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HISTORICAL REVIEW

5000 - first artificial mouth to mouth


3000 BC ventilation
1780 first attempt to rescucitate a newborn
by blowing
1874 first experimental direct cardiac
massage
1901 first successful direct human cardiac
massage
1946 first experimental indirect cardiac
massage and defibrillation
1960 indirect cardiac massage
1980 development of cardiopulmonary
resuscitation arrising from the works of
Peter Safar

1
all cases accompanied by
hypoxia
extracardiac

Causes of cardiac
arrest

cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors 2
Causes of circulation
arrest
Cardiac Extracardiac
Ischemic heart disease
(myocardial infarction, airway obstruction
stenocardia)
acute respiratory failure
Arrhythmias of different
origin and character shock
Electrolytic disorders
Valvular disease reflector cardiac arrest
Cardiac tamponade embolisms of different
Pulmonary artery origin
thromboembolism
Ruptured aneurysm of drug overdose
aorta
poisoning
3
ABC CAB
2005 : 2 rescue breaths followed by 30 chest
compressions and then 2 breaths
2010 : initial chest compression before
ventilation
Reasons :
Chest compression deliveres blood to heart and brain
Early compression had good outcome


Elimination Look, Listen, Feel
2005 : Look, listen and feel used to assess
breathing after opening airway
2010 : After 30 compressions the lone rescuer
opened victims airway and delivered 2 breaths
Reasons :
With the new chest compression, first sequence CPR
is performed if the adult is unresponsive and not
breathing or not breathing normaly (C-A-B sequence)
Chest compression at least 100 per minute

2005 : Compress at a rate 100 per minute


2010 : reasonable for a lay and healthcare
provider to perform chest compression at least
100 per minute
Reasons :
Push hard and fast
Compression delivered per minute is an important
determinant of ROSC
More compressions are associated with higher
survival rates
Chest compression Depth

2005 : The adult sternum should be depressed


approximately 1,5 to 2 inches (4-5cm)
2010 : sternum should be depressed at least 2
inches (5cm)
Reasons :
Compression creates blood flow primarily by increasing
intrathoracic pressure and directly compressing the
heart. Compressions generate critical blood flow,
oxygen and energy delivery to the heart and brain
Shock first vs CPR First

2010 (Reaffirmed 2005)


When any rescuer witnessing an out-of-hospital
arrest and AED,and who is immedietly available
on site, should start CPR with chest
compressions and use the AED as soon as
possible
1-shock vs 3 shock sequence

2010 (no change from 2005)


If 1 shock fails to eliminate VF, the incremental
benefit of another shock is low treatment of VF
cardiac arrest
Defibrilation waveforms and energy Levels

2010 (no change from 2005)


Data shows that biphasic waveform shock at
energy settings comparable to or lower than
200-J monophasic shock have equivalent or
higher success in terminating VF
Defibrilator at the maximum dose may be
considered
Supraventricular Tachyarrhytmia

2005 : The recommended initial monophasic


energy dose for cardioversion of AF is 100 to
200 J
2010 : recommended initial biphasic energy
dose for cardioversion of AF is 120-200 J, And
monophasic is 200 J
Ventricular Tachycardia

2010 :
o Adult stable monomorphic VT responds well
to monophasic or biphasic cardioversion shock
at initial energies of 100 J
o Cardioversion should also not be used for
pulseless VT or polymorphic VT (irregular VT)
New Medication Protocols

2010 : Atropine is not recommended for routine


use in the management of PEA/Asystole and
has been romoved from the ACLS Cardiac
Arrest Algorithm
Adenosine is recomended in the initial diagnosis
and treatment of stable, monophormic wide
complex tachycardia
Atropine unlikely have therapeutic benefits
during PEA or asystole
Tapering of inspired Oxygen
Concentration After ROCS based on
monitored Oxyhemoglobin Saturation
2005 : No Specific information about weaning
was provided
2010 :
Once the circulation is restored, monitor arterial
oxyhemoglobin saturation
Titrate oxygen administration to maintain the
arterial oxyhemoglobin saturation 94%
Cont.......

Why :
An Oxygen saturation of 100% may correspond
to a PaO2 anywhere between approximately 80
and 500 mmHg
A recent study has documented the harmful
effects of hyperoxia after ROSC
Organized Post Cardiac Arrest Care

Optimizing cardiopulmonary function and vital


organ perfusion after ROSC
Transportation to an appropriate hospital or
critical care unit with comprehensive post
cardiac arrest treatment system of care
Identification and intervention for acute coronary
syndrome (ACS)
Temperature control to optimize neurological
recovery
Anticipation, treatment, and prevention of
multiple organ dysfunction
DC shock
Oles dulu paddles
dengan jelly ECG
tipis rata, baru
kemudian :

1. Switch ON
Pasang paddles pada posisi sternum
apex dan parasternal
(boleh terbalik)
apex
2. Charge 360 Joules DC shock
(Non-synchronized)
Ucapkan dengan keras :
Awas semua lepas dari pasien!
nafas buatan berhenti dulu
bawah bebas,
samping bebas,
sternum
atas bebas,
saya bebas!
apex apex
3. Shock!!
(tekan dua tombol paddles bersama)
Lepas paddles dari dada,
lanjutkan chest compression.
4. Segera pijat jantung lagi 2 menit
baru raba lagi/ baca lagi ECG
Position
of the paddles electrodes
on thorax of an infant sternum

apex

Size of paddle electrode


- 4.5 cm diameter for infants and small children
- 8-12 cm diameter larger children
Jelly kurang rata, menekan paddles kurang kuat - luka bakar
INDICATIONS

Defibrillation (Non-Synchronized DC Shock):


VF
Pulseless VT
Recommended joule: 360 J

27
INDICATIONS

Synchronized DC Shock (Only with unstable


hemodynamic):

AF
Atrial Flutter start with 50 J
SVT

VT with pulse
start with 100 J
(despite of Infant and Children: 2
medication) J/kg

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DO NOT SHOCK!!!
Asystole
Pulseless Electrical Activity
Bradicardia
Heart Block
Stable hemodynamic with AF, Atrial Flutter, SVT, &
VT with pulse

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TERIMA KASIH
VF / pulseless VT

1). a single shock


Biphasic 150-200 Joule
Defibrilation strategy Monophasic 360 Joule
CPR 30 : 2
2 MINUTES, 30 : 2

NO Check ECG
YES
Check pulse

2). a single ROSC


shock Recovery of
Biphasic 150-360 2 MINUTES, 30 : 2 Spontaneous
Joule
Circulation
Monophasic 360 Joule
VF/ VT
Intubasi : as soon as possible, without stop CPR Pijat >100x/menit
Nafas 8-10x/menit

Cardiac adrenalin adrenalin


arrest VF / VT
2 menit 2 menit

2 menit 2 menit
CPR -1 Amiodaron
a single shock a single shock a single shock a single shock
30 : 2 a single shock
CPR-2 CPR-3 CPR-4 CPR-6
CPR-5
CALL adrenalin
FOR Amiodaron is the first choice
HELP 300 mg, bolus. Repeated 150 mg
Adrenaline: 1 mg, iv,
for reccurrent VT/VF. Followed by
PASANG repeated every 3-5
900 mg infusion over 24 hours
MONITOR minutes
LIDOCAIN. Do not exceed
a total dose of 3 mg/kg,
Evaluasi CPR : tiap 2 menit during the first hour.

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