cadiorespiratory arrest

1. CARDIORESPIRATORY
ARREST
FAISAL SOMMENG
Traumatology , FK-UMI 2020
https://quizizz.com/join?gc=842043

2. DEFINISI
Cardiorespiratory arrest is
The sudden, unexpected cessation of
respiration and functional circulation.

3. CPCR Principle
4 – 6 minutes
CPCR
During respiratory and cardiac arrest, CPCR may be successful
if performed before biological death of vital tissue develops.

4. 4
CPCR
MATI KLINIK MATI BIOLOGIK
(REVERSIBEL) (IRREVERSIBEL)
4 - 6 menit
PRINSIP CPCR
MENGALIRKAN DARAH YG MENGANDUNG
OKSIGEN KE ORGAN VITAL TERUTAMA
JANTUNG DAN OTAK

5. 5
RESUSITASI JANTUNG PARU
DAN OTAK (RJPO)
ADALAH USAHA UNTUK MENGEMBALIKAN FUNGSI
PERNAPASAN, SIRKULASI DAN ATAU SEREBRAL SERTA
PENANGANAN AKIBAT TERHENTINYA FUNGSI PERNAPASAN,
DENYUT JANTUNG DAN ATAU
AKTIFITAS SEREBRAL PADA :
 ORANG YANG MENGALAMI KEGAGALAN ORGAN
TERSEBUT SECARA TIBA-TIBA
 MASIH MEMUNGKINKAN HIDUP NORMAL

6. CARDIAC ARREST
1. Ventricular fibrillation or Pulseless VT
Electrical defibrillation is required to
reestablish spontaneous and effective
cardiac electrical activity.
2. Cardiac asystole.
3. Electromechanical dissociation (PEA)
Circulatory collapse that occurs despite
satisfactory electrical complexes on the ECG

7. CAUSES OF CARDIAC ARREST
1. Low cardiac output.
2. Hyparcapnia.
3. Hyperkalemia.
4. Hypoxia and vagal stimulation.
5. Stimulation of the heart.
6. Coronary occlusion.
7. Overdosage.
8. Hypothermia.
9. Hyperthermia
10. Acidosis

9. CAUSES OF RESPIRATORY FAILURE
1. Airway obstruction
Vomitus, foreign body, blood, secretions, solid material,
mucous plugs, laryngeal or bronchial spasm, or tumor.
2. CNS depression
Stroke, head trauma, hypercapnia, barbiturates,narcotics,
tranquilizers, or anesthetics.
3. Neuromuscular failure
Secondary to Poliomyelitis, muscular dystrophy,
myasthenia, or muscle relaxant drugs.
4. Lung or Parenchyma Diss..

10. PRIMARY CAUSES OF
CARDIAC OR RESPIRATORY ARREST.
Flail chest
Pneumothorax
Massive atelectasis
Acute pulmonary embolism
Congestive heart failure
Overwhelming pneumonia
Gram-negative septicemia
Lung burns
Carbon monoxide poisoning
Massive blood loss.

11. CARDIAC ARREST IS
More frequent in:
1. Geriatric patients.
2. Patients with a history of
arrhythmias, heart block, digitalis
toxicity, myocarditis , myocardial
infarction, congestive heart failure,
electrolyte imbalance , or
dehydration.
3. Massive hemorrhage.
4. During or following heart surgery.

12. MANAGEMENT
1. The initial goal of therapy is BRAIN oxygenation
2. The second goal is restoration of circulation.
3. Underlying condition must be corrected.
CPCR
CPCR is not indicated for all patients.
Natural death in the aged or in the terminal stages of a
chronic illness
CPCR should be performed in cases of reversible unexpected
death

13. CPCR.....
1. Basic Life support (BLS):
A: Airway,
B: Breathing,
C: Circulation, + (Defibrillation )
2. Advanced life support (ALS):
D: Drug and Fluid Therapy
E: Electrocardiography.
F: Fibrillation treatment.
3. Bantuan Hidup Jangka Panjang
G: Gauging
H: Human Mentation
I: Intensive Care
R: Rehabilitation

