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8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Cardiac resynchronisation therapy
INDONESIA HEALTHCARE FORUM
Bidakara Hotel, Jakarta
WEDNESDAY, 3 February 2016
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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CO
Kardiovaskuler dan syokKardiovaskuler dan syok
Syokhipovolemik
TD
HR SV
Syok Distributif
SyokObstruktif
Preload Kontraktilitas
SyokKardiogenik
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Target ResusitasiTarget Resusitasi
Global Endpoints
Makrosirkulasi
Mikrosirkulasi
Regional Endpoints
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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MakrosirkulasiMakrosirkulasi
RVEDV : jantung ka
LVSWI : jantung ki
Fungsi jantungFungsi jantung
DO2
SvO2
LVP : SVR
Base Deficit
LactateLactate
PerfusiPerfusiJaringanJaringan
MetabolikMetabolikJaringanJaringan
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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MikrosirkulasiMikrosirkulasi
Gastric Intramucosal pH (pHi)Gap Intramucosal & Arterial PCO2
Skeletal Intramucosal pH &PCO2
Near Infra Red Spectroscopy
Tissue Electrodes
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Akibat SyokAkibat Syok
MakrosirkulasiMakrosirkulasi
MikrosirkulasiMikrosirkulasi
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Konsep dasar ResusitasiKonsep dasar Resusitasi
CardiacCardiacoutputoutput
Arterial OArterial O22 contentcontent
DO2
= CO x CaO2
OXYGEN DELIVERY OXYGEN DELIVERY
..
FluidsFluids
TransfuseTransfuse
AirwayAirwayManagementManagement
and oxygen th/ and oxygen th/
DefibDefibCardio drugsCardio drugs
Algt ACSAlgt ACS
No pulseNo pulse•• VT/VFVT/VF•• PEA/AsistolePEA/Asistole
CPRCPRDefibDefib
PulsePulse•• VTVT•• AFAF•• Brady/TachyBrady/Tachy
Myocard
• ACS
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Serangan Jantung di Dalam Rumah Sakit(HCA)
AHA 2015 GuidelinesAHA 2015 Guidelines
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Serangan Jantung di Luar RumahSakit (OHCA)
AHA 2015 GuidelinesAHA 2015 Guidelines
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Anjuran dan Larangan BLS untuk CPRBerkualitas Tinggi Dewasa
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Cardiac Arrest Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Cardiac Arrest Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Cardiac Arrest Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Tachycardia With a Pulse Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Tachycardia With a Pulse Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Bradycardia With a Pulse Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Acute Coronary Syndromes Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Algoritma GawatDarurat (Dewasa) yang
Mengancam JiwaTerkait Opioid
Teknik CPR berdasarkan tingkatpelatihan penolong
AHA 2015 GuidelinesAHA 2015 Guidelines
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Algoritma Serangan Jantunga a as en e a r un u
Satu Penolong
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Algoritma Serangan Jantung Pada Pasien Pediatriuntuk 2 Penolong atau Lebih
AHA 2015 GuidelinesAHA 2015 Guidelines
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Resusitasi Neonatal
Waktu Emas (60 detik) untukmenyelesaikan langkah awal :
3 pertanyaan utama :1. Kehamilan normal?2. Nada baik?
3. Bernapas atau menangis?
-
-memulai ventilasi
•Rekomensi : penundaan pemotongan talipusar > 30 detik ( bayi normal & prematur)yang tidak memerlukan resusitasi saat lahir.•Suhu
• Suhu tanpa asfiksia :36,5°C -37,5°C
• Cegah hipotermi• Hindari hipertemi ( >38°C)
AHA 2015 GuidelinesAHA 2015 Guidelines
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Bayi asprasi cairan amniotik tercemar mekonimum, tonus otot lemah dan
sulit bernapas :•Hrs dirawat dlm inkubator•Diberikan PAP, jika perlu.•Intubasi tidak lagi disarankan
Resusitasi Neonatal
•Dukungan ventilasi dan kadar oksigen sesuai yang diindikasikan
•Penilaian detak jantung penting selama menit pertama resusitasi• ECG 3 sadapan (kl ada) atau auskultasi dan palpasi
•Penilaian oksigenisasi menggunaka pulse oksimetri•Resusitasi pada bayi baru lahir prematur (< 35 mg)
• oksigen rendah (21% - 30%) dan oksigen dititrasi.• masker laring sebagai alternatif penggati intubasi trakea (>34 mg)
AHA 2015 GuidelinesAHA 2015 Guidelines
8/16/2019 Workshop Rs Cardiac Resynchronisation Therapy Update Aha 2015 Guidelines
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Bayi prematur yang bernapas secara spontan dengan kesulitan pernapasan•memberikan udara/oksigen tekanan positif secara berkelanjutan•Intubasi rutin untuk pemberian PPV tdk dianjurkan
Rekomendasi tentang teknik kompresi dada•Gerakan melingkar dengan dua ibu jari di atas dada•Rasio kompresi berbanding ventilasi (3:1 dengan 90 kompresi dan 30 napasbuatan/mnt), dapat mempertimbangkan untuk menggunakan rasio yang lebihtinggi (misalnya, 15:2)
Resusitasi Neonatal
• em er an o s gen a ompres a a er an ttp saran an,
oksigen dapat dihentikan segera setelah detak jantung normal.•Rekomendasi tentang penggunaan epinefrin selama CPR dan tindakanpemberian volume tidak ditinjau pada tahun 2015, sehingga rekomendasitahun 2010 tetap berlaku.
Hipotermia terapeutik :•berdaya dukung tinggi•bayi yang lahir > 36 minggu•Bayi dgn ensefalopati hipoksik-iskemik (sedang s/d berat)
Nilai Apgar 0 pada 10 menit : pertanda kuat mortalitas dan morbiditas (bayi
prematur dan normal) AHA 2015 GuidelinesAHA 2015 Guidelines
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Post-Cardiac Arrest Care Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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Post-Cardiac Arrest Care Algorithm
AHA 2015 GuidelinesAHA 2015 Guidelines
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RingkasanKomponen CPR
Berkualitas
• Kedalaman kompresi tidak boleh lebih dari 2,4
inci (6 cm).• Singkatan: AED, defibrilator eksternal otomatis;
AP, anteroposterior; CPR, resusitasikardiopulmonari.
AHA 2015 GuidelinesAHA 2015 Guidelines
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CC – – A A -- BB
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Semoga BermaafatSemoga Bermaafat
Terima Kasih atasTerima Kasih atasPerhatiannyaPerhatiannya
