Management
Ns. Yudi Elyas, S.Kep
UPJT RSUPN Dr. Cipto Mangunkusumo Jakarta
Disampaikan pada :
HOPECARDIS 2018- Nursing Session, Ritz-Carlton Hotel Jakarta, 31 March 2018.
CURICULUM VITAE
Nama : Ns. Yudi Elyas, S.Kep
NIRA : 31730118302
Lama Bekerja : 14 Tahun
Riwayat jab. struktural : Ka. Ruang ICU bedah Jantung PJT RSCM
Jabatan Saat ini : Supv. Ruang Rawat, ICCU, ICU bedah jantung PJT RSCM Jakarta
Pendidikan :
• Formal : Ners Keperawatan FIK UI
• Informal : Pendidikan ICU Bedah Jantung (CCNP) Institute Jantung Negara (IJN) Malaysia
OXYGEN DELIVERY
(DO2)
X SVR
Timothy J. Ellender, MDa,b,*, Joseph C. Skinner, MDa,b, The Use of Vasopressors and Inotropes in the Emergency Medical
Treatment of Shock, Emerg Med Clin N Am 26 (2008) 759–786
Cardiogenic shock is a state of inadequate tissue perfusion caused by cardiac
dysfunction and is most commonly associated with acute myocardial infarction
with left ventricular failure
Support for aggressive therapy has been championed by several large trials : Early
support, timely revascularization, and intra-aortic balloon pump
Timothy J. Ellender, MDa,b,*, Joseph C. Skinner, MDa,b, The Use of Vasopressors and Inotropes in the Emergency Medical
Treatment of Shock, Emerg Med Clin N Am 26 (2008) 759–786
SYOK KARDIOGENIK
Pemeriksaan Fisik :
• Dispnu, nyeri dada, berdebar.
• JVP/CVP meningkat.
• Edema ekstremitas
• Murmur atau gallop.
Rontgen Edema Paru
EKG dapat ditemukan tanda iskemia.
Kadar enzim jantung dapat meningkat.
Ekokardiogram memperlihatkan etiologi
Low cardiac output syndrome (LCOS)
Rontgen
Peningkatan JVP EKG
CTR > 50%
Pemantauan Haemodinamik
Pasien Dengan Syok Kardiogenik
Non Invasive
1. Keadaan Umum
2. Tingkat kesadaran Invasive Monitoring
3. Warna kulit / Suhu
tubuh 1. IBP
2. CVP
4. Tanda-tanda vital
3. PAC (Swanganz)
(TD,HR,SatO2,RR)
5. Nadi perifer
6. Capilary refill time
7. Urine output
Tidak Hanya Pencatatan
Pemantauan untuk :
• Mengevaluasi fungsi dasar kardiovaskular
• Menentukan adanya disfungsi sistem kardiovaskular dan derajatnya
• Mempertahankan sirkulasi tetap adekuat
• Mempertahankan nilai normal dan mengevaluasi perubahan hemodinamik
• Panduan awal dalam memberikan intervensi untuk mencegah masalah
• Melakukan evaluasi tindakan yang telah diberikan
Non Invasive Monitoring
ABP
PAP
CVP
PCWP
Invasive Monitoring In ICU
Direct Arterial Blood Pressure
Measurement
Pemasangan CVC
Arteriovasodilators :
Volume Ca Channel Blokers
Vasopressors : SVR/PVR
Alpha Inhibiitors
Alpa Stimulator Afterload Vascular Relaxants
Ace Inhibitors
Positif Inotropik:
Beta 1 stimulator Negatif Inotropik :
Phospodiaters inhibitor Contractility Beta Blokers
Cardiac Glikosiders Ca Channel Blockers
Inotropik adalah agen obat yang berperan dalam kontraksi otot jantung
Kronotropik : obat yang berperan dalam denyut jantung
Dromotropic : Meningkatkan konduksi jantung
Classification, Location & Primary Action
of Adrenergic Reseptor
RECEPTOR LOCATION PRIMARY ACTION
Alpha adrenergic
Alpha-1 Vascular smooth muscle Vasocontriction
arterioles and venules
Timothy J. Ellender, MDa,b,*, Joseph C. Skinner, MDa,b, The Use of Vasopressors and Inotropes in the Emergency Medical
Treatment of Shock, Emerg Med Clin N Am 26 (2008) 759–786
CO MO2 Coronary Renal Arrhythmia
Norepinephrine
Epinephrine DD DD
Dopamine DD DD
Dobutamine DD
IABP
Lollgen et. Al. Care of the critically ill. Vol 6. No 2. P62-66
Intra Aortic Ballon Pump (IABP)
• Intra-aortic Balloon Counterpulsation (IABC)
Counterpulsation has become a standard component of
treatment in patients with cardiogenic shock or severe
acute left heart failure that :
• Does not respond rapidly to fluid administration, vasodilatation, and inotropic support;
• Is complicated by significant MR or rupture of the interventricular septum, to obtain
haemodynamic stabilization for definitive diagnostic studies or treatment; or
• Is accompanied by severe myocardial ischemia, in preparation for coronary angiography and
revascularization.
• Class of recommendation I, Level of evidence B
• Jan M. Headley, RN, BS, CCRN Irvine,Invasive hemodinamic monitoring : Physiological Principles and clinical
applications
• Patient center in acute care training, Haemodynamic monitoring and management Haemodynamic monitoring and
management, Module Authors, Skills and techniques: 2013.
• PPNI, Standar Diagnosis Keperawatan Indonesia, Definisi dan Indikator Diagnostik, edisi 1, 2017.
• Steven M. Hollenberg , MD, FCCP, CHEST, Hemodynamic Monitoring, CHEST 2013; 143- (5): 1480 – 1488
• Update in Intensive Care and Emergency Medicine, M.R. Pinsky D. Payen (Eds.)2005
TERIMAKASIH...
Email : yudielyas@gmail.com
HP : 081316006831
IG : YUDIELYAS