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EM ER G EN C IES
CARDIAC
ARREST ???
as a result of a multitude of
cardiovascular,
metabolic,
infectious,
neurologic,
inflammatory, and traumatic
diseases
Elevasi ST
NSTEMI
Infark Miokard
Akut
Angina Tdk Stabil
NQMI
Kursus SKA
Qw MI
SAKIT DADA
Curiga Sindrom Koroner Akut
Elevasi ST
menetap
Troponin
(CKMB)
Troponin
Pengobatan
Pencegahan
sekunder
Esc/EHJ 2002
BEBERAPA G AM BARAN
ARITM IA LAIN
TakikardiVentrikel
11
Torsade de pointes
13
FibrilasiVentrikel
14
Fibrilasiventrikuler
Undulasi-undulasiyang tidak teratur dan cepat,
diikutioleh hentiventrikelatau asistol
ventrikuler :tak ada kom pleks Q RS
15
PEA
Identifying Asystole
CPR
NO TRAINING : HANDS ONLY CPR
TRAINED : 30:2 CPR
HIGHLY TRAINED : MULTIRESCUER
COORDINATED CPR
BAN TU AN H ID U P D ASAR
H EN TIN APAS D AN H EN TI
JAN TU N G
Penyebab henti napas
PRO TO KO L BCLS
AIRW AY
HEAD TILT
CHIN LIFT
JAW THRUST
BREATH IN G
Berikan napas bantuan dalam 1 detik
Volume tidal yg cukup untuk mengangkat dinding
dada
2 kali napas bantuan setelah 30 x kompressi dada
Kondisi 2 atau lbh penolong dgn terpasang alat
bantu napas, bantuan diberikan setiap 6-8 detik
(8-10x per menit)
Penderita dgn masalah hambatan jalan napas
memerlukan tekanan tinggi
Pemberian bantuan napas berlebih tidak
diperlukan
sadar.
Cara melakukan kompresi dada
dan bantuan pernapasan.
Bagaimana mengoperasikan
defibrillator eksternal secara aman.
Bagaimana menempatkan korban
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
A PPR O A CH SA FELY!
Scene
Rescuer
Victim
Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
CH ECK R ESPO N SE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
CH ECK R ESPO N SE
Shake shoulders
gently
Ask Are you all
right?
If he responds
Leave as you find him.
Find out what is
wrong.
Reassess regularly.
SH O U T FO R H ELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
O PEN A IR W AY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
CH ECK B R EATH IN G
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
CH ECK B R EATH IN G
agonal breathing
with NORMAL
breathing
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
30 CH EST CO M PR ESSIO N S
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
CH EST CO M PR ESSIO N S
Place the heel of one
hand in the centre of the
chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 min-1
Depth 5 cm
Equal compression :
relaxation
R ESCU E B R EATH S
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
R ESCU E B R EATH S
breath
Place lips over
mouth
Blow until the
chest rises
Take about 1
second
Allow chest to fall
CO N TIN U E CPR
30
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
compressions
2 rescue breaths
D EFIB R ILLATIO N
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice
prompts
SW ITCH O N A ED
automatically
switch themselves
on when the lid is
opened
ATTA CH PA D S TO
CA SU A LTYS B A R E CH EST
A N A LYSIN G R H YTH M
D O N O T TO U CH V ICTIM
SH O CK IN D ICATED
Stand clear
Deliver shock
SH O CK D ELIV ER ED
FO LLO W A ED IN STR U CTIO N S
30
N O SH O CK A D V ISED
FO LLO W A ED IN STR U CTIO N S
30
CPR IN CH ILD R EN
Adult CPR
techniques can be
used on children
Compressions 1/3
AED IN
CHILDREN
Age > 8 years
use adult AED
Age 1-8 years
use paediatric
pads / settings if
available (otherwise
use adult mode)
Age < 1 year
use only if
manufacturer
instructions indicate
it is safe
Approach safely
Approach safely
Check response
Check response
Open airway
Open airway
Check breathing
Check breathing
Call 118
Call 118
30 chest
compressions
2 rescue breaths
Attach AED
Follow voice
AcuteHeart
Failure
Globaltimebomb?
HEART FAILURE
H em odynam ic Profi
le ?
Congestion at rest?
No
No
Yes
Yes
Sign of congestion:
Orthopnea, elevated JVP,
edema,pulsatile hepatomegaly,
asites, rales,louder S3,
P2 radiation left ward,
abdomino-jugular reflex,
valsava square wave
M AN AG EM EN T ACU TE H EART
FAILU RE?
ConventionalTreatm ents of
AD H F
Diuretics
Vasodilators
Reduce
fluid
volume
Decrease
preload
and/or
afterload
Inotropes
Augment
contractility
Orthopnea/PND
Increased JVD
DOE/SOB
S3 or S4
Pitting Edema
Rales
Chest Xray; pulmonary congestian HJR
Recent Weight Gain
BNP
(C) Mild
Volume Overload
(E) Mod-Severe
Volume Overload
(G) MildModerate
SBP > 90 mmHg
On a -Blocker
Yes Chronically
No
(H) Milrinone
(I) Dobutamine
Inadequate Response
Very Low Cardiac Output (J)
(D) IV Diuretics
82
84
TraditionalVasodilators:
Lim itations
Nitroglycerin
? Efficacy in CHF
Tachycardia
Tachyphylaxis
Neurohormonal
activation due to
reflexive sympathetic
activity
Nitroprusside
Difficult titration
ICU/arterial line monitoring due
86
IdealAgent for AD H F
Oxygen
Compensation
Optimize oral drug regimen
Optimize patient education
Discharge home
Initial Therapy
Nesiritide
2 mcg/kg bolus followed
by
0.01 mcg/kg/min infusion
Inadequate
Response
Increase
Nesiritide
MonitoringDose
Refractory Therapy
Hemodynamic
V Inotropic
Agent(s)
Mechanical
Assist
88
Abraham WT et al. Prev Cardiovasc
Med 2001;2:235236
G oalofTreatm ent
for AD
HF
Hemodynamic
:
Clinical :
symptoms
clinical signs
body weight
diuresis
oxygenation
Laboratory:
serum electrolyte
normalization
BUN and/or creatinine
plasma BNP
blood glucose
normalization
stroke volume
Outcome:
length of stay in the ICU
duration of
hospitalization
time to hospital readmission
mortality
Tolerability:
low rate of withdrawal from
therapeutic measures
low incidence of adverse
effects
89
Cardiogenic Shock
TERIMA KASIH