14. TINJAUAN BUKTI ILMIAH
KONSENSUS ILMIAH
PEDOMAN PENGOBATAN
CPCR GUIDELINES

15. Organisasi Resusitasi Dunia

16. 2015

19. RANTAI KEHIDUPAN
2005
2010

20. 2015

21. 2020

27. Deskripsi Kerja Siloam Semanggi
1. Dokter/RMO ICU
(Leader)
2. RMO ED 4. Perawat ED
5. Perawat Ruangan/ Duty
Manager
3. Nurse leader
(Perawat ICU)
Korban/Pasien Troley
Emergency
1. RMO ICU (Leader) : pemimpin lapangan
2. RMO ED : membantu tindakan resusitasi
3. Nurse leader (Perawat ICU) : kesiapan
peralatan, obat-obatan dan koordinasi
dg farmasi, lab, dll
4. Perawat (ED) : akses intravena dan
obat-obatan
5. Perawat Ruangan atau DM : pencatatan
status kronologis

29. 1. vertically downward 4-5 cm
2. Push hard push fast
3. 100 - 120x/min.
4. Ratio Comp : Vent  30 : 2
External Cardiac Compression

31. Cardiac Compression 100 -120 x/menit

32. Assisting Sirkulasi
Mekanikal kompressi
• Autopulse
• LUCAS
2015: Angka survive sama namun gangguan neurologis
lebih banyak pada Autopulse

34. KOMPRESI DADA YANG
BERKUALITAS
TERAPI ELEKTRIK
DEFIBRILASI
• Sejak awal , kompresi dada jangan
terputus
• Meminimalkan interupsi sebelum
dan setelah kejut
• Lanjutkan kompresi selama
pengisian defibrilasi

35. DEFIBRILATION
BIFASIK
Rekomendasi :
• Idealnya : energi bifasik awal tidak kurang dari
150 J (120 – 200 J ) untuk semua bentuk
gelombang
• Pemakaian alat mekanikal kompresi dapat
digunakan bila kompressi dada tidak adekuat atau
memerlukan CPR jangka lama

36. ENERGI DEFIBRILASI
TETAP ATAU ESKALASI ?
2010/2015 :
• Keduanya dapat diterima, bagaimanapun Jika
kejut pertama tidak berhasil dan defibrilasi masih
dapat memungkinkan untuk meningkatkan energi
yang lebih tinggi, maka masih dapat diterima
untuk ditingkatkan

37. EARLY DEFIBRILLATION
IT IS CRITICAL TO SURVIVAL FROM SUDDEN CARDIAC ARREST (SCA)
FOR SEVERAL REASONS:
(1) The most frequent initial rhythm
in witnessed is ventricular
fibrillation (VF),
(2) The treatment for VF is electrical
defibrillation,
(3) The probability of successful
defibrillation diminishes rapidly
over time, and
(4) VF tends to deteriorate to asystole
within a few minutes.

38. PADDLE POSITIONS
DEFIBRILLATION OR CARDIOVERSION

39. DEFIBRILLATION WAVEFORMS
AND ENERGY LEVELS
 Defibrillation  delivery of current through the chest
and to the heart to depolarize myocardial cells and
eliminate VF.
 The energy settings for defibrillators are designed to
provide the lowest effective energy needed to terminate
VF.
 Electrophysiologic event that occurs in 300 to 500
milliseconds after shock delivery.
 Defibrillation (shock success) is typically defined as
termination of VF for at least 5 seconds following the
shock.

40. SHOCK ENERGIES
• Biphasic defibrillator (initial shock) :
• selected energies of 120 J to 200 J
(biphasic truncated exponential
waveform) or
• 120 J (rectilinear biphasic waveform).
• For second and subsequent shocks, use the
same or higher energy

41. SHOCK ENERGIES
• Monophasic defibrillator : select a dose of 200-
360 J for all shocks.
• If VF is initially terminated by a shock but
then recurs later in the arrest, No need to
deliver subsequent shocks BUT continous CPR

42. SYNCHRONIZED
CARDIOVERSION
• Shock delivery that is timed (synchronized) with the QRS
complex.
• The energy (shock dose) used is lower than that used for
unsynchronized shocks (defibrillation).
• These low-energy shocks if delivered as unsynchronized
are likely to induce VF.
• If cardioversion is needed and it is impossible to
synchronize a shock (eg, the patient’s rhythm is
irregular), use high-energy unsynchronized shocks.

