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1. Pembimbing :
dr. Dedi Fitri Yadi, Sp.An, KAR, M.Kes
ADVANCE LIFE SUPPORT
ALLPPT.com _ Free PowerPoint Templates, Diagrams and Charts
Oleh :
dr. Ade Novita

2. 2020 American Heart Association Chains of Survival for IHCA and OHCA

3. Adult Cardiac Arrest Algorithm
• High Quality CPR
• Shock Energy for
Defibrillation
• Drug Therapy
• Advanced Airway
• Reversible Causes

4. HIGH QUALITY CPR
Push hard and fast
Allow complete chest recoil
Minimize interruptions
Avoid excessive ventilation
Change compressor every 2 minutes
If no advance airway, 30:2 compression-ventilation ratio
Quatitative waveform capnography, if PETCO2 is low or decreasing, reassess CPR quality
Chest Compression Fraction >80%

5. ASISTOL and PEA
TRUE ASISTOL
•Check lead and cable connections
•Monitor power on?
•Monitor gain up?
•Verify asystole in another lead?
Asystole
• complete absence of demonstrable
electrical & mechanical cardiac
activity.
PEA
• any one of a heterogeneous group
of organized electrocardiographic rhythms
without sufficient mechanical contraction of the
heart to produce a palpable pulse or measurable
blood pressure.

6. Ventricular tachycardia
Monomorphic V
T
Polymorphic VT
Ventricular tachycardia refers to a wide QRS complex heart rhythm, QRS duration beyond
120 milliseconds
Type : monomorphic and polymorphic
duration : sustained or non-sustained

7. Ventricular Fibrilation
•Fibrillation waves of varying amplitude and shape.
•No identifiable P waves, QRS complexes, or T waves
•Heart rate anywhere between 150 to 500 per minute

8. Defibrilasi
Defibrilasi merupakan proses pemberian sejumlah arus listrik untuk kejut jantung melalui alat
defibrillator yang diharapkan dapat mengembalikan irama menjadi normal. Keberhasilan defibrilasi
akan menurun jika dilakukan semakin lama dan VF cenderung berubah menjadi asistol dalam
beberapa menit. Angka kematian meningkat 7-10% setiap menit yang terlewati tanpa dilakukan
resusitasi.

9. Defibrilasi
 Buka pakaian pasien bagian dada, siapkan are apex jantung dan bagian
sternum
 Lakukan kompresi dada dan ventilasi hingga alat defibrillator siap
 Nyalakan alat defibrillator, gunakan dosis energi maksimum (bifasik 200j, mon
ofasik 360j)
 Siapkan gel pada paddles
 paddle pada posisi sternal-apical. Lempeng dada kanan (sternal) diletakkan
pada dada bagian supero-anterior bagian kanan dan lempeng apical (kiri) dilet
akkan pada dada bagian infero-lateral kiri.
 Lakukan charging, Ketika alat defibrillator sudah charge hingga penuh, beri
aba apa kepada tim supaya tidak menyentuh pasien, hentikan kompresi dan v
entilasis
 Pastikan irama masih menunjukkan VT/VF, tekan kedua tombol di paddle defi
brillator untuk melepas energi shock, berikan tekanan 12,5 kg Ketika akan mel
akukan defibrilasis
 Setelah selesai defibrilasis, segera lanjutkan kompresi dan ventilasi selama 5
siklus atau 2 menit.

10. Defibrilator
Biphasic Monophasic

11. Defibrilator
The main difference between monophasic and biphasic shock delivery is that a
monophasic electrical current moves in a single direction while a biphasic current is
bidirectional (moving in a straight line and then reversing its direction).
1.Biphasic Defibrillators Are More Effective
2.Biphasic Defibrillation Is Less Likely to Burn the Patient
3.Biphasic Waveforms Take a Smaller Toll on Battery Life

12. Drug Therapy
• Epinephrine
Epinephrine α-Adrenergic effects increase myocardial
and cerebral blood flow. β-Adrenergic effects may
increase myocardial work and decrease subendocardial
perfusion and cerebral blood flow
Initially, 1 mg (10 mL of a 1:10,000 solution), may
repeat as often as every 3-5 dosage.
For endotracheal doses: 2-2.5 mg every 3-5 minutes

