ACLS Provider Manual 2016 - Supplementary Material

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 ...................................................................................62 Fibrinolytic Checklist for STEMI.........................................................................................63 Human, Ethical, and Legal Dimensions of ECC and ACLS .......................................................64 Rescuer and Witness Issues .............................................................................................64 How Often Will CPR, Defibrillation, and ACLS Succeed?...................................64 Take Pride in Your Skills as an ACLS Provider ..................................................65 Stress Reactions After Resuscitation Attempts ..................................................65 Techniques to Reduce Stress in Rescuers and Witnesses ................................66 Psychological Barriers to Action.........................................................................66 Legal and Ethical Issues....................................................................................................67 The Right Thing to Do........................................................................................67 Principle of Futility..............................................................................................68 Terminating Resuscitative Efforts.......................................................................69 When Not to Start CPR......................................................................................69 Withholding vs Withdrawing CPR.......................................................................70 Withdrawal of Life Support .................................................................................70 Advance Directives, Living Wills, and Patient Self-Determination.......................71 Out-of-Hospital DNAR Orders............................................................................72 EMS No-CPR Programs ....................................................................................72 Legal Aspects of AED Use.................................................................................73 Providing Emotional Support for the Family.......................................................................74 Conveying News of a Sudden Death to Family Members...................................74 Family Presence During Resuscitation...............................................................74 Organ and Tissue Donation ...............................................................................75