Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation 2015 EmergSim LLC / 10Min Equip ACLS

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1 Equipment Adult Medical Emergency Oxygenation, Ventilation, and Airway Management Practitioner with AHA BLS and ACLS training Equipment Oxygen E alloy tank with regulator (integral to tank or detachable with key) Regulator includes pressure gauge and flow meter providing at least 5 L/minute Yankauer tip suction handle, suction tubing, operatory vacuum high volume system adapter Face mask non-rebreather adult Resuscitation bag adult with pressure manometer, face mask, reservoir bag, and tubing Consider Ambu SPUR II with pressure limiting valve with override feature and flow through supplemental oxygenation for spontaneously breathing patient Oropharygeal Guedel airways: 80 mm; 90 mm; 00 mm Nasopharyngeal polyvinyl vinyl chloride airways 4 Fr / 6.0 mm ID; 6 Fr / 6/5 mm ID; 8 Fr / 7.0 mm ID; 30 Fr / 7.5 mm ID Laryngeal mask (LMA) / supraglottic gastric venting airways: Size 3 / kg; Size 4 / kg; Size 5 / 90+ kg Consider Intersurgical i-gel - no air inflation, tip does not flip, gastric venting, and bite block Stethoscope Sphygmomanometer portable and blood pressure cuffs (adult small - large long) Magill forceps Laryngoscope LED handle and blades practitioner preference: (Miller, 3 / MAC 3, 4) Consider LED disposable handle and blade system Endotracheal tubes practitioner preference: (consider 6.0, 6.5, 7.0, 7.5) Syringe 0 ml (inflates endotracheal tube cuff) Endotracheal tube stylet Equipment optional Eschmann introducer / bougie End-tidal carbon dioxide detector or adapter to end-tidal portable office monitor Albuterol metered dose inhaler holding chamber Attaches albuterol inhaler in circuit between resuscitation bag and LMA / endotracheal tube Consider Monaghan AeroChamber mini. Item # 9880 Video laryngoscope Consider Ambu King Vision video laryngoscope with disposable blade Surgical airway kit Consider Cook Critical Care Melker Emergency Cricothyrotomy Set. Universal Order # G393. Part # C-TCCSB-500 Cricothyroid transtracheal jet ventilation kit Consider Cook Critical Care Enk Oxygen Flow Modulator Set - transtracheal jet oxygenation Order # G345. Order # C-EFMS-00 Intraosseous access Consider Pyng FastResponder - sternal Consider Teleflex Arrow EZ-IO Power Drive System including 45 mm needle - tibia and humerus IV 000 ml manual pump pressure infusion bag. Consider Medex Clear-Cuff, Pahsco, Merit PIB Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation 05 EmergSim LLC / 0Min Equip ACLS 5

2 Drugs and Supplies Office Emergency Case Adult Emergency Management Drugs Albuterol Inhalation Metered Inhaler (90 mcg/actuation) Amiodarone 50 mg/ml 3 ml vial three Epinephrine :,000 mg/ml ml vial Epinephrine auto-injectors (0.3 mg/actuation) - two (optional) Epinephrine :0, mg/ml 0 ml prefilled syringe two Aromatic Ammonia Inhalant Vaporole(s) - two (optional) Flumazenil 0. mg/ml 0 ml vial (or 5 ml vials two) Aspirin 8 mg tablets - four or Aspirin 35 mg tablets Not enteric coated. Atropine mg/ml ml vial Atropine 0. mg/ml 0 ml prefilled syringe (optional) Glucose Oral 5 gram tube two (or 4 gram tube one) Glucagon Kit mg vial + ml sterile water (optional) Naloxone 0.4 mg/ml ml vial Diphenhydramine 50 mg/ml ml vial Ephedrine 50 mg/ml ml vial Nitroglycerin 0.4 mg tablets Nitroglycerin 0.4 mg/dose pump spray bottle (optional) Succinylcholine 0 mg/ml 0 ml vial (Refrigerated) Syringes and Needles ml syringe with gauge inch needle - four Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation 05 EmergSim LLC 0Min Emerg Drugs 5 5 ml syringe with gauge.5 inch needle - two 0 ml syringe with gauge.5 inch needle - two

