Essential Veterinary Crash Kit: Preparing for Emergencies

Author: Dr Rosalind Wright MRCVS 

A well-stocked and organized veterinary crash kit is crucial in emergency situations, as it can significantly enhance the chances of successful cardiopulmonary resuscitation (CPR). Having the right drugs and equipment readily accessible is just the beginning; proper organization, clear labeling, and staff training are equally important to ensure efficient and effective use of the crash kit during critical moments. 

Basics of Veterinary Crash Kits 

Customization and Portability: Design your crash kit to meet your practice's specific needs. Smaller practices might use portable toolboxes, while larger veterinary hospitals could benefit from carts or units with drawers. Ensure the crash kit is portable, either on wheels or with a carry handle, and designed for easy access to each item. 

Strategic Location: Place your crash kit in a central area where critical patients are assessed, oxygen is available, and anesthesia is routinely administered. If multiple kits are necessary, standardize their design and layout for consistency and ease of use. 

Clear Labeling: The crash kit should be easily identifiable, visible at all times, and have a designated spot to be returned to after use. Label each drawer or section, with a common design being drawers organized by function and an alphabetical list of contents mounted on each drawer. 

Crash Cart Layout Example: 

• Top of Trolley: Monitoring equipment. For a box, position the monitoring equipment next to it. 
• Drawer 1: Airway 
• Drawer 2: Intravenous (IV) access 
• Drawer 3: Drugs 
• Drawers 4 + 5: Additional equipment (label contents on each drawer) 

Top Tip: Hang a step stool on the trolley or a nearby wall for effective chest compressions. 

Essential Items for Your Veterinary Crash Kit 

Monitoring:

• Capnography (crucial for identifying return of spontaneous circulation, ROSC) 
• Pulse oximeter 
• Blood pressure equipment 
• Electrocardiogram (ECG) – for arrhythmias, though chest compressions take priority over readings. 

Airway: 

• Endotracheal (ET) tubes (various sizes, prepped with ties and capnography adapters) 
• Laryngoscope (different size blades, working bulbs, spare bulbs and batteries) 
• Local anesthetic spray for feline airways 
• Canine urinary catheter for endotracheal drug administration if IV access is delayed 
• Ambubag for manual ventilation 
• Tracheostomy tubes (if a full tracheostomy kit isn't included) 

IV Access: 

• IV catheters (various sizes) 
• Tourniquet 
• Intraosseous catheter or large needle for intraosseous access 
• Alcohol wipes 
• Tape and bandaging material 
• Saline for flushing 
• Needles and syringes (1ml, 3ml – preassembled) 
• Scalpels or cut-down kit 
• Working clippers 
• Sterile gloves 
• Butterfly needles and 50ml syringe (for thoracocentesis if not included) 
• Saline for fluid boluses and 10ml syringes for flushing medications 
• Giving set 

Drugs: 

• Adrenaline (dose every 2 minutes during asystole) 
• Atropine (used for asystole or high vagal tone bradycardia) 
• Naloxone (opioid reversal) 
• Atipamezole (alpha-2 agonist reversal) 
• Lidocaine (for ventricular fibrillation or pulseless ventricular tachycardia) 
• Induction agent (e.g., propofol) 
• Glucose (for hypoglycemic patients) 

Protection and Organization: Store drugs to protect them from light. Each drug should have a designated, labeled spot in the drawer or tray. Separate medications with similar names to prevent errors. 

Optional Items 

• Procedure Kits: Prepare and sterilize kits for chest drain/thoracocentesis, tracheostomy, etc. 

• Defibrillator: Ensure suitability for veterinary patients and staff training. 

• Timer/Metronome: Improves chest compression accuracy. 

• Sterile Suction Unit 

• Additional Drugs: Calcium gluconate, furosemide, diazepam, norepinephrine, dobutamine, antiarrhythmics like amiodarone. 

Maintaining Your Crash Kit 

Daily and Monthly Checks: Restock and tidy the crash kit after every use or daily. Attach a full list of contents to the box or trolley for easy reference. Perform a full maintenance check monthly, including: 

• Checking all medications for presence and expiration. 
• Ensuring sterile equipment and procedure kits are sealed and in date. 
• Replacing preassembled needles and syringes. 
• Checking laryngoscope bulbs. 
• Performing a defibrillator check. 

Optimizing CPR 

Cognitive Aids: Attach laminated CPR guides, algorithms, and emergency drug charts to the crash cart. Utilize resources from VECCS and the RECOVER initiative. Wall charts can also be helpful. 

Debriefing: Conduct "hot debriefing" immediately after CPR to discuss and reflect on the event, improving future performance and providing psychological support. 

Training: Regularly train staff in CPR techniques and familiarize them with the crash box. Conduct impromptu crash drills, informing the team in advance to prevent confusion. 

For enhanced emergency and critical care knowledge, consider enrolling in ECC CPD courses offered by Improve Veterinary Education, which boost clinical confidence and improve patient outcomes. 

Conclusion 

An effective veterinary crash kit, combined with comprehensive training and organization, is vital for managing emergencies. Regular checks, proper labeling, and continuous staff education will ensure your team is prepared to provide the best possible care during critical situations.