EKG - ARITMIA

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Presentation Description

Aritmia pada gambaran EKG adalah suatu kondisi atau keadaan yang perlu diperhatikan dengan seksama, karena kelainan ini dapat berakibat fatal. Aritmia dapat meninmbulkan keluhan berdebar,nyeri dada, sempoyongan bahkan pingsan

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Presentation Transcript

Slide 1: 

My I Let it beat !

NARROW COMPLEX : 

NARROW COMPLEX (Supraventricular Tachycardia) BROAD COMPLEX TACHYCARDIA

NARROW COMPLEX TACHYCARDIA : 

NARROW COMPLEX TACHYCARDIA (Supraventricular Tachycardia)

Slide 4: 

NARROW COMPLEX TACHYCARDIA Vagal manouevres Atrial Fibrillation (>130 bpm) Adenosine lv Seek expert help Adverse signs ?  Esmolol or  Digoxin or  Verapamil or  Amiodarone or  Overdrive pacing Sedation Synchronized cardioversion Amiodarone lv No Yes

Slide 5: 

Adverse signs ?  Hypotension Systolic  Chest pain  Heart failure  Impaired consciousness  Rate  200 bpm BP  90 mmHG

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Vagal manouvers : caution possible digitalis toxicity, acute ischaemia, or presence of carotid bruit.

Slide 7: 

Adenosine 3 mg by bolus injection repeat if necessary every 1-2 min. using 6 mg, then 12 mg, then 12 mg (ATP is an alternative)

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If no adverse signs choose from : Esmolol : 40 mg over 1 min + infusion 4 mg/min (iv injection can be repeated with increments of infusion to 12 mg/min). Digoxin : max dose 500 g over 30 min x 2. Verapamil : 5 - 10 mg iv. Amiodarone : 300 mg over 1 hour (may be repeated once). Overdrive pacing (not AF).

Slide 9: 

Amiodarone 300 mg over 15 min then 300 mg over 1 hour if necessary, preferably by central line and repeat cardioversion.

Slide 10: 

BROAD COMPLEX TACHYCARDIA (Sustained Ventricular Tachycardia)

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BROAD COMPLEX TACHYCARDIA Use VF protocol Seek expert help Adverse signs ?  Lidocaine iv Synchronised DC shock 100J: 200J: 360J Amiodarone iv Sedation No Yes Pulse ? No Yes If potassium low  Give K+  Give Mg+ + Seek expert help Synchronised DC shock 100J: 200J: 360J Sedation Start  Lidocaine +/-  Magnesium & potassium as opposite Further cardioversion as necessary consider other agents

Slide 12: 

Use VF protocol Adverse signs ?  Lidocaine iv Yes Pulse ? No Yes Seek expert help No Seek expert help

Slide 13: 

Adverse signs ?  Systolic BP  90 mmHG  Chest pain  Heart failure  Rate  150 bpm

Slide 14: 

 Lidocaine iv 50 mg over 2 min  Start infusion 2 mg/min after repeated every 5 min to total dose of 200 mg. first bolus dose.

Slide 15: 

 Give potassium chloride up to  Give magnesium sulphate iv 60 mmol, max rate 30 mmol/h. 10 ml 50 % in 1 hour. If potassium known to be low :

Slide 16: 

For refractory cases consider other pharmacological agents : amiodarone, procainamide, flecainide or bretylium, or overdrive pacing.

Slide 17: 

Amiodarone 300 mg over 5 - 15 min, preferably by central line then 300 mg over 1 hour.

Slide 19: 

Adverse signs ?  Clinical evidence of low cardiac  Hypotension : systolic BP  Heart failure  Rate < 40 bpm output.  Presence of ventricular arrhytmias requiring supression.  90 mmHg

Slide 20: 

Risk of asystole  History of asystole  Mobitz II AV Block  Any pause  3 seconds  Complete heart block, wide QRS

Slide 21: 

Interim measure  External pacing  iv isoprenaline or orciprenaline

Slide 22: 

Atropine IV 500 g initially to max 3 mg.

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E M D Ventilate/Intubate 100 % oxygen IV/IO Access Adrenaline 10 mcg/kg Fluids 20 ml/kg CPR 3 min Adrenaline 10 mcg/kg Consider : Hypovolaemia Tension pneumothorax Cardiac tamponade Drug overdosage Hypothermia Electrolytic imbalance and treat appropriately

Slide 25: 

Consider :  pressor agents  calcium  alkalising agents  adrenaline 5 mg iv

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Think of, and if indicated give specifik teratment for : If not already :  intubate  iv acces hypovolaemia tension pneumothorax cardiac tamponade pulmonary embolisme drug overdose/intoxication hypothermia electrolyte imbalance Adrenanline 1 mg iv 10 CPR sequences of 1:5 ventilation/compression

Slide 28: 

Precordial Thump Note : after 3 loops consider alkalising and/or antiaarhytmic agents

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Precordial Thump Defibrillate 2 J/kg Defibrillate 2 J/kg Defibrillate 4 J/kg Ventilate/Intubate 100 % oxygen IV/IO Access Adrenaline 10 mcq/kg CPR 1 min Defibrillate 4 J/kg Defibrillate 4 J/kg Defibrillate 4 J/kg Adrenaline 100 mcq/kg Consider hypothermia drugs electrolytes

Slide 30: 

DC shock 200 J 1 DC shock 200 J 2 DC shock 200 J 3 Ventilate/Intubate 100 % oxygen IV/IO Access Adrenaline 10 mcq/kg CPR 1 min Defibrillate 4 J/kg Defibrillate 4 J/kg Defibrillate 4 J/kg DC shock 200 J 1 DC shock 200 J 2 DC shock 360 J 3 If not already  intubate  iv access Adrenaline 1 mg iv 10 CPR sequences of 1:5 ventilation/compression DC shock 360 J 4 DC shock 360 J 5 DC shock 360 J 6 Precordial Thump

Slide 31: 

Notes : The interval between shocks 3 and 4 should not be > 2 mins. Adrenaline given during loops approx. every 2-3 mins. Continue loops for as long as defibrillation is indicated. After 3 loops consider :  alkalising agents  antiarrhythmic agents

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Silakan kunjungi kami di : http://www.jantunghipertensi.com Dr.H.M.Edial Sanif SpJP.FIHA

Slide 34: 

VF excluded ? no DC shock 200 J DC shock 200 J DC shock 360 J If not already  intubate  iv access Adrenaline 1 mg iv 10 CPR sequences of 1:5 ventilation/compression (Atropine 3 mg iv once only) Electrical activity evidence ? yes Pace Precordial Thump yes no

Slide 35: 

Ventilate/Intubate 100 % oxygen IV/IO Access Adrenaline 10 mcq/kg CPR 3 min Adrenaline 100 mcq/kg Fluids and/or alkalising agents Consider

Slide 36: 

Notes : If no response after 3 cycles, consider high dose adrenaline 5 mg iv