3 Office Emergency Case Layout amiodarone aspirin flumazenil naloxone epinephrine :0,000 prefilled syringes syringes and needles alcohol pads atropine nitroglycerin diphenhydramine atropine prefilled syringe succinylcholine keep refrigerated not in case ephedrine epinephrine albuterol inhaler epinephrine :,000 auto-injectors glucose oral aromatic ammonia glucagon nitroglycerin pump spray bottle Case Lid - Left dextrose 50% Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation 05 EmergSim LLC / 0Min Drug Case 5

4 Ten Minutes Saves a Life! Office Medical Emergencies Drug Case Sponsors: Florida and Ohio ADSA Components Anesthesia Research Foundation ADSA Patient Safety Initiative Bill To: Ship To: (if different from Bill To): Company Company Name Name Address Address Line Line Line 3 Line 3 City, State, Zip Code City, State, Zip Code Phone Phone Fax Fax Address Address Ten Minutes Saves a Life! Case A patient safety initiative of the Florida and Ohio Dental Societies of Anesthesiology In conjunction with ARF ADSA Algorithms/Checklists on ADSA website Case provided at cost of $65.00 each shipping and handling included Check or credit card payable to ODSA Select Drugs, Equipment, and Supplies from vendors of your choice Options include: Emergency Drugs Medical Purchasing Solutions Marla Bouise Extension 3 Includes complimentary Code Blue Emergency Drug Monitoring MPS does not ship to Florida To order: Mail or fax form to: Rosie Mays Ohio Dental Society of Anesthesiology UC Health-Anesthesiology PO Box Cincinnati, OH Fax Questions and/or credit card information : call Rosie Mays rosie.emergsim@gmail.com Emergency Equipment Sedation Resource, Inc Standard and advanced airway options Emergency Drugs and Equipment Southern Anesthesia & Surgical Requires individual item ordering

5 Respiratory Distress - Adult Unresponsive Patient Monitoring (blood pressure, heart rate, pulse oximetry, respiratory rate) ongoing throughout evaluation and management. All initial actions are performed simultaneously after verification of unresponsiveness by stimulating the patient including head tilt and jaw lift. Reversal agents (naloxone and flumazenil) may be administered at any time. Unresponsive - Breathing Normally Clinical Condition Respiratory rate >0 and Oxygen saturation > 95% Unresponsive - Respiratory Depression Clinical Condition Respiratory rate <0 and/or Oxygen saturation <95% Apnea with Carotid Pulse Clinical Condition Respiratory rate 0 Verify unresponsiveness. Consider EMS call. Call for emergency equipment. Monitor patient. Open the airway with head tilt, chin lift, and jaw thrust. Ammonia vaporole respiratory stimulant (optional). Supplemental oxygen with Non-rebreathing face mask 5 L/minute or Nasal cannula/nasal hood 4 L/minute. Raise the legs. 3 Reversal agent(s) if indicated. Raise legs with BP drop. 4 Respiratory deterioration. Continue to Ventilation Management. (see bottom box below) Verify unresponsiveness and respiratory depression. Consider EMS call. Call for emergency equipment. Monitor patient. Continue to Ventilation Management. (see bottom box below) 3 Reversal agent(s) if indicated. Raise legs with BP drop. Action Action Action Verify unresponsiveness and not breathing. Consider EMS call. Call for emergency equipment. Monitor patient. Verify not breathing. Check Pulse oximeter (BP >80 systolic) and/or Carotid pulse present (BP >60 systolic) indicates chest compressions not needed. 3 Continue to Ventilation Management. (see bottom box below) 4 Reversal agent(s) if indicated. Raise legs with BP drop. Apnea without Carotid Pulse - see Cardiac Emergency Management Ventilation Management - Apnea / Hypoventilation / Obstruction Open the airway with head tilt, chin lift, and jaw thrust. Consider oral or nasal airway if apneic. 3 Bag Mask ventilation - two person preferred. One breath every 6 seconds, breath volume ml, pressure <0 cm. Oxygen flow 5 L/minute. 4 Confirm chest rise with each breath. 5 Consider advanced airway. Intubation or LMA/supraglottic airway with gastric venting capacity if unable to ventilate with bag mask easily or pressure > 0 cm. 6 Confirm advanced airway placement with chest rise, stethoscope, and end-tidal CO. 7 If no chest rise seen, evaluate for foreign body, larynospasm, bronchospasm, or chest wall rigidity. Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation / 05 EmergSim LLC / 0Min Resp Distress 5

