ARHYTHMIA

ADULT CARDIAC ARREST

CPR

Precordial thump

Assess rhythm

Check pulse +/-

VT/VF Non-VT/VF
• VT/VF refractory to initial
shock:
Attempt epinephrine 1 mg iv every
Defibrilation X3 3-5 minutes
• Consider buffers, pacing,
antiarrhythmics
CPR
CPR 1 minute • Search for and correct
reversible causes up to 3 minute

ILCOR Guidelines. Circulation 2000;102 (suppl ): -1–I-384

• BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES
• SPECIFIC ECG CHANGES
 GANGGUAN KONDUKSI DI SA NODE

Gambaran sinus ritme dengan episode sinoatrial block.

Gambaran sinus ritme dengan episode sinus arrest

 GANGGUAN KONDUKSI DI AV NODE

First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second -degree AV block, Mobitz I

Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
Second-degree AV block, Mobitz II

Rhythm : Regular usually;

can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
 Third-degree AV block

Rhythm : Regular
Rate : 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
RBBB

0.04
LBBB
Gambaran asistol

Gambaran ”P wave” asystole.

 BRADYCARDIA

Serious signs and symptoms?

Due to bradycardia?

No Yes

Type II second-degree AV block or Intervention sequence

Third degree AV block
Yes
If symptoms develop, use
transcutaneous pacemaker
until transvenous pacer placed
• Atropine 0.5-1.0 mg
• Transcutaneous pacing
No • Dopamine 5-20 g/kg/min
• Epinephrine 2-10 g/min
Observed

ILCOR Guidelines. Circulation 2000;102 (suppl ): -1–I-384

 The
Deadly
Rhythms

PEA
VT VF
VF (Pulse less
Electrical
Activity)
Asystole
TH A N K YO U