Nizam Akbar Dept .

Cardiology & Vascular medicine Universitas Sumatera Utara Adam Malik Hospital - Medan

Definition of Cardiac Arrest

Abrupt cessation of cardiac

pump function which may be reversible by a prompt intervention but will lead to death in its absence

Causes Of Cardiac Arrest

Coronary heart disease (most Sympathetic nervous system

common)
Myocardial hypertrophy Cardiac inflammatory diseases Cardiac valvular disease Electrophysiologic

disorders
Proarrhythmic toxic exposures Electrocution Tension pneumothorax Trauma Drowning

Abnormalities (e.g. WPW)

Electrolyte disturbances Abnormal metabolic states

Pulmonary embolism

The 'chain of survival' concept

Early activation of emergency services

Early basic life support

Early defibrillation Early advanced life support

How Does An Arrest Present?

Patient found, usually unconscious most often by a nurse An arrest is called (Do YOU know the emergency number?) BLS should commence immediately
The nature of the arrest identified quickly Appropriate action should be taken

The Deadly Rhythms

VT VF

PEA
(Pulse less Electrical Activity)

A systole

CARDIAC ARREST
Ventricular Tachycardia Ventricular Fibrilation Asystole

PEA (Pulseless Electrical Activity)

EKG
Normal Sinus Rhythm

The Heartbeat

Ventricular Tachycardia

Ventricular Fibrillation

ASYSTOLE

P. E. A

BASIC LIFE SUPPORT

(BANTUAN HIDUP DASAR) Primary survey

Airway
Breathing

: Head tilt Chin lift

: Feel, look and Listen No breathing 2 rescue breathing : Carotid or Femoral artery No Pulse Compression 30 : 2 : Shockable or Unshockable

Circulation

Defibrilation

(Assess responsiveness)

No Movement or response

(Activate E M S)

Call for help / or call emergency number Get AED

Or send second rescuer (if available) to do this

(Airways,

Assess breathing)

Open AIRWAYS, check BREATHING

(rescue Breathing)

If not breathing give 2 BREATH that make chest rise

Definite pulse

(Check Pulse)

If no response, check pulse : Do you DEFINITELY feel Pulse within 10 seconds ? No pulse

Give 1 breath every 5-6 seconds Recheck pulse every 2 minutes

(Chest Compression)

30 COMPRESSION and 2 BREATHS Until AED/defibrillator arrives, ALS providers take over Or victim starts to move Push hard and fast (100x/min) and release completely Minimize interruption in compression

(Defibrillation)

AED / defibrillator ARRIVES

Advance Cardiac Life Support

Shockable

Not shockable

Cardiac Arrest
Shockable (VT atau VF) Unshockable (PEA atau Asystole)

Shock CPR CPR Obat Obat

3A
Adrenaline (Epinephrine) Amiodarone Atropin Sulfat

DC 360 Joule

VF/VT pulseless yang menetap dan berulang

-CPR - Ventilasi / Intubasi - I.V. Line : - Epinephrine 1 mg ( 1 menit !! )

D C 360 Joule

C P R 2 menit
D C 360 Joule C P R 2 menit DC 360 Joule Epinephrine 1 mg

C P R 2 menit D C 360 Joule C P R 2 menit D C 360 Joule C P R 2 menit

D C 360 Joule
Anti aritmia : -Amiodarone 300 mg I.V.

A. Ventricular Fibrillation/Pulseless VT
Cardiac Arrest Defibrillator Arrives Give Vasopressor Consider Antiarrhythmic

Go to

CPR

CPR

CPR

CPR

Rhythm Check

Rhythm Check

Rhythm Check

CPR

= 5 cycles or 2 minutes of CPR

= CPR while defibrilator charging

= Shock

B. Asystole and Pulseless Electrical Activity

Defibrillator Arrives

Cardiac Arrest

Give Vasopressor, Identify Contributing Factors

For Adult Arrest Consider Atropin

Go to

CPR

CPR
A
Rhythm Check Rhythm Check = 5 cycles or 2 minutes of CPR

CPR

Rhythm Check

CPR

Secondary Survey
Airway Breathing Circulation

: Intubation : Check 5 point of Auscultation : IV access, NGT or Urinary Catheter

Differential Diagnose

: 6H dan 5T

The 5Hs & 5Ts

Hypovolemia
Hypoxia Hydrogen ions

Tablets (Drug OD)

Tamponade Tension

(Acidosis) Hyper/hypokalemia Hypothermia Hipoglycaemia

Pneumothorax Thrombosis, Coronary Thrombosis, Pulmonary

Goals In A Cardiac Arrest

Restore spontaneous pulse

Restore BP
Aim for no neurological deficit

Know when to STOP