Post on 03-Apr-2018
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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