13. Drug Therapy
• Amiodaron
Amiodarone is a class III antiarrhythmic agent.
Its main effect is to lengthen the action potential
and refractory period in the myocardial tissue.
It blocks the Na, K, and Ca channels
Initially, 300 mg (or 5 mg/kg) via rapid inj.
Additional 150 mg (or 2.5 mg/kg)

14. Drug Therapy
• Atropin
Initially, 0.5 mg repeated every 3-5 minutes.
Max total: 3 mg.
Atropine is an anticholinergic agent which
competitively
blocks the binding of acetylcholine to
muscarinic receptors at the parasympathetic
sites in the CNS and peripheral tissues such as
the heart, intestines, bronchial muscles, iris and
secretory glands.

15. Drug Therapy
• Lidocaine
1-1.5 mg/kg repeated as necessary. Max: 3 mg/kg
Lidocaine is classified as a class Ib antiarrhythmic that d
ecreases the permeability of the neuron membrane to sod
ium, which causes inhibition of depolarization, resulting
in blocked conduction

16. Advanced Airway
Tracheal intubation
•Tracheal intubation should be attempted as soon as practical.
Do not interrupt ventilation for more than 10 s.
After intubation, the patient can be ventilated with a selfinflating bag capable of delivering
high oxygen concentrations.
A ratio of 8–10 breaths/min in a secure airway should be maintained, as high
respiratory rates can impede cardiac output in a cardiac arrest situation.
Wavefrom Capnography or capnometry to confirm and monitor ETT tube placement

17. Reversible Causes
5 H
• Hypovolemia
• Hypoxia
• Hydrogen ion
• Hyper / Hypokalemia
• Hypothermia
5 T
• Toxins
• Tamponade Cardia
• Tension pneumothorax
• Thrombosis coronary (ACS)
• Thrombosis pulmonary
(embolism)

18. Reversible Causes
Hypovolemia Hypoxia Hydrogen Ion
(acidosis)
Hypo/Hyperkalemia Hypotermia
Loss of fluid volume
in circulatory system
most important interv
ention is to obtain
IV access and adminis
ter IV Fluid
Use fluid challenge
to determine if the ar
ret is related to hypov
olemia
An adequate oxygen
supply
Ensure that the
airway is open
Ensure adequare venti
lation, and bilateral br
eath sounds
Obtain an arterial blo
od gas to determine r
espiratory acidosis
Provide adequate
ventilations
Use sodium bicarbona
te to prevent metabol
ic acidosis if necessar
y
Sign of hiperkalemia :
Taller, peaked T- wav
es, and widening of t
he QRS complex
Sign of hipokalemia :
flattened T-wave, pro
minent U-waves, wide
ned QRS complex
If patients has been e
xposed to the cold, w
arming measures sho
uld be taken.
Core tempt should
be above 30 C as soo
n as possible

19. Reversible Causes
Toxins Tamponade Tension Pneumoth
orax
Thrombosis
Coronary
Thrombosis Pulmo
nal
Most common :
tricyclics, digoxin, beta
blockers and CCB
Cocaine
Physical sign : bradyca
rdia, pupil symptoms,
other neurological cha
nges
Fluid buil-up in the
pericardium result in
ineffective pumping of
the blood which can le
ad to pulseless arrest
ECG : narrow QRS
complex and rapid hea
rt rate
physical sign : jugular
vein distention, no pul
se, muffled heart soun
f
ECG sign : narrow QRS
complexes and rapid h
eart rate
physical sign: JVD,
tracheal deviation,
unequal breath sound,
difficulty with ventilati
on
ECG signs : 12 lead
ECG with ST segment
changes, T inversions,
and or Q waves
Elevated cardiac
markers
ECG sign : narrow QRS
complex and rapid hea
rt rate
Positive D-dimer test,
positive test for DVT
or PE

20. THANK YOU