Primary Care Out of Hospital Cardiac Emergency (Cardiac Arrest) in Adult - Bambang Herwanto, MD, FIHA PDF

Primary Care Out of Hospital cardiac
emergency (Cardiac Arrest) in Adult
Bambang Herwanto
Irien Eko Hermawati
CARDIOVASCULAR EMERGENCIES COURSE
Bumi Surabaya Hotel, November 7-8th, 2015
INTRODUCTION
Cardiac emergencies should be
recognized quickly
Cardiac
Arrest
Elshazly M&Nissen 2014,Chugh S et al

2008,DepKes 2006e
Out of hospital cardiac Arrest
America approximately 300,000/yr

and 92% died
The prevalence of cardiac arrest in
Indonesia unclear, but is estimated
at about 30 people per day
Out of hospital
Cardiac Arrest
Survival rates out of hospital

cardiac arrest until arriving at
the hospital approximately
23.8% and until hospital
discharge 7.6%.
From the reports of various
countries,
obtained
an
average survival to hospital
discharge 6.4%
Other data showed 21.6% of
people died although CPR
performed by bystanders
PATOPHYSIOLOGY
Cardiac Cause of Out of hospital Cardiac Arrest :
1. Coronary Heart Disease
2. Cardiomyopathies
3. Other heart abnormality:
- congenital heart structure abnormalities :
Coronary artery anomalies
Cyanotic and acyanotic heart disease

- Electrical abnormalities and genetic
Long QT Syndrome ( LQTS)
Brugada Syndrome
Cathecolaminergic Polymorphic Ventricular

Takikardia (CPVT)
Short QT Syndrome (SQTS)
Coronary Heart Disease
Atherosclerosis
Total
occlusion
Plaque
Partial
Occlusion
Rupture
Platelet activation
Coagulation casade
Trombus
Cardiomyopathies
Hypertrophic Cardiomyiopathy, Dilated Cardiomyopathy,
Arrhytmogenic right ventricular displasia, myocardial
infiltratifve disease
Myocardial disorganization + small scar tissue
VT/VF
CLINICAL EXAMINATION
The most important sign of cardiac

arrest in adults is :
unconscious
no breathing
The presence of these sign showed
that no blood and oxygen reaching
the brain and vital organs
SUPPORTING EXAMINATION
Defibrillator and monitor :
200-360 J for monophasic
Heart
120-200
rhythm
J for biphasic.
During
The
success
cardiac
rate after
arrestthe
: VF,
firstVT
shock:
without
a biphasic
pulse, PEA and asystole.
96%
VF
monophasic
and VT
54-77%.
> 70% of patients
Better
whoneurological
experiencedstatus
cardiac arrest.
biphasic
87%
monophasic
53% .
MANAGEMENT
First Aid
Assessment and actions that can be

performed by bystanders or victims with
minimal equipment or no equipment
Everyone should be able to help
First aid competencies include, at any
level of training:
Recognizing,
assessing,
and
prioritizing the need for first aid
Providing care by using appropriate
knowledge, skills, and behaviors
Recognizing limitations and seeking
additional care when needed
CASE
Basic Life Support Sequence
Lay Rescuer
Not Trained
Kleinman E M et al 2015
Lay Rescuer
Trained
Healthcare
Provider
Lay Rescuer Not Trained

Ensure Scene Safety
Check for response
Shout for nearby help. Phone or

ask someone to phone 9-1-1 (the
phone or caller with the phone
remains at the victims side, with
the phone on speaker).
Follow the dispatchers
instructions
Look for no breathing or only
gasping, at the direction of the
dispatcher.
CARDIOVASCULAR
EMERGENCIES
COURSE
Follow the dispatchers
instructions
Lay Rescuer Trained

Ensure Scene Safety
Check for response
Shout for nearby help and activate

the emergency response system
(9-1-1, emergency response). If
someone responds, ensure that
the phone is at the side of the
victim if at all possible.
Check for no breathing or only

gasping; if none, begin CPR with
compressions.
Answer the dispatchers
questions, and follow the
dispatchers instructions.
Send the second person to retrieve an
CARDIOVASCULAR
EMERGENCIES
AED, if one
is available.COURSE
th
Bumi Surabaya Hotel, November 7-8 , 2015
Healthcare Provider
Ensure Scene Safety
Check for response
Shout for nearby help/activate the

resuscitation team; can activate
the resuscitation team at this time
or after checking breathing and
pulse.
Check for no breathing or only gasping

and check pulse (ideally simultaneously).
Activation and retrieval of the
AED/emergency equipment by either the
lone healthcare provider or by the second
person sent by the rescuer must occur no
later than immediately after the check for
no normal breathing and no pulse
identifies cardiac arrest.
Healthcare Provider
Immediately begin CPR, and use

the AED/ defibrillator when
available.
When the second rescuer arrives,

provide 2-person CPR and use
AED/defibrillator
System-specific
Chain of
Chain of Survival
Survival
Immediate recognition of sudden cardiac arrest

