supplies, additional syringes | Secondary medications and fluids — adjunct ACLS drugs and resuscitation fluids |
| Drawer 5 (bottom) | CPR backboard, Yankauer suction catheter + suction tubing, 12-lead ECG electrodes, cardiac monitoring leads, pulse oximeter probe, BP cuff, additional gloves, spare IV supplies | Monitoring, procedural support, and physical adjuncts to resuscitation |
The backboard in drawer 5 slides under the patient’s torso during CPR to provide a firm surface for effective chest compressions. Without it, mattress compression absorbs force and reduces CPR quality.
Crash cart medications
This section covers every drug you will find in the cardiac medication drawers of a standard crash cart. Know the concentration on the cart, the indication, and the ACLS dose for each drug. These appear on NCLEX in pharmacology questions, prioritization scenarios, and simulation competencies. Medication safety principles apply here too — before giving any crash cart drug, verify the right drug, right dose, and right route. For a refresher on the framework, see medication rights nursing.
| Drug | Concentration / form on cart | Primary indication | ACLS dose / route |
|---|---|---|---|
| Epinephrine 1:10,000 | 1 mg / 10 mL pre-filled syringe | Cardiac arrest: VF, pulseless VT, PEA, asystole — first-line vasopressor | 1 mg IV/IO every 3–5 minutes throughout arrest; give as soon as IV/IO access established (after 3rd shock in shockable rhythms per current AHA guidelines) |
| Amiodarone | 150 mg / 3 mL vial | Refractory VF or pulseless VT after 3rd shock; also for stable VT and rate control | 300 mg IV/IO bolus first dose; 150 mg IV/IO second dose if VF/pVT persists; dilute in D5W for infusion |
| Atropine | 1 mg / 10 mL pre-filled syringe | Symptomatic bradycardia; PEA with bradycardic rate while pacing is being established | 1 mg IV push every 3–5 minutes; max 3 mg total; no longer recommended in pulseless arrest PEA/asystole in current AHA guidelines |
| Adenosine | 6 mg / 2 mL vial | Narrow-complex supraventricular tachycardia (SVT) with pulse — rhythm conversion | 6 mg rapid IV push (antecubital or above, followed by 20 mL NS flush); if no conversion in 1–2 min, 12 mg IV push; maximum single dose 12 mg |
| Vasopressin | 20 units / mL vial | Alternative to epinephrine in VF/pulseless VT/PEA — vasopressor for cardiac arrest | 40 units IV/IO single dose, may replace first or second dose of epinephrine; removed from AHA pulseless arrest algorithm as a separate step in 2015 (may still appear in institutional protocols — know both) |
| Sodium bicarbonate 8.4% | 50 mEq / 50 mL pre-filled syringe | Hyperkalemia-induced cardiac arrest; severe metabolic acidosis (pH <7.1); tricyclic antidepressant overdose; prolonged arrest with documented acidosis | 1 mEq/kg IV/IO initial dose; flush IV line with NS before and after (incompatible with calcium and epinephrine); not routinely used in standard VF/asystole arrest without documented indication |
| Dextrose 50% (D50W) | 25 g / 50 mL pre-filled syringe | Symptomatic hypoglycemia; cardiac arrest with documented hypoglycemia as contributing cause | 25 g (50 mL of D50W) IV push; monitor blood glucose after administration; use large-bore peripheral IV — vesicant if extravasated |
| Naloxone (Narcan) | 0.4 mg / mL vial (may also appear as 2 mg / 2 mL) | Opioid-induced respiratory depression or arrest; opioid overdose reversal | 0.4–2 mg IV/IO/IM/intranasal; titrate to effect (adequate respiratory effort — not full reversal in opioid-dependent patients); repeat every 2–3 min as needed; shorter half-life than most opioids — watch for re-narcotization |
| Dopamine | 400 mg / 250 mL premixed bag (standard concentration) | Post-resuscitation hypotension; cardiogenic shock; symptomatic bradycardia when pacing unavailable | 2–20 mcg/kg/min IV infusion; low dose (2–5 mcg/kg/min) for renal perfusion; medium dose (5–10 mcg/kg/min) for inotropy; high dose (10–20 mcg/kg/min) for vasopressor effect; requires infusion pump |
| Lidocaine | 100 mg / 5 mL vial | Alternative antiarrhythmic to amiodarone for VF/pulseless VT; alternative if amiodarone unavailable | 1–1.5 mg/kg IV/IO initial dose; 0.5–0.75 mg/kg every 5–10 minutes; maximum 3 mg/kg total; may be used when amiodarone is contraindicated or unavailable |
