Cardiac Arrest & Post Cardiac Arrest Management
Cardiac Arrest & Post Cardiac Arrest Management
Pendidikan :
• Ners Keperawatan FIK UI
• Pendidikan ICU Bedah Jantung (CCNP) Institute Jantung Negara (IJN) Malaysia
• Mahasiswa Magister Ilmu Keperawatan (S2) FIK UI, Peminatan Sp.KMB
Sumber :
Ashish R. Panchal. Circulation. Part 3: Adult Basic and Advanced Life Support: 2020 American
Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care, Volume: 142, Issue: 16_suppl_2, Pages: S366-S468, DOI:
(10.1161/CIR.0000000000000916)
Sumber :
Ashish R. Panchal. Circulation. Part 3: Adult Basic and Advanced Life
Support: 2020 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,
Volume: 142, Issue: 16_suppl_2, Pages: S366-S468, DOI:
(10.1161/CIR.0000000000000916)
Basic Life Support
D R C C A B
▪ Danger : Bahaya.
▪ Respon : Respon.
▪ Call For Help : Panggil bantuan.
▪ Circulation : Sirkulasi.
▪ Airway : Jalan napas.
▪ Breathing : Nafas.
The History Of CPR
1800s
ANJURAN & LARANGAN
BLS UNTUK CPR BERKUALITAS TINGGI
Pada Pasien Dewasa
Penolong HARUS Penolong TIDAK boleh
Melakukan kompresi dada dengan kecepatan Kompresi dada dengan kecepatan lebih
100 – 120 x/ mnt rendah dari 100 x/ menit atau lebih cepat
dari 120 x/ menit
Kompresi dada dengan kedalaman minimal 2 Kompresi dada dengan kedalaman kurang
inchi (5 cm) dari 2 inchi atau lebih dari 2,4 inchi (6 cm)
Rekoil penuh setelah setiap kali kompresi Bertumpu di atas dada di antara kompresi
yang dilakukan
Sumber:
http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf
CPR
Survival with CPR
Early CPR
CPR
CPR
CPR
Early CPR
TEHNIK RJP PADA KEHAMILAN
Manual Left Uterine Displacement Technique
✓ .
Pulse Oximetry Waveform
X
Asistole
Gbr EKG pada saat terjadi serangan jantung , sekitar 60%-70% adalah irama
Ventricular Fibrilasi (VF)
Henti Jantung
Shockable
DC Shock 360 J Not shockable
monofasik/200J bifasik Do chest compression
Chest compression
CPR
CPR
Shock First VS CPR First
✓ Henti jantung dewasa yang disaksikan / diketahui →
Defibrillator / AED digunakan sesegera mungkin
✓ Henti jantung yang tidak diketahui / Defibrillator (AED)
belum siap→ Mulai CPR, jika indikasi dan alat sudah siap
maka lakukan defibrilasi sesegera mungkin
(Sumber: http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf)
Adult :
Bi phasic = 120-200 J
Monophasic =360 J
Pediatrik:
1st = 2 J/kg
2nd = 4 J / kg
Maks = 10 J/kg
Defibrillation
• Siapkan defibrilator
• Siapkan paddle
• berikan Jelly
• Isi energi: CHARGE
• Stop CPR
• Tempel paddle
• I’m clear, you’re clear,
everybody’s clear..!!!
• Lakukan shock
• Angkat paddle
• Lanjutkan CPR
• Evaluasi monitor
Defibrillation
Aba –aba saat akan melakukan defibrilasi..Wajib.
Obat-Obatan Resusitasi
(Cardiac Arrest)
Epinephrine
Jenis Pasien Adrenalin Cara Pengoplosan
Jenis Obat (1 amp = 1 mg) obat
DEWASA 1 ampul = 1mg bolus 1 amp adrenalin
tiap 3-5 menit murni
Administration:
▪ Bolus doses: in 100 ml D5W over 10 min (maximum infusion rate
30 mg/min)
▪ Cardiac Arrest:
First dose: Give 300 mg (6 mL) IV direct UNDILUTED.
Second dose: If patient remains in pulseless ventricular
tachycardia or ventricular fibrillation 5 minutes after the first
dose, give a second dose of amiodarone 150 mg (3 mL).
Contraindications:
Do not use amiodarone for individuals with polymorphic VT
associated with a prolonged QT interval because this may
worsen the patient’s condition.
VT Polymorphic
Obat-Obatan Resusitasi
(Cardiac Arrest : VF & pVT)
▪ Lidocaine is not on the crash carts. Amiodarone should be considered the first-line
drug for VT/VF rhythms (unless long QT syndrome).
▪ Lidocaine can terminate a re-entry ventricular arrhythmia by decreasing
ventricular excitability and increasing stimulation threshold of the ventricle.
▪ Lidocaine can be an alternative for VT/VF arrhythmias if the patient has a:
• Known allergy to Amiodarone
• Documented prolonged QT interval
1. CPR
2. Pasang Elektrode EKG tanpa menghentikan CPR
3. EKG terpasang → Stop CPR sebentar
4. Identifikasi EKG :
Sumber :
Edelson, D. P., Sasson,Topjian, A. A. (2020). Interim Guidance for Basic and Advanced Life Support
in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the
Emergency Cardiovascular Care Committee and Get with the Guidelines-Resuscitation Adult
and Pediatric Task Forces of the American Heart Association. Circulation, E933–E943.
https://doi.org/10.1161/CIRCULATIONAHA.120.047463
RJP Dengan Pasien Terpasang Sungkup Oksigen
Pada Kasus Covid-19
In Prone Position… How To DoCPR..???
CPR & Defibrilation in Prone Position
CPR
When patient in Supine position → rescuers to provide CPR with the
patient in the prone position, particularly in hospitalized patients with an
advanced airway in place. (Class IIb, LOE C-LD / Lemah, Data terbatas).
• 2 hands Together
• Put Hands on T 7 from scapula
• While performing a prone CPR, it is important to ensure high-
quality CPR
Defibrillator
• Defibrillator should be applied using maximum energy
discharge and should be shocked at the end of expiration
with the lowest positive end expiratory pressure to minimize
the chest impedance.
• One of which is the one electrode technique placed to the left
lower sternal border and the other posteriorly below the
scapula.
• Successful electrical defibrillation has been reported in
patients having spinal surgery in the prone position
Perawatan Pasca Henti Jantung
Di Ruang ICU
ABC
Management