Nizam Akbar

Dept . Cardiology & Vascular medicine

Universitas Sumatera Utara

Adam Malik Hospital - Medan

Definition of Cardiac Arrest

�Abrupt cessation of cardiac �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 (most common)

• Myocardial hypertrophy

• Cardiac inflammatory diseases

• Sympathetic nervous system disorders

• Proarrhythmic toxic exposures

• ElectrocutionCardiac inflammatory diseases

• Cardiac valvular disease

• Electrophysiologic Abnormalities (e.g. WPW)

• Electrolyte disturbances

• Abnormal metabolic states

Electrocution

• Tension pneumothorax

• Trauma

• Drowning

• Pulmonary embolism

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?)� (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 VFPEA

(Pulse less

Electrical

Activity)

A systole

CARDIAC ARREST

� Ventricular Tachycardia

� Ventricular Fibrilation� Ventricular Fibrilation

� Asystole

� PEA (Pulseless Electrical Activity)

Normal Sinus Rhythm

EKG

The Heartbeat

Ventricular Tachycardia

Ventricular Fibrillation

ASYSTOLE

P. E. A

BASIC LIFE SUPPORT(BANTUAN HIDUP DASAR)

Primary survey

� Airway : Head tilt Chin lift

� Breathing : Feel, look and Listen

No breathing 2 rescue breathingNo breathing 2 rescue breathing

� Circulation : Carotid or Femoral artery

No Pulse Compression 30 : 2

� Defibrilation : Shockable or Unshockable

No Movement or response

Call for help / or call emergency number

Get AEDOr send second rescuer (if available) to do this

(Assess responsiveness)

(Activate E M S)

Open AIRWAYS, check BREATHING

If not breathing give 2 BREATH that make chest rise

(Airways, Assess breathing)

(rescue Breathing)

If no response, check pulse :

Do you DEFINITELY feel

Pulse within 10 seconds ?

Give 1 breath every

5-6 seconds

Recheck pulse every

2 minutes

30 COMPRESSION and 2 BREATHS

Until AED/defibrillator arrives, ALS providers take over

Definite pulse

No pulse

(Check Pulse)

(Chest

Compression) 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

AED / defibrillator ARRIVES

Compression)

(Defibrillation)

Advance Cardiac Life Support

Not shockable

Shockable

Cardiac Arrest

Shockable(VT atau VF)

Unshockable(PEA atau Asystole)

� Shock

� CPR

� Obat

� CPR

� Obat

3 A� Adrenaline (Epinephrine)

� Amiodarone� Amiodarone

� Atropin Sulfat

DC 360 JouleDC 360 Joule

VF/VT pulseless yang menetap dan berulang

- C P R- C P R- 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 menitC 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/Pulseless VT

Cardiac Defibrillator Give Consider Arrest Arrives Vasopressor Antiarrhythmic

CPR CPR CPR CPR

A

Go to

A

Rhythm Rhythm Rhythm

Check Check Check

= 5 cycles or = CPR while = Shock 2 minutes of CPR defibrilator charging

CPR

B. Asystole and Pulseless Electrical Activity Defibrillator Arrives Give Vasopressor, Identify Cardiac Contributing For Adult Arrest Arrest Factors Consider Atropin

CPR CPR CPR

Go to

A

Rhythm Rhythm Rhythm Check Check Check = 5 cycles or 2 minutes of CPR

CPR CPR CPR

A

CPR

Secondary Survey

� Airway : Intubation

� Breathing : Check 5 point of Auscultation� Breathing : 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 OD)

�Tamponade

�Tension �Hydrogen ions (Acidosis)

�Hyper/hypo-kalemia

�Hypothermia

�Hipoglycaemia

�Tension Pneumothorax

�Thrombosis, Coronary

�Thrombosis, Pulmonary

Goals In A Cardiac Arrest

�Restore spontaneous pulse

�Restore BP

�Aim for no neurological deficit

�Know when to STOP