| Calcium gluconate / calcium chloride | Calcium gluconate: 1 g / 10 mL; calcium chloride: 1 g / 10 mL (10% solution) | Hyperkalemia (cardiac membrane stabilization); hypocalcemia; calcium channel blocker overdose; hypermagnesemia | Calcium chloride: 500–1000 mg (5–10 mL of 10%) IV slow push over 5–10 min; calcium gluconate: 1–2 g IV over 5–10 min; calcium chloride delivers 3× more elemental calcium per mL — do not interchange doses; central line preferred (peripheral causes severe tissue damage if extravasated) |
| Magnesium sulfate | 5 g / 10 mL vial (or 2 g / 4 mL pre-mixed) | Torsades de pointes (polymorphic VT associated with prolonged QT); refractory VF when hypomagnesemia suspected | 1–2 g IV/IO over 5–20 minutes in cardiac arrest; faster push in torsades de pointes; dilute in 50–100 mL D5W for non-arrest administration |
A note on epinephrine concentration
Two epinephrine concentrations appear in clinical practice. The crash cart contains 1:10,000 (1 mg per 10 mL) — the correct cardiac arrest concentration for IV/IO administration. The 1:1,000 concentration (1 mg per mL) is used for anaphylaxis given intramuscularly or subcutaneously. Giving 1:1,000 IV during a code is a tenfold overdose error. Always confirm the label. For administration technique and intramuscular dosing context, see injection techniques nursing.
Crash cart equipment
Beyond medications, the crash cart carries every physical tool needed for resuscitation. Knowing what each item is and where it is stored lets you anticipate what the team needs before they ask.
| Item | Size / type | Purpose |
|---|---|---|
| Defibrillator / monitor | Biphasic, device-specific energy settings; may include AED mode | Defibrillation (VF/pulseless VT), synchronized cardioversion, cardiac monitoring, 12-lead ECG acquisition; always on top of the cart |
| Bag-valve-mask (BVM) | Adult (1600 mL bag), pediatric (500 mL bag); 15 L/min O₂ connection | Manual ventilation when patient is not breathing or is inadequately breathing; delivers ~100% O₂ with reservoir; two-person technique preferred (one masks, one squeezes) |
| Endotracheal tubes (ETT) | Cuffed tubes: 6.0, 6.5, 7.0, 7.5, 8.0 mm internal diameter | Definitive airway management; 7.0–7.5 standard for women, 7.5–8.0 standard for men; cuff prevents aspiration; requires confirmation (waveform capnography, CXR) |
| Laryngoscope handle + blades | Miller (straight) blades 2, 3; Macintosh (curved) blades 3, 4 | Direct laryngoscopy for orotracheal intubation; Miller blade lifts epiglottis directly; Macintosh blade fits into the vallecula; check batteries and light bulb function at each cart check |
| Endotracheal tube stylet | Adult size; malleable, should not extend beyond tube tip | Provides rigidity to ETT during intubation; bent at 35° angle; must be withdrawn immediately after tube passes cords |
| Oral pharyngeal airway (OPA) | Sizes 80, 90, 100 mm (small, medium, large adult) | Maintains airway patency by displacing tongue in unconscious patients without gag reflex; NEVER used in conscious patients — triggers vomiting and laryngospasm |
| Nasopharyngeal airway (NPA) | Sizes 6, 7, 8 Fr (French) | Maintains airway patency in semi-conscious patients who have a gag reflex; lubricate before insertion; contraindicated in suspected basilar skull fracture |
| Yankauer suction catheter | Rigid tip, adult size | Oral suctioning to clear blood, secretions, or emesis before or during intubation; connect to wall suction at −80 to −120 mmHg; for technique see [airway suctioning nursing](/nursing-tips/airway-suctioning-nursing/) |
| Intraosseous (IO) kit | EZ-IO drill or FAST1 system; 15 gauge needles standard | Vascular access when IV insertion fails after 2 attempts or 90 seconds; insertion sites: proximal tibia (most common), distal femur, humeral head; all ACLS medications and fluids can be given IO |
| IV catheters | 14, 16, 18, 20 gauge angiocaths; also 10 mL NS pre-filled flushes | Peripheral IV access for medication and fluid delivery; 14–16 gauge for rapid fluid resuscitation; 18–20 gauge for standard medication administration |
| Cardiac monitoring leads and electrodes | 5-lead monitoring set; 10-lead 12-lead ECG electrodes | Continuous cardiac monitoring during code; 12-lead ECG acquisition post-ROSC or when rhythm interpretation needed; for monitoring background, see [cardiac monitoring and telemetry nursing](/nursing-tips/cardiac-monitoring-telemetry-nursing/) |
| CPR backboard | Rigid, full-torso width | Placed under patient's back to provide a firm surface for chest compressions; critical for CPR quality on a hospital mattress |
