Download - EKG BTCLS
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PEMERIKSAAN ELEKTROKARDIOGRAFI
1. Proses kelistrikan jantung
2. Peta kelistrikan jantung
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Elektrokardiogram (EKG)
Rekaman grafik potensial listrik yang dihasilkan oleh jaringan jantung
Goldman & Goldschlager
Cara Perekaman EKG :- Permukaan- Epikardial- Endokardial / intrakardial
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Peran Diagnostik EKG
Hipertrofi /dilatasi atrium dan ventrikelAritmia /gangguan konduksi : RBBB, LBBB,
VES, SVT, VT, AF, VF dll.Iskemia dan infark miokard akut atau infark
lamaEfek obat-obatan : digitalis, antiaritmiaGangguan keseimbangan elektrolit : kalium
(hipo/hiper kalemia ), kalsium
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Indikasi EKG
Gangguan irama jantungSinkop/pra sinkopDicurigai PJKHipertensiDicurigai kelainan kongenitalKelainan katupdll
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3 Sandapan BipolarI = Potensial Lki – Potensial Lka II = Potensial Lka – Potensial Tki III= Potensial Tki – Potensial Lki 3 Sandapan Ekstremitas UnipolaraVR = Potensial LkaaVL = Potensial LkiaVF = Potensial Tungkai
6 Sandapan PrekordialV1 – V6
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Proses Aktivasi Jantung
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Arah Defleksi
Arah impuls Arah defleksi
Menuju Elektroda (positif)
Ke atas (positif)
Menjauhi Elektroda (negatif)
Ke bawah (negatif)
Menuju kemudian menjauhi Elektroda
Bifasik
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SANDAPAN DADA UNIPOLAR(UNIPOLAR CHEST LEAD = V LEAD)
Sandapan V1 : Sela iga IV garis sternal kananSandapan V2 : Sela iga IV sternal kiriSandapan V3 : pertengahan antara V2 dan V4Sandapan V4 : Sela iga V garis midklavikula kiri semua sandapan selanjutnya V5- V9 diambil dalam bidang horizontal seperti V4Sandapan V5 : Setinggi V4 aksilaris anterior kiriSandapan V6 : Setinggi V4 garis mid aksilaris kiriSandapan V7 : Garis aksilaris posteriorSandapan V8 : Garis skapularis posteriorSandapan V9 : Batas kiri kolumna vertebralisSandapan V3R-V9R : Dada sisi kanan dengan tempat
yang sama seperti sandapan V3-9 sisi kiri
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Standard Rekaman EKG :- Kecepatan rekaman : 25 mm/detik- Kalibrasi : 1 milivolt (mV) = 10 mm ( standar ganda, separuh, seperempat )
Ukuran di Kertas EKG :Garis horizontal
- Tiap satu mm = 1/25 detik = 0,04 detik- Tiap lima mm = 5/25 detik = 0,20 detik- Tiap 25 mm = 25 x 0,04 = 1,00 detik
Garis vertikal- 1 mm = 0,10 mV- 10 mm = 1,00 mV
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IRAMASistim konduksi jantung yang normal
Dalam keadaan normal, impuls dibentuk oleh pace-maker di simpul SA kemudian melalui INTERNODAL ATRIAL PATHWAY simpuls AV berkas His cabang berkas kanan & kiri serabut Purkinye mengaktifkan serabut otot ventrikel.
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Jantung
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Sistem Konduksi Jantung
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Irama jantung menyerupai orkestra
Potensial elektrik jantung
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Komponen EKGGelombang PPR IntervalSegmen PRKompleks QRSSegmen STGelombang TQT IntervalAksis I & AVF
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nilai bersifat baku
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Nilai NormalNilai NormalInterval P (Durasi) ≤ 0,12 secInterval P (Durasi) ≤ 0,12 secInterval PR : 0,12 - 0,20 secInterval PR : 0,12 - 0,20 secInterval QRS : 0,07 – 0,10 secInterval QRS : 0,07 – 0,10 secInterval QT tergantung dari frekwensi jantungInterval QT tergantung dari frekwensi jantung
Gambaran EKG Normal
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RATE: 1500 . R-R interval (small boxes)
RATE
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Menentukan Frekwensi
1500
Jumlah kotak kecil antara R-R
300Jumlah kotak besar
antara R-R
Jumlah R (6s) x 10 = N
Jumlah R (12s) x 5 = N
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DEFLEKSI EKG NORMAL
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Gelombang P harus ada mendahului QRS kompleksIrama teratur, interval R-R harus sama dengan interval P-P :
regularRate: 60-100PR interval: .12-.20 (constant)QRS: normal (<.12)
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Gelombang P tidak adaGelombang P tidak adaJarak Interval R – R tidak samaJarak Interval R – R tidak sama
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• Defleksi atrial berupa undulasi teratur cepat, seperti gergaji• Atrial rate : 250 - 350• Rate ventrikel : teratur atau bervariasi• Kompleks QRS : normal
