NURSING SEMINAR

Management Lethal Arrhythmia :

New Insight for Nurse Role In Era
Pandemi COVID

Di Sampaikan Oleh :
Ns. Sugiyono. S.Kep. M.Kep. C.T

Supported by :
Curiculum Vittae
• Nama : Ns. Sugiyono.S.Kep. M.Kep. C.T
• Moto : “Selalu Menuju Perbaikan dan Keep Spirit ,
Belajar, Amal, Ibadah”
• No Telepon/WA: 081326616855
• Email/fb/ig : sugiyononers@gmail.com , Sugiyono Ners
• YouTube channel : Sugiyono official
• https://www.youtube.com/watch?v=iYQqtrCoZjo
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• Profesion :
Ners Emergency RSPJNHK, Dosen Keperawatan, Trainer
BLS/BTCLS/ACLS/EKG , Hypnoterapist Profesional.
 Riwayat Pendidikan dan Training
School
SPK PPNI SEMARANG 1999-2002
UNIVERSITAS NGUDI WALUYO SEMARANG 2002-2006
PROGRAM PROFESI NERS 2006-2007
MAGISTER KEPERAWATAN (S2) 2018-2020
On SPESIALIS PROGRAM (Sp.KMB) 2020

Training
Basic Cardivascular 20110
Advace Cardiovascular 2017
Electrocardigrafi 2017
ACLS/BTCLS 2020
OVERVIEW
Latar Belakang

Anatomi KV dan sistem konduksi

Konsep Aritmia dan arhtmia lethal

Managemen Suden cardiac arrest

pada Arhrtmia lethal

Nursing Consideration

Kesimpulan
 BACKGROUND
As nurses, we need to be prepared in the even
of a lethal arrhythmia ; a deadly heart rhythm
When a patient suffers a lethal arrhythmia
every few second count, Are you ready ?
Will you able to make the quick decisions
necessary to save your patients life?
How U can asses in Pandemi Covid 19?
• The 2017 update of cardiovascular statistics from the AHA
estimated the total annual burden of outof-hospital cardiac
arrest at 356,500
• SCA (Sudden Cardiac Arrest) and its most common
consequence SCD (Sudden Cardiac Arrest), constitute major
public health problems, accounting for approximately 50% of
all cardiovascular deaths.
• Approximately half of patients with out-of-hospital cardiac
arrest with the first rhythm identified as VF and who survive
to hospital admission have evidence of acute MI (AMI) (27).
Of all out-of-hospital cardiac arrests, >50% will have
significant coronary artery lesions on acute coronary
angiography
 PEA vs. VF/VT in Sudden Cardiac Arrest

• The initial rhythm was VF/VT in 48% of

patients and PEA in 25%. Overall, 13% of
patients survived to hospital discharge;

https://www.jwatch.org/em201101070000003/2011/01/07/fact
ors-associated-with-pea-vs-vf-vt-sudden
Indicates sudden cardiac death with
Ariytmia Lethal.
 DEFINISI ARITMIA
Adalah gangguan denyut jantung yang meliputi frequensi, irama dan
konduksi yang dapat ditimbulkan oleh karena gangguan pengeluaran /
pembentukan impuls maupun gangguan sistem hantaran / konduksi
atau keduanya.
Klasifikasi aritmia ( sesuai dengan prognosis )
 Aritmia minor
Ini tidak memerlukan tindakan segera sebab tidak mengganggu
sirkulasi dan tidak berlanjut ke aritmian yang serius, biasanya tidak
memerlukan teraphi

 Aritmia mayor
Dapat menimbulkan gangguan penurunan curah jantung & dapat
berlanjut ke aritmia yang mengancam jiwa. Memerlukan tindakan
segera dan teraphi

 Aritmia mengancam jiwa

Aritmia yang memerlukan resusitasi segera untuk mencegah kematian
 Faktor penyebab aritmia antara lain
sebagai berikut :
 Hipoksia  Physiological
 Pathological:
 Iskemia  Valvular heart disease.
 Rangsangan susunan saraf  Ischemic heart disease.
otonom  Hypertensive heart
diseases.
 Obat-obatan  Congenital heart disease.
 Gangguan keseimbangan  Cardiomyopathies.
elektrolit dan gas darah  Carditis.
 RV dysplasia.
 Regangan dinding otot  Drug related.
jantung  Pericarditis.
 Kelainan struktur sistem  Pulmonary diseases.
konduksi  Others.
 Mechanism of Arrhthmogensis
1. Disorder of impulse formation.
a) Automaticity.
b) Triggered Activity.
1) Early after depolarization.
2) Delayed after depolarization.
2. Disorder of impulse conduction.
a) Block – Reentry.
b) Reflection.
3. Combined disorder.
Mechanism of Arrhthmogensis Takikardia
 Arrhythmia Presentation
Palpitation.
Dizziness.
Chest Pain.
Dyspnea.
Fainting.
Sudden cardiac death.
 Arrhythmia Assessment
• ECG
• 24h Holter monitor
• Echocardiogram
• Stress test
• Coronary angiography
• Electrophysiology study
What is a lethal Arrhythmia?