and activation of the emergency response
system
Early CPR
Rapid defibrillation with an automated external
defibrillator (AED)
EMS and transitional to the hospital
Post Cardiac Arrest Care
Immediate recognition of sudden cardiac arrest

and activation of the emergency response system
Time is very important in witnessed cardiac

arrest
Recognition and immediately activate the
emergency system by people around the
victim becomes very important.
A frequent mistake
abnormal
breathing or gasping
no action
Early CPR
High-quality
CPR improves
arrest,
In adult victims
of cardiacsurvival
arrest, from
it is cardiac
reasonable
for
including
: to perform chest compressions at a rate of 100 to
rescuers
Ensuring
120/min chest compressions of adequate rate
chest compressions
of adequate
Ensuring
During manual
CPR, rescuers
shoulddepth
perform chest
Allowing
full chest
between
compressions
compressions
at arecoil
depth
of at least
2 inches or 5 cm for an
Minimizing
interruptions
in chestexcessive
compressions
average adult,
while avoiding
chest compression
Avoiding
excessive
ventilation
depths (greater
than
2.4 inches [6 cm])
Rapid defibrillation with an automated external

defibrillator (AED)
1. Turn on AED
2. Open and wipe the victim's
chest
3. Place AED pad in the victims
chest
4. Plug AED connector
5. AED analyze the rhythm
6. Do as AED instruction
If the AED instructs shock:

- Make sure there are no people, including helper touching the patient.
- Shout "everyone, stay away"
- Give the shock by pressing the "shock botton
- After giving shock or no shock instruction:
Perform CPR for 2 minutes
Continue as AED directed
EMS and transitional to the

hospital
If the EMS personnel arrive

advanced life
support + immediately sent to hospital.
Post Cardiac Arrest Care
ROSC
post-cardiac arrest care should
(1)be
to given.
identify and treat the underlying etiology of the
cardiac
arrest,thing is the handling of hypoxemia
The
important
(2)and
to hypotension
mitigate ischemia-reperfusion injury and
prevent
secondaryand
organ
injury, andof underlying
early
diagnosis
treatment
(3)disease
to makethat
accurate
of prognosis to guide
causesestimates
cardiac arrest
clinicalpatients
team and
to inform
the family
when
IntheROSC
> 70%
of victims
in Europe
selecting goals
of continued
careimmediately
performed
coronary
angiography
Emergency Coronary
angigraphy
PROGNOSTIC
The survival rate of patients who experienced

OHCA > 50% is obtained when the initial
documented rhythm is ventricular fibrillation or
ventricular tachycardia.
When the initial rhythm was PEA or asystole
survival rate 6-10%.
Neurological recovery as previously occurred>
50%
of
victims,
severe
neurological
abnormalities occurred in <20% .
SUMMARY
Cardiac Arrest is a heart emergency that must be handled

immediately.
The prevalence in the United States range from 180000250000 every year, and most of it was out of hospital
cardiac arrest.
In the America approximately 300,000 people experience
cardiac arrest out of hospitals each year, and 92% died.
Etiology of cardiac arrest are coronary heart disease,
cardiomyopathy and other cardiac abnormalities.
Cardiac arrest first aid continue update.

Guideline Updates stressed that first aid should be done by
people who are surround the victim ( bystanders)
The chain of survival unchange
AHA guideline for cardiopulmonary resuscitation and
emergency cardiovascular care in 2015 even stressed
about the existence of mobile phones everywhere, which
can be used to call the dispatcher's helper to go to the side
of the victim.
If the initial rhythm documented ventricular fibrillation or
ventricular tachycardia prognosis will be better (50%)
compared to the PEA or asystole (6-10%).
THANK YOU

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Primary Care Out of Hospital cardiac

emergency (Cardiac Arrest) in Adult

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Elshazly M&Nissen 2014,Chugh S et al

Out of hospital cardiac Arrest

America approximately 300,000/yr

Bumi Surabaya Hotel, November 7-8th, 2015

Survival rates out of hospital

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Coronary artery anomalies

Cyanotic and acyanotic heart disease

Long QT Syndrome ( LQTS)

Cathecolaminergic Polymorphic Ventricular

Short QT Syndrome (SQTS)

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Coronary Heart Disease

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Bumi Surabaya Hotel, November 7-8th, 2015

Myocardial disorganization + small scar tissue

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

The most important sign of cardiac

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Assessment and actions that can be

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Basic Life Support Sequence

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Lay Rescuer Not Trained

Check for response

Shout for nearby help. Phone or

Bumi Surabaya Hotel, November 7-8th, 2015

Lay Rescuer Trained

Check for response

Shout for nearby help and activate

Check for no breathing or only

Bumi Surabaya Hotel, November 7-8 , 2015

Check for response

Shout for nearby help/activate the

Check for no breathing or only gasping

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Immediately begin CPR, and use

When the second rescuer arrives,

CARDIOVASCULAR EMERGENCIES COURSE

Bumi Surabaya Hotel, November 7-8th, 2015

Immediate recognition of sudden cardiac arrest

Bumi Surabaya Hotel, November 7-8th, 2015

Immediate recognition of sudden cardiac arrest

Time is very important in witnessed cardiac