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First Degree AV Block
P-R interval memanjang (> 200 msec)Setiap P wave diikuti kompleks QRS
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Type I Second-Degree AV Block
Pemanjangan PR interval bertahap hingga gelombang P hilang
Pemendekan RR interval hingga P menghilang
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Third Degree (Complete) AV Block
Aktivitas atrial dan ventrikel berjalan sendiri (tidak berhubungan)
Atrial rate lebih cepat dibanding ventricular rate
Ventricular rate : junctional atau an idioventricular
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Premature Atrial Contractions
Berasal dari fokus ektopik di atriumMorfologi gelombang abnormalPR interval : normal, memanjang atau memendekPanjang sikuls setelah PACmemanjang tetapi waktu kompensasi
tidak penuh
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Premature Ventricular Contractions
Komples QRS : abnormal baik durasi maupun konfigurasi
Peubahan sekunder ST dan T
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GAMBARAN EKG
SINUS RITME
SINUS BRADICARDI
SINUS TACHYCARDI
SINUS ARITMIA
SINUS ARREST
SINUS BLOCK
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ARITMIA ATRIUM
PAC
ATRIAL FLUTTER
ATRIAL TACHYCARDI
MULTIFOCAL ATRIAL TACHYCARDI
Wandering Atrial Pacemaker
Junctional Rhytm
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AV Blok 2nd Degree Type I atau Wenckebach
AV Blok 2nd Degree Type II
AV Blok Total/Komplit
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Idioventrikular Rhytm
Accelerated Idioventrikular
Ventrikel Takikardia/ VT
VT Polymorphic
ventrikel Fibrilasi/VF
Torsade de pointes
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Lakukan bantuan hidup lanjut sesegera mungkin sesuai protokol
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DEFIBRILATORDefibrilator AED
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PERUBAHAN AHA 2005 & 2010AHA 2005
Airway (A)Breathing (B)Circulation (C)
AHA 2010Circulation (C)Airway (A)Breathing (B)
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Algoritma BHD (AHA 2010)
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Paddle Positposisiions – Defibrillation
Paddle Positposisiions – Defibrillation
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DefibrilasiUNSYNCRHONIZED CARDIOVERSION
Synchronized Cardioversion
Unstable polymorphic (irregular) VT / VF : 200 J (BV), 360 J (MV)
Dosis pada anak : 2-4 Joule/KgBB
Atrial fibrilasi = 100 – 200 J
Atrial Fluter = 50 – 100 JSVT = 50 – 100 J“Management of
Symptomatic Bradycardia and Tachycardia.” Unstable monomorphic (regular) VT with pulses : 100 J 100 J, 200 J, 300 J, 360 J
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DRUGSADRENALIN
Indikasi : Henti jantungDosis : 1 mg (IV flush NaCl 0,9 % 10-20 cc tangan di elevasi) diulang setiap 3 – 5 mnt
SA Indikasi : Bradikardi tidak stabilDosis : 0,5 mg IV diulang 3 – 5 mnt. Max 0,04 mg/KgBBPada Henti jantung sama dengan adrenalin
LIDOKAINAnti aritmia, dosis 1 – 3 mg/KgBB
AMIODARONPada henti jantung dosis 300 mg IV, pada aritmia 150 mg IV diencerkan dalam 10 cc NaCl 0,9 % diberikan selama 10 menit seperti lidokain
Dopamin (inotropik +) dengan dosis 5 mcg/KgBB/mnt cara pemberian diencerkan
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Drug Therapy (AHA 2010)Epinephrine IV/IO Dose: 1 mg every 3-5
minutesVasopressin IV/IO Dose: 40 units Amiodarone IV/IO Dose: First dose: 300 mg
bolus. Second dose: 150 mg.
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Akan membantu mempertahankan sirkulasi spontan pada Cardiac Arrest untuk 1-2 menit.
Aktifitas reseptor Alfa dan Beta
Aktifitas reseptor Alfa penting pada cardiac arrest
Dosis: 1 mg IV dapat diulang setiap 3-5 menit.
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Alfa adrenergic : menyebabkan pembuluh darah
perifer vasokonstriksi
Meningkatkan tekanan diastol
Memperbaiki sirkulasi koroner
Mempertahankan oksigenasi ke miokard
Kemungkinan besar akan menyebabkan jantung berkontraksi spontan
Epinephrine ( Adrenaline )
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Lidocaine
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Lidocaine
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Lidocaine
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Laki-laki usia 46 tahun, datang ke UGD dengan keluhan nyeri dada
Acute inferior myocardial infarction
(with reciprocal changes)
• ST elevation in the inferior leads II, III and aVF
reciprocal ST depression in the anterior leads
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EKG berisiko KEMATIAN
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