dr erwin sukandi, sppd, k-kv belum

7/29/2019 Dr Erwin Sukandi, SpPD, K-KV Belum

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Dr. Erwin Sukandi, SpPD, K-KV,FINASIM


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Nama: Tn/Ny. Tanggal: ../../.... RSMH PalembangUmur : tahun Pukul :

Interpretasi:


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IramaAksisHRGel. PInterval PRGel. Q, R, SInterval QRSInterval QT

Segmen STGel. TGel. U


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1500

RR (Ktk kecil)atau

300

RR (ktk sdg)


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Common- 2.2 million AmericansPrevalence increases with ageIncreased mortality secondary to

stroke 75,000 strokes/year in USClassifications

First episode

Recurrent (paroxysmal) Persistent


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Causes

Advancing age

Uncontrolled htn

CAD CHF

Valvular heartdisease

Acute pulmonary

process (PE) Hyperthyroidism Acute alcohol

intoxication Illicit narcotic abuse


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Absence of P wavesIRREGULARLY IRREGULARAtrial rates 350-750Ventricular rate varies

Controlled versus rapid responseUp to 30% decrease in cardiac output

No atrial kick


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Treatment Goals: rate control and anticoagulation

Rate control

Beta-blockers and Ca channel blockers Metoprolol (Lopressor)5mg IV q 5 min times 3 doses, then oral load Diltiazem (Cardizem)10 to 20 mg SLOW IV push

Digoxin may be used in chronic setting


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Regular atrial activitySawtooth pattern

Single irritable foci in atriainitiates impulse

Atrial rate 250-300 Slower than in a-fib

Causes: No underlying cardiac disease CAD, Htn, MI, hypoxia, digitalis toxicity,

CHF, PE, COPD, thyrotoxicosis, alcohol


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Treatment Ventricular rate controlBeta Blockers or Ca channel blockers

ER/admissionAtrial overdrive pacing

Ablation

Adenosine may be helpful indiagnosisTransiently blocks AV node


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Ventricular FibrillationMarquette Electronics Copyright 1996


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Ventricular AsystoleMarquette Electronics Copyright 1996


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Rhythm strip recording of ECG

revealing that paroxysmal attacksof atrial fibrillation alwaysterminated with a long ventricularasystole


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ABCs

HIGH QUALITY CPR

Secure the airway, provide 02

IV or IO access

Epinephrine 1 mg*(Repeat every 3 5 minutes)

If the rhythm is Bradycardia,


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The 5 Hs and the 5 Ts, while beginning drug therapyHypoxia Toxins/overdoseHypovolemia Thromboemboli (coronary/pulmonary)Hyper/hypokalemia TraumaHypothermia Tension pneumothoraxHydrogen ion/acidosis Tamponade (cardiac)

Hypoglycemia

Consider fluid bolus, 200-300cc; may repeat if lungs remain clear

Once perfusing rhythm is restored, maintain adequate ventilations,and then stabilize

Rate, Rhythm, and Blood Pressure

Note: Repeated unsuccessful intubation attempts are notrecommended. BVM support of the airway is acceptable until

advanced airway can be placed.*You may consider Vasopressin instead of the first or second dose


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ABCs, EFFECTIVE CPR

SECURE AIRWAY

IV/IO access

Epinephrine 1.0 mgOR

Vasopressin 40u(one time only instead of 1st or 2nd epi dose)

Atropine 1 mg

Epinephrine 1 mg

Atropine 1 mg

Epinephrine 1 mg


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Several factors should be considered when making the decision to terminate

resuscitation efforts on a patient in extended Asystole:Down Time Rigor MortisCold Water Drowning Chronic Medical Conditions

Age Skin TemperatureBlood Pooling Trauma

And most importantly.quality of life!


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ABCs

Start HARD, FAST, EFFECTIVE CPRIf un-witnessed code or down time > 4 minutes,

2 minutes of CPRprior to defibrillation

Defibrillate 200 j biphasic(or device specific dose, 360j if monophasic)

Continue CPRimmediately w/o pulse rhythm check

Secure the airway without prolonged intubation attempts

And establish IV or IO with Saline or LR

Vasopressin 40 Units I.V.DURING CPR


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OREpinephrine 1 mg I.V.

(Repeat every 3 5 minutes)

Defibrillate200-360 joules (Repeat every 1 2 minutes)

Amiodarone 300 mg I.V.OR

Lidocaine 1 - 1.5 mg/kg I.V.(May repeat to a max of 3 mg/kg)

Defibrillate200-360 joules

Consider Sodium Bicarbonate 1meq/kg(acidosis, tricyclic overdose, or hyperkalemia)Consider Magnesium Sulfate 1 2 grams I.V. (if Torsades is present)Upon return of spontaneous circulation (ROSC): Assess airway, breathing andvital signs. Provide medication appropriate for heart rate, rhythm and bloodpressure. Consider hanging a maintenance anti-arrhythmic drip upon ROSC

to prevent reoccurrence of V-Fib.


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Assess ABCs

Secure airway, provide oxygen, pulse oximetry

Start IV

Revised 9/2009 10Obtain 12 lead EKG if possible, and review patients history,

especially history of possible A-fib or A-flutter

If determined a new onset, consider synchronized cardioversion@

100, 200, 300, 360 joules(Consider Sedation)

Cardizem 0.25 mg/kgOR

Verapamil 2.5 5 mg


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*Note: never delay cardioversion in lieu of sedation if the patientis unstable. (You can always apologize later)

If AF has been present for >48 hours, a risk of systemic

embolization exists with conversion to sinus rhythm unlesspatients are adequately anticoagulated for at least 3 weeks.

Electrical cardioversion and the use of antiarrhythmic agentsshould be avoided unless the patient is unstable orhemodynamically compromised.


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Which one is more tachycardicduring this exercise test?

TERIMA

dr erwin sukandi, sppd, k-kv belum

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