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EMERGENCY
Dr. Tri Wisesa Soetisna, SpB TKV (K)
Cardiovascular Emergency
Cardiac Wall
Blood Vessel Rupture
Cardiac Septum
Cardiac Valve
Bleeding Tamponade
Hemodinamic Disturbance
Shock
+
Penetrating Heart Injury
• Wilson et al 1975 : inhospital mortality rate > 50 %
• Bodai ( 1983) : prehospital mortality 38 – 83 %
• Paul Tahalele 1985 - 89: inhospital survival 91.2% (12)
• Wuryantoro ( 1989 ) : inhospital mortality 0% (6)
• Djoko J : inhospital mortality 50 % (4)
HOSPITAL
Transportation to Hospital
• Placed the patient in supine position
• Fluid Resuscitation Immediately (Electrolite Solution)
• Contact the Hospital for Preparing
In Hospital
• Stop a Bleeding
* Sampai 1881 - 1897 hanya perikardiosentesis
Robert, Wiliams, Rehn berhasil menjahit jantung yang luka
* Sampai 30 - 40 tahun kemudian kardiorapi banyak dianut.
1930 Blalock & Ravitch melaporkan keberhasilan perikar-
diosentesis. Sejak itu terapi jadi kontroversial
* Pengalaman Wilson, et al, 1975 dengan kardiorapi selama
20 tahun dengan survival rate: * 83% pada 173 penderita
luka tusuk dan * 74% pada 27 penderita luka tembak.
Ini menyokong tindakan torakotomi segera dan kardiorapi
Chest wall Incision for Emergency Thoracotomy
Bleeding controle
• Coronary Laceration
• Septal Defect
• Conduction System Damage
PITFALL8 :
Arrythmias could occured if large
coronary laceration is not repair
Blunt Cardiac/Great Vessel
Injuries
Djoko J : thoracotomy:
1. Immediate ( emergency ) thoracotomy for
resusciatation
2. Early thoracotomy, first 24 hours
3. Late thoracotomy, > 24 hours
Congenital Heart Disease
• Cyanotic
• Respiratory distraess tachypnea
• Tachycardia
• Enlargement heart
• Systolik mur mur, thrill
• Sign of acute congestive heart failure
Hospital
Hypoxic Spell
• Inadequate Pulmonary Blood Flow
• CHD :
– Tetralogy of Fallot
– Pulmonary Stenosis
– Pulmonary Atresia
• Sign of Severe Systemic Hypoxia
,Cyanosis, provoke by severe activity / cry
/ acidosis (severe diarrhea/dehidration)
Hypoxic Spell
• Management :
– Stop activity that provoke hupoxic
spell
– Put the patient in knee chest
position
– Oxygen
– Rehidration (IV fluid)
– Medical Surgical
Congestive Heart Failure
• < 6 month of Live
• CHD :
– L R shunt (ASD,VSD,PDA,AVSD,APVD)
– TGA, HLHS
– Coarctation
– Valvular (severe AS)
• Sign :
– Feeding difficulty
– Reccurent Respiratory Track Infection
– Failure to thrive
Heart Failure
PRE LOAD
- INTRAVASCULAR VOLUME
CONTRACTILITY
- CAD
- TAMPONADE
- CHRONIC / COMPLEX VALVULAR
(THROMBUS FORMATION)
- ARRYTHMIAS
- MYXOMA
AFTERLOAD
- HYPERTENSION
OTHER
- TENSION PNEUMOTHORAX
- ACUTE PULMONARY EMBOLISM
- CHRONIC LUNG DISEASE
Heart Failure
CONSERVATIVE
-BEDREST
-OXYGEN
-LOW SALT DIET
-FLUID RESTRICTION
MEDICAL
-DIGITALS
-DIURETIC
-ACE inhibitor
-THROMBOLYSIS
- ANTIARRYTHMIAS
DEFINITIF / SURGICAL
-PERICARDIOTOMY
-CABG
-CARDIOMYOPLASTY
-VALVE REPLACE/REPAIR
-ARTERECTOMY
-ABLASION
ACS
Acute Myocardial Infarction
Medical
PTCA
Cito CABG
ST elevasion
Acute Myocardial Infarction
16
14
12
10
0
<6h 6 – 23 h 1–3d 4–7d 8 – 14 d > 15 d
THANK YOU