43. SYNCHRONIZED
CARDIOVERSION
• Ventricular tachycardia
• Ventricular tachycardia with a pulse responds
well to cardioversion using initial monophasic
energies of 200 J.
• Use biphasic energy levels of 120—150 J for
the initial shock.
• Give stepwise increases if the first shock fails
to achieve sinus rhythm.

44. Electrode Position

48. DRUGS
• Drugs should be considered only after initial
shocks have been delivered (if indicated) and
chest compressions and ventilation have
been started.
• Three groups of drugs relevant to the
management of cardiac arrest (2015
Consensus Conference): vasopressors, anti-
arrhythmics and other drugs.

49. INOTROPS and VASOPRESSORS
• Adrenaline - the primary sympathomimetic agent
for the management of cardiac arrest for 40 years.
• Alpha-adrenergic actions, vasoconstrictive effects 
systemic vasoconstriction, which increases coronary
and cerebral perfusion pressures.
• Beta-adrenergic actions, (inotropic, chronotropic)
may increase coronary and cerebral blood flow.

50. ADRENALINE
 Indications
 Adrenaline is the first drug used in cardiac arrest of any
aetiology: it is included in the ALS algorithm for use every
3—5 min of CPR.
 Adrenaline is preferred in the treatment of anaphylaxis.
 Adrenaline is second-line treatment for cardiogenic shock.
 Dose. During cardiac arrest, the initial intravenous dose of
adrenaline is 1 mg.
 When intravascular (intravenous or intra-osseous) access is
delayed or cannot be achieved, give 2—3 mg, diluted to 10 ml
with sterile water, via the tracheal tube. Absorption via the
tracheal route is highly variable.

51. ANTI-ARRHYTHMICS
• Amiodarone is a membranestabilising anti-arrhythmic
drug that increases the duration of the action
potential and refractory period in atrial and
ventricular myocardium.
• Atrioventricular conduction is slowed, and a similar
effect is seen with accessory pathways.
• Amiodarone has a mild negative inotropic action
and causes peripheral vasodilation through non-
competitive alpha-blocking effects.

52. AMIODARONE
• Indications.
• refractory VF/VT
• haemodynamically stable ventricular tachycardia (VT) and other
resistant tachyarrhythmias
• Dose. Consider an initial intravenous dose of 300
mg amiodarone, diluted in 5% dextrose to a
volume of 20 ml (or from a pre-filled syringe), if
VF/VT persists after the third shock.
• Amiodarone can cause thrombophlebitis when
injected into a peripheral vein; use a central
venous catheter if one is in situ but,if not, use a
large peripheral vein and a generous flush.

53. LIDOCAINE
 Indications. Lidocaine is indicated in refractory
VF/VT (when amiodarone is unavailable).
 Dose. an initial dose of 100 mg (1—1.5 mg/kg) for
VF/pulseless VT refractory to three shocks.
 Give an additional bolus of 50 mg if necessary.
 The total dose should not exceed 3 mg/kg during
the first hour.

54. OTHER DRUG
• Atropine. antagonises the action of the
parasympathetic neurotransmitter
acetylcholine at muscarinic receptors.
• Blocks the effect of the vagus nerve on
both the sinoatrial (SA) node and the
atrioventricular (AV) node, increasing
sinus automaticity and facilitating AV
node conduction.

55. ATROPINE
• is indicated in:
• Asystole
• pulseless electrical activity (PEA) with a rate
<60/min.
• sinus, atrial, or nodal bradycardia when the
haemodynamic condition of the patient is
unstable.
• The recommended adult dose of atropine for
Asystole or PEA with a rate <60 /min is 3 mg
i.v. in a single bolus.