6 Cardiac Emergency Management - Adult BLS / ACLS Ten Minutes Saves A Life! Responsive with Chest Pain: ACS Diagnosis Acute Coronary Syndrome (ACS) symptoms: Chest, arm, or face discomfort / pressure Diaphoresis Syncope Hemodynamic instability Unresponsive with Apnea and Carotid Pulse Absent Apnea No pulse oximeter reading 3 Assistance and Emergency Medical Service (EMS) called. Call for emergency equipment. Monitor patient Supplemental oxygen: Face mask non-rebreathing 5 L/min or Nasal cannula/nasal hood 4 L/min. Nitroglycerin 0.4 mg tablet sublingual or metered spray dose if blood pressure >90 systolic and heart rate > 50. Aspirin 35 mg tablet or 8 mg x 4 tablets chew and swallow. Repeat nitroglycerin 0.4 mg in 5 minutes if pain persists, blood pressure >90 systolic and HR >50. Assistance and EMS called. Call for emergency equipment. Begin chest compression at 00/minute for 30 compressions. Turn on AED and follow directions. Insert oral airway and deliver bag-mask ventilations at the end of each 30 chest compression cycle. 3 4 Advanced Airway placement as soon as possible. Continue with 30 chest compressions and bag mask ventilations or with LMA continuous compressions and ventilations until AED sys to stop to analyze rythm. AED will indicate either shock recommended (V-fib or pulseless V-tach) or no shock recommended (PEA/Asystole) - see below. Optimizing CPR AED minute timer is activated once unit is turned on. Practitioner should check carotid pulse at end of each minute interval of chest compressions while AED is analyzing ECG rhythm. With bag-mask ventilation the minute interval of chest compressions to ventilations at a ratio of 30- for 5 cycles provides 50 chest compressions and 0 ventilations. Additionally, the coronary and cerebral perfusion pressures drop with each pause and require ~ 3 compressions to peak again. With placement of an LMA/advanced airway, compressions and ventilations are continuous resulting in 00 compressions and 0 ventilations for the minute interval. Additionally, the coronary and cerebral perfusion pressures are maintained throughout the minute interval. Chest compressions are optimized at a depth of at least inches / 50 mm and a rate of 00/minute. Good chest recoil is necessary to fill the heart. Change the individual performing chest compressions at the end of each minute interval. Monitor End-tidal CO when using LMA. Ideal >0 AED Indicates Shock AED charges and practitioner clears and defibrillates #. Resume CPR for minutes per AED timer. 3 Two minute interval complete. AED analyzes ECG rhythm and carotid pulse absent. AED indicates shock. 4 AED charges and practitioner clears and defibrillates #. 5 Resume CPR and administer epinephrine mg in prefilled syringe :0,000 0 ml IV followed by flush. 6 Two minute interval complete. AED analyzes ECG rhythm and caroitid pulse absent. 7 AED charges and practitioner clears and defibrillates #3. 8 Resume CPR and administer amiodarone 300 mg/iv followed by flush. 9 Two minute interval complete. AED analyzes ECG rhythm and carotid pulse absent. AED indicates shock. 0 AED charges and practitioner clears and defibrillates #4. Resume CPR and administer epinephrine mg in prefilled syringe :0,000 0 ml IV followed by flush. CPR continues at minute intervals per BLS/ACLS until EMS arrives. AED Indicates No Shock Resume CPR and administer epinephrine mg in prefilled syringe :0,000 0 ml IV followed by flush. Two minute interval complete. AED analyzes ECG rhythm and carotid pulse absent. AED still indicates no shock. 3 Resume CPR. 4 Two minute interval complete. AED analyzes ECG rhythm and carotid pulse absent. AED still indicates no shock. 5 Resume CPR and administer epinephrine mg in prefilled syringe :0,000 0 ml IV followed by flush. 6 CPR continues at minute intervals per BLS/ACLS until EMS arrives. Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation / 05 EmergSim LLC / 0Min Cardiac Emerg Mgmt 5

