ACLS Provider Manual Supplementary Material © 2016 American Heart Association ACLS Provider Manual Supplementary Material Contents Airway Management ...................................................................................................................4 Basic Airway Management ..................................................................................................4 Devices to Provide Supplementary Oxygen ................................................................. 4 Overview ..............................................................................................................4 Oxygen Supply ....................................................................................................4 Nasal Cannula .....................................................................................................5 Simple Oxygen Face Mask .................................................................................. 6 Venturi Mask ........................................................................................................6 Face Mask With Oxygen Reservoir ...................................................................... 6 Giving Adult Mouth-to-Mask Breaths .................................................................... 7 Bag-Mask Ventilation ...................................................................................................8 Overview ..............................................................................................................8 Tips for Performing Bag-Mask Ventilation ............................................................ 9 Ventilation With an Advanced Airway and Chest Compressions ........................ 11 Advanced Airway Management ......................................................................................... 11 Advanced Airway Adjuncts: Laryngeal Mask Airway .................................................. 11 Overview ............................................................................................................ 11 Insertion of the Laryngeal Mask Airway .............................................................. 12 Advanced Airway Adjuncts: Laryngeal Tube .............................................................. 13 Overview ............................................................................................................ 13 Insertion of the Laryngeal Tube .......................................................................... 13 Advanced Airway Adjuncts: Esophageal-Tracheal Tube ............................................ 14 Overview ............................................................................................................ 14 Insertion of the Esophageal-Tracheal Tube........................................................ 16 Advanced Airway Adjuncts: ET Intubation ................................................................. 17 Overview ............................................................................................................ 17 Technique of ET Intubation ................................................................................ 19 Indications for ET Intubation .............................................................................. 21 Ventilating With an ET Tube in Place During Chest Compressions .................... 21 Tube Trauma and Adverse Effects ..................................................................... 22 Insertion of ET Tube Into One Bronchus ............................................................ 22 Confirmation of ET Tube Placement: Physical Exam ......................................... 23 Confirmation of ET Tube Placement: Qualitative and Quantitative Devices........ 24 Waveform Capnography .................................................................................... 24 Quantitative End-Tidal CO2 Monitors (Capnometry) ........................................... 26 Exhaled (Qualitative) CO2 Detectors .................................................................. 26 Esophageal Detector Devices ............................................................................ 26 ACLS Core Rhythms ................................................................................................................. 29 Recognition of Core Electrocardiogram Arrest Rhythms .................................................... 29 The Basics ......................................................................................................... 29 Cardiac Arrest Rhythms and Conditions ............................................................ 29 Recognition of Selected Nonarrest ECG Rhythms ............................................................. 33 Recognition of Supraventricular Tachyarrhythmias (SVTs) ........................................ 33 Recognition of Ventricular Tachyarrhythmias ............................................................. 37 Recognition of Sinus Bradycardia .............................................................................. 41 Recognition of AV Block ............................................................................................ 42 VF Treated With CPR and Automated External Defibrillator .............................................. 47 Defibrillation ..............................................................................................................................48 Automated External Defibrillator Operation ........................................................ 48 Know Your AED ................................................................................................. 48 Universal Steps for Operating an AED ............................................................... 48 Troubleshooting the AED ................................................................................... 50 © 2016 American Heart Association 2 ACLS Provider Manual Supplementary Material Shock First vs CPR First .................................................................................... 51 AED Use in Special Situations ........................................................................................... 51 Introduction ........................................................................................................ 51 Hairy Chest ........................................................................................................ 51 Water ................................................................................................................. 51 Implanted Pacemaker ........................................................................................ 52 Transdermal Medication Patches ....................................................................... 52 Defibrillation and Safety ..................................................................................................... 52 Manual Defibrillation .................................................................................................. 52 Using a Manual Defibrillator/ Monitor ................................................................. 52 Safety and Clearing the Patient ................................................................................. 54 Clearing: You and Your Team ............................................................................ 54 A Final Note About Defibrillators ........................................................................ 54 Access for Medications ............................................................................................................. 55 Intravenous Access ........................................................................................................... 55 Using Peripheral Veins for IV Access ................................................................. 55 General IV Principles ......................................................................................... 57 Intraosseous Access ......................................................................................................... 57 Introduction ........................................................................................................ 57 Needles ............................................................................................................. 57 Sites................................................................................................................... 58 Indications and Administration ........................................................................... 58 Contraindications ............................................................................................... 58 Complications .................................................................................................... 58 Equipment Needed ............................................................................................ 58 Procedure .......................................................................................................... 59 Follow-up ........................................................................................................... 61 Acute Coronary Syndromes ...................................................................................................... 62 ST-Elevation Myocardial Infarction Location and AV Block ................................................ 62 Right Ventricular Infarction ................................................................................. 62 AV Block With Inferior MI ..................................................................................