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Nizam Akbar
Dept . Cardiology & Vascular medicine
Universitas Sumatera Utara
Adam Malik Hospital - Medan
Definition of Cardiac Arrest
�Abrupt cessation of cardiac �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 common)
• Myocardial hypertrophy
• Cardiac inflammatory diseases
• Sympathetic nervous system disorders
• Proarrhythmic toxic exposures
• ElectrocutionCardiac inflammatory diseases
• Cardiac valvular disease
• Electrophysiologic Abnormalities (e.g. WPW)
• Electrolyte disturbances
• Abnormal metabolic states
Electrocution
• Tension pneumothorax
• Trauma
• Drowning
• 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?)� (Do YOU know the emergency number?)
� BLS should commence immediately
� The nature of the arrest identified quickly
� Appropriate action should be taken
CARDIAC ARREST
� Ventricular Tachycardia
� Ventricular Fibrilation� Ventricular Fibrilation
� Asystole
� PEA (Pulseless Electrical Activity)
BASIC LIFE SUPPORT(BANTUAN HIDUP DASAR)
Primary survey
� Airway : Head tilt Chin lift
� Breathing : Feel, look and Listen
No breathing 2 rescue breathingNo breathing 2 rescue breathing
� Circulation : Carotid or Femoral artery
No Pulse Compression 30 : 2
� Defibrilation : Shockable or Unshockable
No Movement or response
Call for help / or call emergency number
Get AEDOr send second rescuer (if available) to do this
(Assess responsiveness)
(Activate E M S)
Open AIRWAYS, check BREATHING
If not breathing give 2 BREATH that make chest rise
(Airways, Assess breathing)
(rescue Breathing)
If no response, check pulse :
Do you DEFINITELY feel
Pulse within 10 seconds ?
Give 1 breath every
5-6 seconds
Recheck pulse every
2 minutes
30 COMPRESSION and 2 BREATHS
Until AED/defibrillator arrives, ALS providers take over
Definite pulse
No pulse
(Check Pulse)
(Chest
Compression) 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
AED / defibrillator ARRIVES
Compression)
(Defibrillation)
Cardiac Arrest
Shockable(VT atau VF)
Unshockable(PEA atau Asystole)
� Shock
� CPR
� Obat
� CPR
� Obat
C P R 2 menit
D C 360 Joule
C P R 2 menitC 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 Defibrillator Give Consider Arrest Arrives Vasopressor Antiarrhythmic
CPR CPR CPR CPR
A
Go to
A
Rhythm Rhythm Rhythm
Check Check Check
= 5 cycles or = CPR while = Shock 2 minutes of CPR defibrilator charging
CPR
B. Asystole and Pulseless Electrical Activity Defibrillator Arrives Give Vasopressor, Identify Cardiac Contributing For Adult Arrest Arrest Factors Consider Atropin
CPR CPR CPR
Go to
A
Rhythm Rhythm Rhythm Check Check Check = 5 cycles or 2 minutes of CPR
CPR CPR CPR
A
CPR
Secondary Survey
� Airway : Intubation
� Breathing : Check 5 point of Auscultation� Breathing : Check 5 point of Auscultation
� Circulation : IV access, NGT or Urinary Catheter
� Differential Diagnose : 6H dan 5T
The 5Hs & 5Ts
�Hypovolemia
�Hypoxia
�Hydrogen ions
�Tablets (Drug OD)
�Tamponade
�Tension �Hydrogen ions (Acidosis)
�Hyper/hypo-kalemia
�Hypothermia
�Hipoglycaemia
�Tension Pneumothorax
�Thrombosis, Coronary
�Thrombosis, Pulmonary
Goals In A Cardiac Arrest
�Restore spontaneous pulse
�Restore BP
�Aim for no neurological deficit
�Know when to STOP