7 Drug Administration Emergency Management - Adult Practitioner with BLS and ACLS Training Drug Administration Supplied Action Respiratory Depression, Respiratory Soft Tissue Obstruction, Over Sedation naloxone 0.4 mg ( ml) IV or SL dose 0.4 mg/ml opioid antagonist flumazenil 0. mg ( ml) IV or SL* q min 0. mg/ml benzodiazepine antagonist * flumazenil SL administration is not manufacturer supported Bronchospasm albuterol Shake, prime, puffs inhalation q4 min 90 mcg/puff beta agonist selective epinephrine 0.3 mg (0.3 ml) :000 IM q4 min mg/ml alpha & beta agonist vastus lateralis or deltoid vial or auto-injector Allergic reaction - Mild diphenhydramine 50 mg ( ml) IM dose 50 mg/ml histamine H antagonist Allergy - Major, Anaphylaxis, Laryngeal Edema epinephrine 0.3 mg (0.3 ml) :000 IM q4 min mg/ml alpha & beta agonist vial or auto-injector to vastus lateralis or deltoid Laryngospasm succinylcholine 0 mg ( ml) IV or IM or SL** dose 0 mg/ml paralysis ** Practitioner trained in use of succinylcholine and paralysis management. Keep refrigerated Fentanyl - Opioid Chest Wall Rigidity succinylcholine 40 mg ( ml) IV or IM or SL ** dose 0 mg/ml paralysis naloxone 0.4 mg ( ml) IV or IM or SL *** dose 0.4 mg/ml opioid antagonist ** Practitioner trained in use of succinylcholine and paralysis management. Keep refrigerated *** naloxone if not trained in use of succinylcholine and paralysis management Hypoglycemia glucose oral Complete tube PO if conscious dose 5, 4, 37.5 gm carbohydrate dextrose 50%.5 gm (5 ml) IV q4 min 0.5 gm/ml 50 ml prefill syringe glucagon mg ( ml) IV, IM, SL, or subcutaneous dose: mg + glucose release from ml diluent liver glycogen breakdown Bradycardia atropine 0.5 mg (0.5 ml) IV or IM or SL q4 min mg/ml vial anticholinergic 0.5 mg (5 ml) IV q4 min prefill syringe 0. mg/ml 0 ml Hypotension ephedrine 0 mg (0. ml) IV q4 min 50 mg/ml alpha and beta agonist 5 mg (0.5 ml) IM or SL q 4 min Acute Coronary Syndrome (ACS) responsive with chest pain nitroglycerine 0.4 mg / 400 mcg tablet/spray SL q 5 min 3 doses vascular smooth muscle relaxation if blood pressure > 90 mm and heart rate > 50 aspirin 35 mg tablet (or 8 mg tablet 4 tablets) PO dose anticoagulant Chew and swallow. Not enteric coated. 35 mg plain white tablet or 8 mg 4 tablets fentanyl 5-50 mcg (0.5- ml) IV, IM, or SL 50 mcg/ml opioid analgesic nitrous oxide 0-50% with oxygen inhalation analgesic Pulseless CPR - Not shockable (PEA, Asystole) epinephrine mg (0 ml) :0,000 IV q 4 minutes mg/0ml prefill syringe alpha & beta agonist Pulseless CPR - Shockable (V-fibrillation, V-tachycardia) epinephrine given only after second shock - dose as above amiodarone 300 mg (6 ml) IV minutes after initial epinephrine antiarrhythmic 50 mg (3 ml) IV minutes after second epinephrine dose Ten Minutes Saves A Life! is a registered trademark of the ADSA Anesthesia Research Foundation 05 EmergSim LLC 0 min Drug adm 5