ER medicine without the panic button

On this week's episode of The Vet Blast Podcast, dvm360 welcomes Anthony R. Coronado, DVM, to our show to discuss what is essential for a crash cart in emergency medicine cases. In this episode, Coronado and our host Adam Christman, DVM, MBA, discuss what items to stock for your crash cart, the importance of regular expiration date checks and training programs to ensure teams are ready for an emergency, common mistakes veterinary professionals make when it comes to emergency cases, and the pros and cons of what it is like to work in emergency medicine.

Below is a partial transcript, edited lightly for clarity.

Adam Christman, DVM, MBA: OK, so let's talk about the crash cart. This is so, so crucial. The reason why we're having this conversation is [because] we've been approached by listeners and learners about this, and...we're here to have you help guide us along the way. So let's talk about some of the nonnegotiables, if you will. What are some of the nonnegotiables that are in a crash card setup or a restock process?

Anthony R. Coronado, DVM: I would say that every hospital is different in terms of what they prefer to have in their crash cart, so the main thing is being consistent in what you have in there. More importantly, though, regardless of what you keep in or on top of your crash cart, the most important thing is that it is stocked and it is secured so that people aren't using it for the day-to-day treatment of patients. Too many times, I see...somebody's using it for catheters [or] for grabbing a drug, and then when a crisis hits, that cart isn't ready for what it's designed for. So what you want to do is keep it stocked at all times. You've got a breakaway lock on there, and you want tape on there that says, "This was restocked at this time by this person," so that you know that it's ready to go and [it's] there when you need it. In terms of items, drugs are going to change...[and] things are on back order. Some require in-depth calculations that take a while, so they're not necessarily crash items. But you want to have chest tube placement kits, pericardiocentesis kits, thoracosynthesis kits, [and] unblocking kits ready for [blocked cats].

[You'll want] tracheal tubes of all sizes, if you have them, and you can get them for tracheostomy tubes, but you can also cut your own [tracheal] tube down in an emergency situation. [You also need] catheters of all sizes. In a shock situation, you want the bigger, the better. That is a common mistake. I see people put in tiny catheters [for] a giant dog, and you're just not able to deliver the fluids they need.... Then you might want to have central lines ready and [intraosseous] catheters with a driver so you can get fluids in those right away. And of course, you want the fluids that we just talked about handy, so your basic crystalloids...and hypertonic saline—[a] little controversial whether you want hetastarch or VetStarch, because of the concerns behind there, but go with those first few, and then epinephrine atropine.

Now, whether you have access to pressors or not...those are one of the ones that have a lot of calculations go with them. But some people prefer to have those in the carts. I like to have insulin ready for those crashing blocked cats. I prefer calcium gluconate because I'm comfortable with it. To have that ready for those guys, too...can make a world of difference in a very short time.