| Colorimetric CO₂ detector | In-line device, connects between ETT and BVM | Confirms endotracheal tube placement post-intubation; color change from purple to yellow indicates CO₂ — correct tracheal placement; no color change suggests esophageal intubation |
| Syringes and needles | 1, 3, 5, 10, 20, 60 mL syringes; 18g and 21g needles; blunt-tip drawing needles | Medication preparation and administration; document how many syringes used during code for accurate pharmacy restock |
Crash cart checks: your daily responsibility
Crash cart verification is a nursing responsibility, not a pharmacy or physician task. Regulations require that every crash cart is checked at the start of each shift (or at minimum once per 24 hours), and that the check is documented in the crash cart log.
The seal check process
Step 1 — Locate the seal. The tamper-evident seal or lock is typically affixed to the top drawer, the cart door, or a designated locking bar that runs across all drawers. It will have a printed serial number.
Step 2 — Verify the seal is intact. The seal should be unbroken, continuous, and show no signs of tampering. Record the serial number in the crash cart log.
Step 3 — Check the defibrillator. Power it on, confirm battery charge level, confirm pads and leads are attached and cables are intact, and confirm the device self-test passes. Some institutions use a checklist posted on the cart for this step.
Step 4 — Verify expiration dates on the outside. Most institutions affix a “next expiration” sticker on the outside of the cart showing the earliest expiration date among all contents. If that date has passed, a full inventory is required.
Step 5 — Document. Sign the crash cart log with your name, credentials, date, time, and seal number. The log must be legible, complete, and available for inspection.
When the seal is broken
A broken, missing, or compromised seal requires a full inventory before the cart can be cleared for use. This means opening every drawer, verifying every item against the master inventory list (posted inside a drawer or attached to the cart), confirming quantities, checking all expiration dates, and replacing any missing or expired items.
After restocking, pharmacy seals the cart with a new numbered seal. Nursing then verifies the new seal number and documents it in the log.
The NCLEX rule: Intact seal → document the seal number and sign the log. No full inventory required. Broken or missing seal → full inventory before the cart is cleared. This distinction appears frequently on NCLEX.
After a code
Following any code or cart use:
- Notify pharmacy immediately — they are responsible for restocking medications
- Nursing verifies all equipment is restocked and functional (airway supplies, defibrillator pads, tubing)
- Pharmacy seals the cart with a new numbered seal
- Nursing documents the new seal number in the log and signs off
The crash cart must be fully restocked and re-sealed before leaving the unit after a code. A nurse leaving the floor with an unsealed, depleted crash cart is a patient safety violation.
Your role before a code
Preparation before a code ever happens is the most underrated part of crash cart nursing. When the code alarm fires, you should already know the answers to every logistical question.
Know where every crash cart is on your unit. This sounds obvious, but nurses who float to unfamiliar units, work agency shifts, or orient to new floors sometimes reach for a crash cart they cannot find. On your first shift on any unit, locate the crash cart before anything else.
Verify you can operate the defibrillator. The nurse is responsible for operating the defibrillator — not just the physician or the charge nurse. If you are unfamiliar with the device model on your unit, ask for a brief orientation before patient care begins. Defibrillation technique is covered in detail in cardioversion and defibrillation nursing.
Never borrow from the crash cart for non-emergency purposes. Using a crash cart syringe because the supply room is out, pulling a piece of IV tubing from drawer 2, or drawing up a routine medication from drawer 3 — all of these leave the cart short and potentially unsealable until pharmacy restocks. This is a serious patient safety event. If you observe this practice, report it through your institutional channels.
