THE HIGH RISK PATIENT

IDENTIFICATION AND
REFFERAL SYSTEM

RISK STRATIFICATION
PRACTICE

THE PATHWAY OF
REFFERAL SYSTEM

1. The primary aim is to achieve ROSC, stabilise the

patient rapidly at scene and then transfer.
2. when and where to transfer patients with OHCA is
key.
3. Patient transfer with continuing cardiopulmonary
resuscitation (CPR) reduces the quality of chest
compressions.
However, with the new mechanical chest
compression devices (eg, LUCAS
(Jolife, Lund,
Sweden) and AutoPulse (Zoll Circulation,
Chelmsford, Massachusetts, USA)) adequate chest
compression quality can be maintained during
transport.
4.

Patient destination, admission to a centre with

HIGH-THREAT ECG
FINDINGS

Sinus Tachycardia

Sinus Bradycardia

Sinus Arrhythmia

First Degree Heart Block

Second Degree Block Type I

Second Degree Block Type II

Rhythm #13

Rate?
Regularity?
P waves?
PR interval?
QRS duration?

40 bpm
regular
no relation to QRS
none
wide (> 0.12 s)

Interpretation? 3rd Degree AV Block

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Third Degree Heart Block

3rd Degree AV Block

Etiology: There is complete block of

conduction in the AV junction, so the
atria and ventricles form impulses
independently of each other. Without
impulses from the atria, the ventricles
own intrinsic pacemaker kicks in at
around 30 - 45 beats/minute.

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Atrial Fibrillation

Atrial Fibrillation

Atrial Flutter

Atrial Tachycardia

Supraventricular
Tachycardia

Ventricular Tachycardia

Ventricular tachycardia

Torsade de Pointes

Torsades de pointes

Ventricular Fibrillation

Ventricular fibrillation

Ventricular Asystole

Left Bundle Branch Block

Infark Non ST Elevasi Inferior dan Anterior

Ekstensif

PERI-ARREST
CARDIAC EMERGENCY NURSING
WORKSHOP
SCU 2014

SINDROMA KORONER AKUT

BRADIKARDI
TAKIKARDI
UDEM PARU, SYOK

SINDROMA KORONER
AKUT

Definisi

Kumpulan keluhan dan tanda klinis yang

sesuai dengan iskemia miokardium akut

Diagnosis bisa Angina pektoris tidak

stabil, infark non ST elevasi, infark ST
elevasi atau kematian jantung
mendadak

Angina Pektoris

Stabil : Timbul
saat aktifitas
sedang atau
berat. Berkurang
dengan
istirahat/pemberi
an ISDN 5 mg
sublingual
Tidak Stabil :
Resting

Angina
New Onset Angina

Infark Miokard Akut

Nyeri dada yang

sangat berat.
> 20-30 menit

Gejala yang harus diwaspadai

Dada rasa tidak enak

(chest dyscomfort)
disertai keringat,
mual, muntah atau
napas pendek,
perasaan lemah.

DIAGNOSIS

KELUHAN NYERI DADA ANGINA

PERUBAHAN ECG ( ST-T CHANGES)

PERUBAHAN ENZYME JANTUNG (TROP-T,CK-CKMB)

39

PRE HOSPITAL
MANAGEMENT
SYMPTOMS COMPATIBLE
WITH STEMI
PREHOSP
D/,TRIAGE
AND CARE

EMS

AMBULANCE

PCI CAPABLE
HOSPITAL

GP/CARDIO
LOGIST

PRIVATE
TRANSPORT

SELF DECISION

PRIVATE
TRANSPORT

NONPCI CAPABLE
HOSPITAL

INTERVENTION (PRIMARY
PCI)

Hipotensi/Syok
dan
Edema Paru Akut

Tanda klinis: syok,

hipoperfusi, gagal jantung
kongestif, edema paru akut
Apakah masalahnya?

Edema paru
akut
Tindakan
pertama bila
syok (-) :
O2 & intubasi
kalau perlu
Nitroglicerin/nitr
at SL
Furosemide IV
0,5-1mg/kgBB
Morphin IV 2-4
mg

Masalah
volume

Masalah
pompa

Berikan:
cairan
transfusi
cairan
spesifik
Pertimbangka
n:
Vasopresor

Masalah
irama
Bradikardi
atau
Takikardi
(ke algoritma
bradikardia
atau
takikardia)

Tekanan
darah?

Tentukan
tekanan
darah,
lanjutkan ke
Tindakan
kedua

TD < 70 mmHg
tanda/gejala
syok (+)

Norepinefri
n

0,5 30
/mint IV

TD 70-100

TD 70-100

mmHg

mmHg

tanda/gejala
syok (+)

tanda/gejala
syok (-)

Dopamine
2 20
g/kg/mnt IV

Dobutamin
e
2 20
g/kg/mnt IV

Tindakan lini kedua:

Nitrogliserin/nitrat bila TD > 100 mmHg
Dopamin bila TD 70-100mmHg dengan tanda
syok
Dobutamin bila TD > 100mmHg tanpa tanda
syok
Pertimbangkan diagnostik dan terapi lanjut:
- Temukan penyebab
- Tambahan prosedur diagnostik
lain
- Bedah
- Kateterisasi arteri pulmonal
- Intraortic ballon pump - Angiografi dan intervensi
koroner
- Tambahan obat-obatan

BRADIKAR
DIA

Definisi

Bradikardi yang menimbulkan gejala

terjadi pada frekuensi < 50 x/menit

Ya

TAKIKARDI
A

Definisi

Takikardia didefinisikan sebagai aritmia

dengan denyut jantung > 100 kali per
menit
Gejala Ekstrim biasanya timbul pada
denyut jantung > 150 x/menit

2
4
Ya

*
Tidak
Ya

**

Tidak
6
7
* 4 Adenosin diberikan bila HR < 150 x/m , tanpa LV disfungsi, dan tanpa
hipotensi
* 6 Adenosin diberikan seperti SVT dengan 3 kali pemberian 6 mg, 12