TACHIKARADIA NURSING

NAMAGEMENT
Guidenlines Amirican Heart Association 2020

PUSBANG DIKLAT DPW PPNI JATIM

 CURRICULUM VITAE Trainer
Ainur Rusdi, S.Kep., Ns., M.Kep

1. PENDIDIKAN
- SPK Soetomo 1988
- Akper Anestesi 1998 2. PEKERJAAN
- S-1 Keparawatan Unair 2006 - MPP IRIR (ICU)
- S-2 Keperwatan Unair 2020 - MPP RIK (ICU-COVID)

4. PELATIHAN
3. ORGANISASI - TOT CRITICAL HIPERCCI 2019
- PPNI DPK - MOT KEMENKES JATIM 2020
- HIPERCCI - TOT DEPKES JATIM 2019
- KOMITE KEPW - TOT GAWAT DARURAT 2019
- TOT Fasdar LAN 2021
 Out Line
1 1
Introduction Definitions
2 2
Definitions Rhytms For Tachicardia
3
Rhytms For Tachicardia
4 4
Managing Tachicardia: The Tachicardia Algorithm
5 5

@inur - 2023
 SINUS RITHEM
1 Irama
1 : Teratur
Frekwensi HR : 60 - 100 x/m
2Gelombang
2 P : Normal setiap gel. P-QRS
Interval PR : Norma (0,12 - 0,20 detik)
3
Gelombang QRS : Normal (0,6 - 0,12 detik)
4Catatan4 : Semua gelombang sama

5 5
 INTODUCTION
1 Memahami
1 Karakteritis EKG
SA node HR: 60 - 100 Sinus P - komplek QRS - T
2 2
AV node HR: 40 - 60 Janct. P terbalik didepan QRS
3
Purkinje HR: 20 - 40 Idioventrikulars. P tdk ada
4 4
Atrial: P spt gergaji / tdk jelas
5 5
Supraventikula P tdk terlihat
 Definitions 1
Tachycardia: defined as an arrhytmia with a heart
1 1
rate typically 100/min or greather
Symptomatic tachikardia: signs and symtoms due to
2
the rapid2heart rate
The rate takes on clinical significance its extremes and
3
is more likely attribuable an arrhthimia if heart rate
150/ min or greater
4 4
It is unlikely that symptoms of instability are caused
primarily by the tachicardia when the heart rate isless
5 minunless the patient has impaired
5 than 150/
ventrikular function.
 Rhythms for Tachicardia 2
1 Sinus1Tachycardia
Athrial Flutter
2 2
Athrial Fibrilation
Supraventrikullar
3 Tachicardia (SVT)
Monomotphic ventrikular tachicardia (VT)
4
4Polimorphic ventrikular tachicardia (VT)

5 5

@inur - 2023
 Atrial Fibrilasi ( AF ) 2
Irama : Tidak teratur
1 1
Frekwensi HR : Berfariasi (Normal, lambat, cepat)
2 Rapid Respon: HR: > 100 x/m
2
Normo Respon: HR: 60 - 100 x/m
Slow Respon: HR: < 60 x/menit
3
Gelombang P : Tdk dapat di Identifikasi, kriting
Interval
4 PR4 : Tidak dapat dihitung
Kompleks QRS : Normal
5 5
Speed 25 mm/sec
 Atrial Flutter ( AFL )
Irama
1 1 : bisa teratur bisa tidak teratur
Frekwensi HR : Berfariasi (Normal, lambat, cepat)
2
Gelombang 2P : Tdk normal, seperti gergaji,
(R : QRS - 2 : 1, 3 : 1 atau 4 : 1)
Interval PR
3 : Tidak dapat dihitung
Kompleks
4 QRS
4 : Normal

5 5
Speed 25 mm/sec
 Jacgtional Takikardi (JT)
1
Irama 1 : Teratur
Frekwensi HR : Lebih dari 100 x/menit
2 2
Gelombnag P : Tidak ada / terbalik dipedan QRS
Interval PR : Tidak dapat dihitung/memendek
3
Kompleks QRS : Normal
4 4

5
Speed 25 mm/sec
5
 Supraventrikular Takikaedi (SVT)
1
Irama 1 : Teratur
Frekwensi HR : Lebih dari 150 x/menit
2 2
Gelombnag P : Tidak ada / Tidak jelas
Interval PR : Tidak dapat dinilai
3
Kompleks QRS : Normal
4 4

5 5
Speed 25 mm/sec Speed 25 mm/sec
 Ventrikel Tachicardi (SVT)
1
Irama 1 : Teratur
Frekwensi HR : Lebih dari 100 x/menit
2 2
Gelombnag P : Tidak terlihat
Interval PR : Tidak ada
3
Kompleks QRS : Lebar (> 0,12 detik)
4 4

5 5
Speed 25 mm/sec
Managing
Tachicardia:
The Tachicardia
Algorithm
Manajent Algorithm
Adult Tachicardia
Manajent Algorithm
Adult Tachicardia
Assess appropriatess
forclinical condition
 BLS
 Primary
 Secondary Assesments
to guide your approach
Identify and treat the
Uderkyng Cause
 Maintain patient airway:
assist breathung as
nacessary
 Give oxygen(if
Gypoxemiic)
 Establish IV access
 Obtain a 12-Lead ECG
availeble
Persistent Thachycardia
Cuising:
 Hypotension ?
 Acutely altered mental
status ?
 Sigs of shock ?
 Ischenic chest discomfort ?
 Acute heart failure ?

@inur - 2023
Persistent Thachycardia Cuising:
 Hypotension ?
 Acutely altered mental status ?
 Sigs of shock ?
 Ischenic chest discomfort ?
 Acute heart failure ?

NO YES

STABLE UNSTABLE

@inur - 2023
UNSTABLE Thachycardia
Chyncronized Cardiovension

 Corsider sedation
 Ig regular narrow complex,
consider adenosin
STABLE Adult
Thachycardia

 Wide QRS komplex is

0,12 second or more
 Narow QRS komplex is
less than 0,12 second

@inur - 2023
Wide QRS kompkek is 0.12 second or more
Consider:
 Adenosin only if regular and
monomorphic
 Anthiarrhytmic infusion
 Expert consultationc
Anthiarritmia Infusion
 Bolus 150 mg selama 10 menit (diencerkan
D5% - 20 ml)
 Maentence 1 mg/menit selama 6 jam
(360 mg/ 6 jam) dalam 3 tahap.
 Pertama 150 mg/2,5 jm, 150 mg/2,5 jm, 6 mg/1 jam
Masing2 diencerkan dengan D5% dalam 50 ml
@inur - 2023
Narrow QRS complex is less 0.12 second
Consider:
 Vagal Manuevers (if regullar) SVT
 -bloker or calcium chanel bloker
 Consider Expert consultation

@inur - 2023
If Refactory, Consider:
 Underlying cause
 Need to increase energy level
for next caediversion
 Addition of anti arrthytmic
drug
 Expert consultation

@inur - 2023
Kesimpulan:

 Assess appropriatessfor for clinical condition

 Identify and Treat the Underlying cause
 Stable or unstable ?
 Expert consultation
DISKUSI