Complete your shift check and document it. Every shift, before your first patient assessment — or immediately after if you take report at the bedside — check the crash cart seal, check the defibrillator, and document in the log. If the previous shift did not document a check, escalate to charge before proceeding.
Your role during a code
The first seconds of a code determine whether high-quality CPR begins within the critical window. Your actions in that time matter.
First responder actions
- Call for help and announce the code. Pull the code alarm, call out “I need help,” or use the call system — use whatever mechanism your facility uses to activate the code team. Do not leave the patient’s side to find a phone.
- Check responsiveness and pulse. Unresponsive, no normal breathing, no pulse → begin CPR immediately. You have 10 seconds to check for a pulse. If uncertain, start CPR.
- Begin chest compressions. Rate 100–120/minute, depth 2–2.4 inches (5–6 cm) on an adult, allow full chest recoil. Place the backboard under the patient immediately.
- Send someone for the crash cart. The second person who arrives should retrieve the cart from its location — not hunt for it. This is why cart location knowledge matters.
- Attach the defibrillator. As soon as the cart arrives, apply pads (anterior-lateral placement: right subclavian and left lateral rib), power on, and analyze the rhythm. For VF or pulseless VT, charge and shock as directed by the ACLS algorithm.
Medication preparation and administration
Crash cart medications are prepared and administered based on physician or ACLS team orders during the code. Your responsibilities:
- Confirm the drug name and dose before drawing up
- Know what concentration is on the cart (see the medication table above)
- Prepare the medication and clearly announce it when passing it to the administering nurse or physician: “This is 1 mg epinephrine 1:10,000 — ready to give”
- Flush the IV line with 20 mL NS after each peripheral IV push medication to ensure it reaches central circulation
- For adenosine: use the most proximal large-bore IV available (antecubital or above) and flush rapidly — the half-life is approximately 10 seconds
For medication safety principles that apply even during high-acuity situations, see safe medication administration nursing.
The scribe role
One nurse should be designated as scribe/timekeeper. This person:
- Records the time of every intervention: chest compressions started, medications given (drug, dose, time, route), defibrillation (energy delivered, time, rhythm response)
- Tracks the 2-minute CPR cycles and calls out compression switches
- Tracks epinephrine timing (every 3–5 minutes)
- Records the time of any rhythm checks
- Documents the patient’s final disposition
Scribe documentation is the official record of the code. It must be legible, timed, and signed. After the code, this becomes part of the permanent chart and the basis for the code debriefing. Rhythm monitoring throughout the code links directly to the cardiac arrhythmias nursing framework for identifying shockable vs non-shockable rhythms.
Your role after a code
The code does not end when the team stops resuscitation or the patient achieves ROSC. Your work continues.
Immediate steps
- Notify pharmacy. Contact the pharmacy to initiate crash cart restock. The cart cannot be re-sealed until medications are replaced and verified.
- Verify equipment. While waiting for pharmacy, check that all airway supplies are accounted for: ETT packaging, laryngoscope blades, BVM components, suction catheter. Anything used or opened needs to be replaced.
- Complete the crash cart log. Document the code event, the time the seal was broken, and all subsequent restock and re-seal information.
- Re-seal the cart. Once pharmacy has restocked medications and you have verified equipment, the cart is re-sealed with a new numbered seal. Document the new seal number.
- Do not leave the unit until the cart is cleared. This is a fixed rule. An unsealed crash cart is a safety failure.
Documentation
The code record — whether on paper or in the EMR — must capture every intervention with precise timestamps. Common NCLEX scenario: a patient develops ROSC at 14:32, and you administered epinephrine at 14:18, 14:23, and 14:28. All three doses, their routes, the intervening rhythm checks, and CPR cycles must be documented. Missing timestamps or undocumented medications create liability and quality review problems.
Debriefing
Most institutions conduct a post-code debrief with the team. Participation is expected. The debrief reviews what went well, what could be improved, whether the crash cart was accessible and complete, and whether any process gaps contributed to delays. Feedback from debriefs can prompt skill updates, cart location changes, or training needs.
NCLEX tips: 20 crash cart must-knows
- The tamper-evident seal is the crash cart’s primary security mechanism. Intact seal = no full inventory needed. Broken or missing seal = full inventory required before cart is cleared.
