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7/31/2019 EM. K7c. Cardiac Arrest
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Nizam Akbar
Dept . Cardiology & Vascular medicine
Universitas Sumatera Utara
Adam Malik Hospital - Medan
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Definition of Cardiac
Arrest
Abrupt cessation ofcardiac pump function
which may be reversible bya prompt intervention butwill lead to death in its
absence
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Causes Of Cardiac Arrest
Coronary heart disease(most common)
Myocardial hypertrophy
Cardiac inflammatorydiseases
Cardiac valvular disease
Electrophysiologic
Abnormalities (e.g. WPW) Electrolyte disturbances
Abnormal metabolic states
Sympathetic nervoussystem disorders
Proarrhythmic toxic
exposures Electrocution
Tension pneumothorax
Trauma
Drowning
Pulmonary embolism
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The 'chain of survival'concept
Early activation of emergency services
Early basic life support
Early defibrillation
Early advanced life support
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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
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The
DeadlyRhythms
VT VF
PEA(Pulse lessElectricalActivity)
A systole
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CARDIAC ARRESTVentricular Tachycardia
Ventricular Fibrilation
Asystole
PEA (Pulseless Electrical Activity)
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Normal SinusRhythm
EKG
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The Heartbeat
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Ventricular Tachycardia
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Ventricular Fibrillation
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ASYSTOLE
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P. E. A
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BASIC LIFE SUPPORT(BANTUAN HIDUP DASAR)
Primary survey
Airway : Head tilt Chin lift
Breathing : Feel, look and ListenNo breathing 2 rescue
breathing
Circulation : Carotid or Femoral artery
No Pulse Compression 30 : 2
Defibrilation : Shockable or Unshockable
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No Movement or response
Call for help / or call emergency number
Get AEDOr send second rescuer (if available) to do this
Open AIRWAYS, check BREATHING
If not breathing give 2 BREATH that make chest rise
(Assess responsiveness)
(Activate E M S)
(Airways, Assess breathing)
(rescue Breathing)
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If no response, check pulse :
Do you DEFINITELY feelPulse within 10 seconds ?
Give 1 breath every
5-6 secondsRecheck pulse every
2 minutes
30 COMPRESSION and 2 BREATHSUntil 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
AED / defibrillator ARRIVES
Definite pulse
No pulse
(Check Pulse)
(ChestCompression)
(Defibrillation)
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Advance Cardiac Life Support
Not shockable
Shockable
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Cardiac Arrest
Shockable(VT atau VF)
Unshockable(PEA atau Asystole)
Shock
CPR
Obat
CPR
Obat
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3 AAdrenaline (Epinephrine)
Amiodarone
Atropin Sulfat
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DC 360 Joule
VF/VT pulseless yang menetap dan berulang
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- C P R- Ventilasi / Intubasi- I.V. Line :- Epinephrine 1 mg
( 1 menit !! )
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D C 360 Joule
C P R 2 menit
D C 360 Joule
C P R 2 menit
DC 360 Joule
Epinephrine 1 mg
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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.
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CPR CPR CPR CPR
A
A
CPR
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A
CPR CPR CPRA
CPR
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Secondary Survey
Airway : Intubation
Breathing : Check 5 point ofAuscultation
Circulation : IV access, NGT or UrinaryCatheter
Differential Diagnose : 6H dan 5T
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The 5Hs & 5Ts
Hypovolemia
Hypoxia
Hydrogen ions(Acidosis)
Hyper/hypo-
kalemiaHypothermia
Hipoglycaemia
Tablets (DrugOD)
TamponadeTension
Pneumothorax
Thrombosis,Coronary
Thrombosis,
Pulmonary
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Goals In A Cardiac Arrest
Restore spontaneouspulse
Restore BP
Aim for no neurologicaldeficit
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