Nizam Akbar Dept .

Cardiology & Vascular medicine Universitas Sumatera Utara Adam Malik Hospital - Medan

Definition of Cardiac Arrest

Abrupt cessation of

cardiac pump function which may be reversible by a prompt intervention but will lead to death in its absence

Causes Of Cardiac Arrest

Coronary heart disease Sympathetic nervous

(most common)
Myocardial hypertrophy Cardiac inflammatory

system disorders
Proarrhythmic toxic

exposures
Electrocution Tension pneumothorax Trauma Drowning Pulmonary embolism

diseases
Cardiac valvular disease Electrophysiologic

Abnormalities (e.g. WPW)

Electrolyte disturbances Abnormal metabolic states

The 'chain of survival' concept

Early activation of emergency services Early basic life support Early defibrillation Early advanced life support

How Does An Arrest Present?

Patient found, usually unconscious most often by a nurse An arrest is called
(Do YOU know the emergency number?)

BLS should commence immediately The nature of the arrest identified quickly Appropriate action should be taken

The Deadly Rhythms

VT VF

PEA
(Pulse less A Electrical Activity)

systole

CARDIAC ARREST
Ventricular Tachycardia Ventricular Fibrilation Asystole PEA (Pulseless Electrical Activity)

EKG
Normal Sinus Rhythm

The Heartbeat

Ventricular Tachycardia

Ventricular Fibrillation

ASYSTOLE

P. E. A

BASIC LIFE SUPPORT

(BANTUAN HIDUP DASAR) Primary survey

Airway Breathing

: Head tilt Chin lift : Feel, look and Listen No breathing 2 rescue

breathing
Circulation

: Carotid or Femoral artery No Pulse Compression 30 : 2 : Shockable or Unshockable

Defibrilation

(Assess responsiveness)

No Movement or response

(Activate E M S)

Call for help / or call emergency number Get AED

Or send second rescuer (if available) to do this

(Airways, Assess breathing)

Open AIRWAYS, check BREATHING

(rescue Breathing)

If not breathing give 2 BREATH that make chest rise

Definite pulse (Check Pulse) If no response, check pulse : Do you DEFINITELY feel Pulse within 10 seconds ? No pulse (Chest Compression) 30 COMPRESSION and 2 BREATHS Until AED/defibrillator arrives, ALS providers take over Or victim starts to move Push hard and fast (100x/min) and release completely Minimize interruption in compression Give 1 breath every 5-6 seconds Recheck pulse every 2 minutes

(Defibrillation)

AED / defibrillator ARRIVES

Advance Cardiac Life Support

Shockable Not shockable

Cardiac Arrest
Shockable (VT atau VF) Unshockable (PEA atau Asystole)

Shock CPR CPR Obat Obat

3A
Adrenaline (Epinephrine) Amiodarone Atropin Sulfat

DC 360 Joule

VF/VT pulseless yang menetap dan berulang

-CPR - Ventilasi / Intubasi - I.V. Line : - Epinephrine 1 mg ( 1 menit !! )

D C 360 Joule C P R 2 menit D C 360 Joule C P R 2 menit DC 360 Joule Epinephrine 1 mg

C P R 2 menit D C 360 Joule C P R 2 menit D C 360 Joule C P R 2 menit D C 360 Joule Anti aritmia : -Amiodarone 300 mg I.V.

A. Ventricular Fibrillation/ P ulseless VT

Cardiac Arrest Defibrillator Arrives Give Vasopressor Consider Antiarrhythm ic

Go to

CPR

CPR

CPR

CPR

R hythm Check

R hythm Check

R hythm Check

CPR

= 5cycles or 5m inutes of CP R

= CP R w hile defibrilator charging

= Shock

B. Asystole and P ulseless Electrical Activity

Defibrillator Arrives

Cardiac Arrest

Give Vasopressor, I dentify Contributing Factors

For Adult Arrest Consider Atropin

CPR

CPR
A
R hythm Check R hythm Check = 5cycles or 5m inutes of CP R

CPR

Go to

R hythm Check

CPR

Secondary Survey
Airway Breathing

: Intubation : Check 5 point of

Auscultation
Circulation

: IV access, NGT or Urinary

Catheter
Differential Diagnose

: 6H dan 5T

The 5Hs & 5Ts

Hypovolemia Hypoxia Hydrogen ions Tablets (Drug

(Acidosis) Hyper/hypokalemia Hypothermia Hipoglycaemia

OD) Tamponade Tension Pneumothorax Thrombosis, Coronary Thrombosis, Pulmonary

Goals In A Cardiac Arrest

Restore spontaneous

pulse Restore BP Aim for no neurological deficit