- Crash cart checks are a nursing responsibility, performed every shift or every 24 hours.
- Epinephrine in cardiac arrest is dosed 1 mg IV/IO every 3–5 minutes. The concentration on the crash cart is 1:10,000 (1 mg per 10 mL), not 1:1,000.
- Amiodarone 300 mg IV/IO is given for refractory VF/pulseless VT after the third defibrillation shock. A second dose of 150 mg may follow.
- Atropine is used for symptomatic bradycardia with a pulse, not for routine pulseless arrest. Current AHA guidelines removed atropine from the pulseless arrest (PEA/asystole) algorithm in 2010.
- Adenosine for SVT conversion must be given as a rapid IV push through a proximal large-bore IV, followed immediately by a 20 mL NS rapid flush. Slow administration inactivates the drug before it reaches the heart.
- The defibrillator sits on top of the crash cart — never inside a drawer — because it must be the first item accessible during a code.
- Every nurse is responsible for knowing how to operate the defibrillator on their unit. This is a nursing competency, not a physician-only task.
- Crash cart medications must never be used for non-emergency purposes. Borrowing supplies from the crash cart compromises patient safety.
- The IO (intraosseous) route is a valid ACLS route for all resuscitation medications and fluids when IV access cannot be established. It is not a last resort — it is an equally acceptable primary route in arrest.
- Biphasic defibrillation for VF in adults: 120–200 J initial dose (manufacturer-specific); if unsure, use maximum available energy. Subsequent shocks at same or higher energy.
- Pediatric defibrillation: 2 J/kg first shock, 4 J/kg for all subsequent shocks.
- Vasopressin (40 units IV/IO) was previously included as an alternative to epinephrine in the ACLS pulseless arrest algorithm. It was removed from the AHA algorithm as a separate step in 2015, but some institutions still stock it and use it in protocols.
- Sodium bicarbonate is not given routinely in cardiac arrest. It is indicated for hyperkalemia-induced arrest, severe metabolic acidosis (pH <7.1), tricyclic antidepressant overdose, and prolonged arrest with documented acidosis.
- After a code, nursing is responsible for verifying equipment restocked and the cart is re-sealed before leaving the unit — regardless of what else is happening on the floor.
- Calcium chloride delivers three times more elemental calcium per mL than calcium gluconate. The two are not dose-interchangeable.
- Magnesium sulfate is the treatment of choice for torsades de pointes (polymorphic VT associated with prolonged QT interval). Know the rhythm: torsades de pointes has a sinusoidal twist pattern — the QRS complexes appear to rotate around the isoelectric baseline.
- Naloxone (Narcan) has a shorter duration of action than most opioids. After giving naloxone for opioid reversal, monitor the patient for re-narcotization — the opioid effect can return before the naloxone wears off.
- The backboard in the bottom drawer is for CPR — it goes under the patient’s torso on the mattress. Without it, chest compression depth is reduced by mattress compression.
- For NCLEX: if a question describes a nurse “borrowing” a syringe from the crash cart, the correct action is to report it and ensure the cart is immediately inventoried and restocked — not to ignore it or plan to replace it later.
Practice questions
Test your crash cart knowledge with these NCLEX-style scenarios. Each presents a clinical situation and asks for the correct nursing response.
