TAKIKARDIA.

dr. Rachmat Stiarsa, SpJP, MARS, FIHA

 KONDISI PASIEN + EKG

SADAR TIDAK SADAR

CR = cek Respon
Anamnesa
CH = Call for help
PF
BHD = BANTUAN C = Cek Nadi
OIM HIDUP DASAR
A. = Bebaskan jalan nafas
Diagnosis
B. = Cek nafas
Terapi
D. = Cek EKG
 Laki2, 57 th, riw CAD / PJK
Keluhan Utama : DEBAR2

ANAMNESA Sejak ? ; keluhan lain ? Faktor Risiko ? Semalam, keringat dingin, Merokok

PEMERIKSAAN GCS 15, TD 140/90 mmHg, 160 x/mnt, 36 ℃,

FISIK Kesadaran, T,N,S,P; Kepala, Leher, dada, perut, ektremitas 12x/mnt. SAT O2 96% PF yang lain normal

O; I; M Oksigen, Infus/ IV line, Pasang Monitor EKG EKG : SVT/ VT/ AF

Diagnosis TAKIKARDIA EC SVT

PASIEN STABIL ATAU TIDAK ?

VAGAL ; ADE; DIL; VERA

AMIODARON IV BOLUS
TERAPI • VAGAL MANUVER
• ADENOSIN ( 6-12 MG )
• DILTIAZEM ( 15- 20 MG DILUALNG 20-25 Bolus 150 mg / 10 menit kmd 1 mg /
MG, ATAU mnt dalam 6 jam, selanjutnya 0,5
• VERAPAMIL (2,5 – 5 MG DI ULANG 5 – 10
mg/mnt
MG)
 Laki2, 60 th, DM, hipertensi, merokok
Datang ke IGD tidak sadar
BHD. = BANTUAN HIDUP DASAR

Bebaskan Lingkungan

CEK RESPON Tepuk2 bahunya

CALL FOR HELP Aktifkan “code blue”, ambilkan alat debifrilator

Nadi (+) ; Kesadaran GCS 7; TD 60 palpasi; nadi

C= CEK NADI
200 x/mnt; Akral dingin; Urine tidak keluar
A = BEBASKAN
JALAN NAFAS Triple manufer; cek ada sumbatan atau tidak

B = CEK NAFAS Nafas (+) ; 40x/ mnt cepat dalam ,Sat O2 80% NRM 10 L/ mneit

D = EKG

PASIEN STABIL ATAU TIDAK STABIL ?

• Persiapan pasien : Inform Concern, premedikasi, Alat
defibrilator
• Persiapan Alat : Sync, Energi (Joule)
• SVT : mulai 50 J, 100 J, 200 J, 300 J, 360 J
CARIOVERSI SYNC (LISTRIK) • VT : 100 J, 200 J, 300 J, 360J
• Bila EKG tidak respon maka energi di naikan bertahap
 ROSC Obtained

Intial Stabilization Phase

Manage Arirway. Early
placememnt of ETT. Resuscitation is ongoing during teh post-ROSC phase, and many of these
activities can occur concurrently. Howwever, if prioritization is necessary,
follow these steps :
Manage respiratory parameters
Start 10 breath/ min • Airway management :
SpO2 92- 98 % Waveform capnography or capnometry to confirm and monitor
Initial PaCO2. 35 – 40 mmHg endotraceal tube placement
Stabilization • Manage respiratory parameters :
Phase Titrate FiO2 for SpO2 92%- 98%, start at 10 breath/mnt, titrate to PaCO2
Manage Hehomidanic parameters of 35 – 45 mmHg
TDS > 90 mmHg
• Manage Hemodinamic parameters :
MAU > 65 mmHg
Administer crystaloid and/or vasopressor or inotrop for goal systolic blood
pressure > 90 mmHg or Mean arterial pressure > 65 mmHg

Continued Management and Additional emergent activities

Obtaned 12- lead ECG
These eveluations should be done concurrently so that decision on targeted
temperature management (TTM) recieve high priority as cardiac interventions.
• Emergent cardiac intervention : serly eveluation of 12 –lead ECG; consider
Consideer for em,ergent cardiac intervention if hrmodynamic for decision on cardiac intervention
STEMI present • TTM : if pstient is not following commands, start TTM as soon as
Unstable cardiogenic shock posswible; begin at 32℃- 36 ℃ for 24 hours by using a cooling device
Mechanical circulatory support required with feedback loop
• Other critical care management
- Continously monitor core temperature (esophageal, rectal, bladder)
- Maintain normoxia, normocapnia, euglycemia
Follows commands ? - Provide continous or intermittent EEG monitoring
NO
YES
5H5T

• Hypovolemia
Comatose • Hypoxia
• TTM • Hydrogen ion (acidosis)
Awake •
• Obtained Brain CT Hypokalemia/ Hyperkalemia
Continued Other critical care
• EEG Monitoring • Hypothermia
Mnagement management
• Other critical care • Tension pneumotorax
and Additional
manaegement • Tamponade cardiac
Emergent
• Toxin
Activities
• Thrombosis pulmonary
• Thrombosis coronary

Evaluate and treat rapidly reversible etiologies involve expert

consultation for continued management