Life threatening arrhythmias may

cause sudden cardiac death and are
divided into bradyarrhythmias and
tachyarrhythmias.
Lethal Arrhythmia Rhythm

VT (-)

PEA
ARYTMIA VF
LETHAL

ASISTOLE
 langkah sederhana
mengenali aritmia letal
VENTRICULAR TACHYCARDIA
 VENTRICULAR TACHYCARDIA
 Rate: usually between 100 to 220/bpm, but can be as rapid as
250/bpm
 P wave: obscured if present and are unrelated to the QRS complexes.
 QRS: wide and bizarre morphology
 Conduction: as with PVCs
 Rhythm: three or more ventricular beats in a row; may be regular or
irregular.
 Ventricular tachycardia almost always occurs in diseased hearts.
 Some common causes are:
 CAD
 acute MI
 digitalis toxicity
 CHF
 ventricular aneurysms.
 Patients are often symptomatic with this dysrhythmia.
 Irama Teratur

HR 100 – 250 X/menit

VENTRIKEL
TAKHIKARDI Gel. P Tidak ada
(VT) Interval Tidak ada
PR
Gel. Lebar (> 0.12 detik)
QRS
 TORSADE DE POINTES
 Rate: usually between 150 to 220/bpm,
 P wave: obscured if present
 QRS: wide and bizarre morphology
 Conduction: as with PVCs
 Rhythm: Irregular
 Paroxysmal –starting and stopping suddenly
 Hallmark of this rhythm is the upward and downward deflection of the QRS
complexes around the baseline. The term Torsade de Pointes means "twisting
about the points."
 Consider it V-tach if it doesn’t respond to antiarrythmic therapy or
treatments
 Caused by:
 drugs which lengthen the QT interval such as quinidine
 electrolyte imbalances, particularly hypokalemia
 myocardial ischemia
Takikardia Ventrikel dan Torsade de Pointes
 VENTRICULAR FIBRILLATION
 Rate: unattainable
 P wave: may be present, but obscured by ventricular waves
 QRS: not apparent
 Conduction: chaotic electrical activity
 Rhythm: chaotic electrical activity
 This dysrhythmia results in the absence of cardiac output.
 Almost always occurs with serious heart disease, especially
acute MI.
 The course of treatment for ventricular fibrillation includes:
immediate defibrillation and ACLS protocols.
Identification and treatment of the underlying cause is also
needed.
 Irama Tidak Teratur

HR Tidak dapat dihitung

Ventrikel
Gel. P
Fibrilasi Tidak ada

Interv Tidak ada

al PR
Gel. Tidak dapat dihitung,
QRS bergelombang & tidak teratur
 Asystole
• Asystole is also known as flatline. It is a state
of cardiac standstill with no cardiac output
and no ventricular depolarization
 Flat line protokol
 The following are common
causes of an isoelectric line that
is not asystole:
1. loose or disconnected leads
2. loss of power to the ECG
monitor Cek Elektroda
3. low signal gain on the ECG
monitor.
Cek Lead I, II,
III

Perbesar
Gelombang
Pulseless electrical activity (PEA),

Pulseless electrical activity (PEA), also known

as electromechanical dissociation, refers
to cardiac arrest in which
the electrocardiogram shows a heart rhythm
that should produce a pulse, but does not.
PEA
MANAGEMENT ARITMIA LETHAL
ON CARDIAC ARREST

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047463
KEY POINT –SCA COVID 19
Role of Nurse in Even lethal
Arrhythmia
Important Considerations in the Evaluation of Patients With
Known or Suspected VA
 Summary
• The following case history describes the first instance
of lifesaving defibrillation performed by a nurse in
the absence of a physician
• lethal arrhythmias can occur at anytime, and rapid
nursing assessment and intervention can result in a
successful outcome.
• Quick recognition of lethal arrhythmias and strong
working
• knowledge of up-to-date treatment will lead to the
best outcome possible.
 Thank You

9/25/2020 48