p purwo ; drugs defib 2010
DESCRIPTION
jujuTRANSCRIPT
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DRUGS AND DEFIBRILASI
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GAMBARAN HENTI JANTUNG
• Ventrikel Fibrilasi• Ventrikel Takhikardi Tanpa Nadi• Asistole• PEA
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PEA (Pulselesse Elektrical Activity) danVT (Ventrikel Tachikardia)
12-Dec-05 26
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VF ( Ventikel Fibrilasi )
12-Dec-05 29
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DEFIBRILASI (ASYNCRONIZE)
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INDIKASI DEFIBRILASI
• VENTRIKEL FIBRILASI• VENTRIKEL TAKHIKARDI TANPA NADI
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DEFIBRILASIDilakukan bila diketahui adanya VF dan VT
• Minta bantuan untuk penggunaan defibrilator pada kasus VF/VT
• 90% pasien non trauma yang tiba-tiba henti jantung karena VF teresusitasi.
• Keberhasilan defibrilasi tergantung dari waktu diketahuinya.
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Survival rate of early defibrillation
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Algoritma penanganan VF/VT tanpa nadi
• Algoritma terpenting dari semua bantuan kegawatan jantung (Advanced Cardiac Life Support)
• Alasannya: karena VF/VT sering terjadi, dan merupakan penyebab kematian yang dapat dikoreksi lebih sering dibandingkan asistol atau PEA
• Ketentuan awal pada awal syok dan sering perlu diikuti dengan defibrilasi dan perlu obat-obat sampai berhasil atau harus pindah ke algoritma lain.
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DEFIBRILATOR
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Paddle Positions – Defibrillation
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ENERGI
• 360 Joule (monophasic)• 120 – 200 Joule (biphasic) JIKA TIDAK ADA RESPON• RJP• LANJUTKAN TINDAKAN ABCD SEKUNDER
AHA 2010
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ABCD SEKUNDER
• Pasang ETT airway• Bagging Breathing• IV line Circulation• Pasang Monitor EKG Circulation• Drugs
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DRUGS• ADRENALIN
Indikasi : Henti jantungDosis : 1 mg (IV flush NaCl 0,9 % 10-20 cc tangan di elevasi) diulang setiap 3 – 5 mnt
• AMIODARONPada henti jantung dosis 300 mg IV, pada aritmia 150 mg IV diencerkan dalam 10 cc NaCl 0,9 % diberikan selama 10 menit seperti lidokain
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Drug Therapy (AHA 2010)
• Epinephrine IV/IO Dose: 1 mg every 3-5 minutes
• Vasopressin IV/IO Dose: 40 units • Amiodarone IV/IO Dose: First dose: 300 mg
bolus. Second dose: 150 mg.
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HENTI JANTUNG
• VF & VT tanpa nadi( DRUG – SYOK - CPR)
• ASISTOL & PEA (DRUGS – CPR)
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KARDIOVERSI
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SUPRAVENTRIKEL TAKHIKARDIA
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ATRIAL FLUTTER
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ATRIAL FIBRILASI
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KARDIOVERSI (SYNCRONIZE)• VT (Ventrikel Takhikardia) dosis awal 100 J• SVT (Supraventrikular Takhikardia) dosis awal 50 J• Atrial Fibrilasi dosis awal 100 J• Atrial Flutter dosis awal 100 J
Dengan kondisi hemodinamik tidak stabil Jika kondisi hemodinamik stabil tindakannya adalah
pemberian obat-obatan pada SVT modinamik stabil dilakukan rangsangan Vagal
manuver, jika tidak berespon maka diberikan adenosin dosis 6 sampai 12 mg IV cara pemberian seperti pada henti jantung
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