| # | Scenario | Correct answer / rationale |
|---|---|---|
| 1 | A nurse arrives at the start of the shift and finds the crash cart seal is intact. The previous shift's check was not documented in the log. What should the nurse do? | Perform the shift check now: verify the seal is intact, note the seal number, check the defibrillator, and document in the log. No full inventory is required because the seal is intact. The undocumented prior check is a documentation gap — escalate to charge nurse and document your own check. |
| 2 | During a code, the physician orders epinephrine 1 mg IV push. The nurse opens drawer 3 and finds both 1:10,000 and 1:1,000 vials. Which does the nurse select? | Epinephrine 1:10,000 (1 mg / 10 mL) — this is the correct concentration for IV cardiac arrest administration. The 1:1,000 concentration is used for intramuscular anaphylaxis and would represent a tenfold overdose if given IV. |
| 3 | A patient in VF receives three defibrillation shocks without rhythm conversion. What medication does the nurse prepare next? | Amiodarone 300 mg IV/IO bolus — this is the first-line antiarrhythmic for refractory VF after three shocks per the ACLS shockable rhythm algorithm. Epinephrine 1 mg IV/IO should also continue every 3–5 minutes throughout the arrest. |
| 4 | A nurse is about to start a shift on a float unit. What should the nurse do immediately, before beginning patient care assignments? | Locate the crash cart on the unit and verify the defibrillator model and operation. Nurses floating to unfamiliar units cannot assume they know where the cart is or how the device operates. |
| 5 | A patient has a 12-lead ECG showing a narrow-complex regular tachycardia at 188 bpm. The patient is alert, BP 104/68, complaining of palpitations. What crash cart medication is most likely to be ordered? | Adenosine 6 mg rapid IV push — this rhythm profile (regular narrow-complex tachycardia in a hemodynamically stable patient with a pulse) is consistent with SVT. Adenosine is first-line pharmacological treatment for SVT conversion. |
| 6 | A charge nurse observes a colleague pull a 10 mL syringe from the crash cart drawer to use for a routine medication. What is the priority action? | Intervene immediately to stop the colleague, then report the incident through the chain of command and ensure the cart is inventoried and restocked. The cart seal is now compromised. This is a patient safety event — silence is not acceptable. |
| 7 | After a successful code and ROSC, the responding nurse prepares to leave the unit. The crash cart seal is broken, medications are depleted, and pharmacy has not yet restocked. What should the nurse do? | Do not leave the unit with the crash cart in this state. Stay on the unit, contact pharmacy to expedite restock, verify equipment, and remain until the cart is re-sealed and documented. Leaving an unsealed, depleted cart is a patient safety violation. |
| 8 | A patient in cardiac arrest is diagnosed with hyperkalemia by a point-of-care potassium of 7.2 mEq/L and peaked T waves on the monitor. In addition to epinephrine and CPR, what crash cart medication is indicated? | Calcium chloride or calcium gluconate to stabilize the cardiac membrane, followed by sodium bicarbonate to drive potassium into cells. These are the targeted treatments for hyperkalemia-induced cardiac arrest, used in addition to standard ACLS. |
| 9 | A patient with a history of opioid use disorder is found unresponsive with a respiratory rate of 4/min and pinpoint pupils. What crash cart medication does the nurse prepare? | Naloxone (Narcan) 0.4–2 mg IV/IO/IM/intranasal — this presentation is classic opioid toxidrome. Titrate to adequate respiratory effort. Monitor closely for re-narcotization, as naloxone's duration of action is shorter than most opioids. |
| 10 | The rhythm monitor shows a sinusoidal twisting QRS pattern — the complexes appear to rotate around the isoelectric line with a rate of 210 bpm and no palpable pulse. What is this rhythm and what medication is first-line? | This is torsades de pointes (a form of polymorphic ventricular tachycardia). First-line treatment is magnesium sulfate 1–2 g IV/IO push. In pulseless torsades, defibrillation and CPR are also initiated simultaneously. |
| 11 | A nurse performing a crash cart check finds the sticker on the outside of the cart showing "next expiration: 2026-03-01" and today's date is 2026-05-11. The seal is intact. What is the priority action? | Break the seal and perform a full inventory to identify and replace the expired item(s). An expired medication or supply renders the cart unsafe for use, regardless of seal integrity. After replacement, pharmacy re-seals and the nurse documents. |
| 12 | During a code, IV access cannot be established after two attempts and 90 seconds. What is the next step for medication administration? | Insert an intraosseous (IO) needle — the IO kit is in drawer 2 of the crash cart. All ACLS medications and fluids can be administered IO. The proximal tibia is the most common insertion site in adults. IO access should not be delayed — it is an equally effective route to IV for resuscitation medications. |
Bringing it together
The crash cart is the physical infrastructure that makes code response possible, but the cart itself is only as effective as the nurse who checks it, knows its contents, and can function under pressure when the alarm fires.
Three things matter most for crash cart nursing competency: knowing the organization drawer-by-drawer so you can retrieve items without thinking, understanding each medication’s indication and dose so you can prepare it correctly under time pressure, and maintaining the cart rigorously every shift so it is always ready when it is needed.
For the full code response protocol and team structure, see rapid response and code blue nursing. For rhythm recognition so you can interpret what the monitor shows during a code, see cardiac arrhythmias nursing. For detailed defibrillation technique, see cardioversion and defibrillation nursing.