57. • Kurangnya penekanan pada
intubasi tracheal sejak awal kecuali
dilakukan oleh tenaga terlatih
dengan interupsi kompresi yang
minimal

58. • Penekanan yang lebih terhadap pemakaian
kapnograf untuk confirmasi dan secara
berkesinambungan memantau letak tube,
kualitas RJP, dan memantau indikasi awal
tanda-tanda ROSC

59. ACLS : GELOMBANG KAPNOGRAF
Perubahan :
• Gelombang kapnograf kuantitatif adalah metode yang
lebih reliable untuk mengkonfirmasi letak ET tube
Kenapa :
• Banyaknya insidens yang tidak diinginkan akibat letak
ET tube yang tidak betul
• Kapnograf memiliki sensitivitas dan spesifitas yang
tinggi untuk mengidentifikasi kebenaran letak ETT
pada pasien gagal jantung

60. ACLS : GELOMBANG KAPNOGRAF
• Setelah intubasi, karbondioksida yang di ekshalasi
akan terdeteksi, sehingga dapat dipakai sebagai
pengkonfirmasi letak selang ETT dan optimalisai CPR
• Nilai yang paling tinggi pada saat akhir ekspirasi

61. PERUBAHAN ACLS : JALAN NAPAS
• Alat jalan napas supra glottis dapat dipakai tanpa
pemberhentian CPR
• Insersi selang ETT > 10 detik sebaiknya dihindari
kecuali jalan nafas beresiko
• Memerlukan banyak latihan dan kekompakan tim

67. CPR -1
30 : 2
CALL
FOR
HELP
PASANG
MONITOR
VF / VT
a single shock -II
a single shock -I - a single shock-IV
a single shock-III a single shock-V
2 menit 2 menit 2 menit 2 menit
adrenalin
adrenalin
CPR-3
CPR-2 CPR-5
CPR-4
- AMIODARON
Adrenaline: 1 mg, iv,
repeated every 3-5
minutes
CPR-6
Cardiac
arrest
Or LIDOCAIN 1mg/kg. Can be
repeated. Do not exceed a total dose
of 3 mg/kg,during the first hour.
Amiodaron is the first choice
300 mg, bolus. Repeated 150 mg
for reccurrent VT/VF. Followed by
900 mg infusion over 24 hours
VF/ VT
Intubasi : as soon as possible, without stop CPR Pijat 100 -120 x/menit
Nafas 8 -10 x/menit
Evaluasi CPR : tiap 2 menit
adrenalin
3’
3’
- AMIODARON

68. ASYST
2 menit 2 menit 2 menit 2 menit
evaluasi
evaluasi
Adrenalin-1
CPR-3
CPR-2 CPR-5
CPR-4 CPR-6
Cardiac
arrest
ASYSTOL/PEA/EMD
Intubasi : as soon as possible, without stop CPR Pijat 100-120 x/menit
Nafas 8-10 x/menit
Evaluasi CPR : tiap 2 menit
evaluasi
evaluasi
CPR -1
30 : 2
CALL
FOR
HELP
PASANG
MONITOR
Adrenalin-2 Adrenalin-3
Adrenaline: 1 mg, iv,
repeated every 3-5
minutes

70. TERMINATION OF
RESUSCITATION
• CPR must be continued until
• Cardiopulmonary system is stabilized
• The patient is pronounced death
• Alone rescuer is physically unable to
continue

71. TERIMAH KASIH

137. ASSESS RHYTHM
• CPR
• Defibrillate mono or
biphasic
• Epinephrine – several
dose options
• Antiarrhythmic agents
• AMIODARON
• Lidocaine
• Magnesium
Ventricular fibrillation

138. PULSELESS ELECTRICAL
ACTIVITY
• CPR
• Search for reversible causes and treat
• Epinephrine
• Atropine for absolute or relative bradicardia

139. ASYSTOLE
• CPR
• Epinephrine
• Consider transcutaneous pacing
• Search for reversible causes and
treat if possible

140. BRADYCARDIA –
PATIENT NOT IN ARREST
 Oxygen
 Atropine
 Dopamine
 Epinephrine
 Transcutaneous pacing
 Transvenous pacing

141. TACHYCARDIA WITH SERIOUS
SIGNS/SYMPTOMS
 Oxygen
 Immediate cardioversion
 Premedicate when possible
 Synchronized setting

142. TACHYCARDIA WITHOUT
SERIOUS INSTABILITY
 Narrow-complex
 Adenosine
 Verapamil
 Diltiazem
 -blockers
 Digoxin
 Synchronized cardioversion

143. TACHYCARDIA WITHOUT SERIOUS
INSTABILITY
• Wide-complex
– Amiodaron
– Lidocaine
• Synchronized cardioversion

144. Terima kasih