Seorang laki-laki, 47 thn, mendadak jatuh di lapangan tenis. 1. Tindakan anda apa? 2. Kemungkinan diagnosa anda apa ?

3. Komplikasi yang mungkin terjadi ?

CARDIOVASCULAR EMERGENCY
R RUKMA JUSLIM,SpJP,FIHA
Subdep Jantung RSAL Dr. Ramelan

COMPREHENSIVE ALGORHYTM

Primary Survey
Airway : Open the airway Breathing : Provide positivepressure ventilations Circulation : Give chest compressions Defibrillation : Shock VF/pulseless VT

Secondary Survey
Airway : Provide advanced airway management (tracheal intubation,laryngeal mask airway) Breathing : Confirm proper tube placement by primary (phy.exam) & secondary (exhaled CO2 esophageal detector device ) methods, check for adequate oxygenation and ventilation

Circulation : Obtain IV access, determine rhythm, give medication appropriate for rhythm and vital sign. Differential Diagnosis : Search for, find, and treat reversible causes.

STOP CPR Guidelines

1. Successfully BLS & ALS 2. Patient is hypothermic 3. Patients was exposed toxic substances or experienced a drug overdoses 4. Recorded via cardiac monitor an interval of 10 minutes or more of persistent asystole 5. 25-30 minutes efforts, without any return of spontaneous circulation

Ventricular Fibrillation/VF

Ventricle Fibrillation

Treatment VF/Pulseless VT
1. Rhythm after first 3 shocks ? PERSISTENT OR RECURRENT VF 2. Secondary ABCD survey 3. Epinephrine 1 mg IV push Primary ABCD Survey (basic CPR & defibrillation 200300360 J 4. repeat 3-5 minutes 5. Resume attempts to Defibrillate (360) 6. Antiarrhytmics(Amiodarone,Lidocai n,Mg)

Amiodarone
Indication : recurring VF unstable & stble VT, wide complex tachycardia, AF Intravenous Dose : 300 mg rapid infusion diluted in 20 to 30 ml D5W. May repeat 150 mg infusion in 3-5 minutes for refractory VF/VT. (for cardiac arrest) IV Dose : 150 mg over 10 minutes (15 mg/min) then 1 mg/min for 6 hours then 0,5 mg/min for 18 hrs.(for stable VT,SVT, wide complex tachy)

Contraindication : Sinus node dysfunction, sinus bradycardia, AV block 2 & 3 Precautions : careful rhythm & BP monitoring are required.

ASYSTOLE

ASYSTOLE Algorhytm
1. 2. 3. 4. Primary ABCD survey Secondary ABCD survey Transcutaneous pacing Epinephrine 1 mg IV push repeat every 3-5 minutes 5. Atropine 1 mg IV, repeat every 35 minutes (total 0,04 mg/kg)

ATRIAL FIBRILATION

Atrial Fibrilation

No P wave R R Interval different

Atrial Fibrillation
1. 2. 3. 4. Patient clinically unstable ? Cardiac function impaired ? WPW present ? Durations < or > 48 hours ? Control rate / Convert rhythm

Bradycardias Algorhytm