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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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