Aritmia Letal
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![Page 1: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/1.jpg)
Lethal Arrhythmias
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Kasus 1
• Laki-laki 55 th datang dibawa supir angkot karena ditemukan pingsan di angkot nya
• Tidak ada respons, tidak bernafas, tidak ada nadi
• Dipasang monitor dengan gambaran
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Arrhythmia : What you need to know for ACLS?
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Introduction
• Rhythm recognition is a key skill that one needs to demonstrate during cardiac arrest situation.
• This can be life saving.• Early defibrillation • Decision making on the right therapy
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Lets Keep it Simple!
• Pulseless Rhythms• Tachyarrhythmias• Bradyarrhythmias
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Pulse less Electrical Rhythm
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Ventricular Fibrillation
• Uncoordinated contractions within the ventricles of heart.
• Due to multiple cardiac cells that function as pacemakers and discharge electrical impulses in a chaotic manner.
• Reduced / No cardiac output : No pulse• Will result in Asystole if not treated.
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• Commonest cause : Hypoxia /Ischemia
• Types : Fine and Coarse
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Therapy
Immediate DefibrillationCPRI/V Amiodarone after 3 shocks
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Ventricular Tachycardia
• Broad Complex Tachycardia (QRS > 0.12s)• Heart rate > 180 beats /mt• Mono-morphic• Poly-morphic / Torsade Pointe• Pulse less vs with pulse
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Mono morphic VT
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Poly morphic VT
• Torsade Pointes if Prolonged QT interval on previous ECG
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Treatment
• Pulseless : Defibrillation
• With pulse : stable = Amiodarone Unstable = DC Cardio version
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No Pulse !
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Pulse Less Electrical Activity (PEA)
• Organized electrical activity but without a pulse
• Usually has underlying treatable cause• Hypovolumea and Hypoxia are the
commonest causes.• If no underlying cause is identified, it will be
treated same as Asystole.
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5 Hs and 5 Ts
5 Hs HypovolumiaHypoxiaHydrogen Ion (Acidosis)HyperkalemiaHypokalemiaHypoglycemia
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5Ts
Toxins Tension Pneumothorax Tamponade Thrombosis : Coronary Thrombosis : Pulmonary Trauma
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ASYSTOLE
Follow flat line protocol – check leads and gainNot a true rhythmState of no electrical activityTerminal event Very poor prognosis : ROSC extremely unlikely Possible underlying cause : 5Hs and 5Ts Treatment : CPR and Epinephrine
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Bradiarrythmia
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First Degree AV Block
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• PR interval is prolonged > 200ms• No clinical significance if asymptomatic• May lead to higher degree AV Block
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Second Degree AV Block
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Mobitz Type 1• Progressive prolongation of PR interval.• Atrial impulse (P waves) may not be conducted
through AVN and gets blocked and hence no QRS.
• No clinical significance unless symptomatic. Mobitz Type 2• Non prolongation and fixed PR interval.• Non conducted p waves• No ventricular activity -Drop beats / No QRS Most times Infranodal
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Third Degree AV Block (CHB)
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P waves with a regular pp intervalQRS complexes with a regular RR intervalQRS complex may be narrow or wide (escape
rhythm) No relationship between P waves and QRS
complexes.
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Treatment
• Trans cutaneous or Trans Venous pacemaker• Atropine (0.5 mg) may be tried Epinephrine 0.5 -1 mg /kg bw
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Tachyarrhythmia
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Atrial Fbrillation
• No p waves preceding QRS complexes as no coordinated atrial contractility
• Irregular (variable) RR intervals
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Treatment
• Unstable : Synchronized DC Cardio version• Stable : Rhythm Control vs Rate Control
• Rhythm : Amiodarone, Sotalol, Flecainide• Rate control : Beta blocker, Calcium channel
blocker, Digoxin.• Anticoagulant if indicated.
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Atrial Flutter
• Atrial rate 250 – 350 /mt• Saw Tooth Appearance• Ventricular rate depends on Degree of AV
block• Electrical foci usually in RA
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Treatment
• Rate Control• Rhythm Control• Anti coagulant• DCC if unstable
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Supra Ventricular Tachycardia
• Broad term for various supra ventricular arrhythmia
• Electrical impulses above the ventricular electrical conducting system.
• Inverted p waves preceding or following qrs complexes.
• Review old ECG – exclude WPW
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Treatment
Vagal maneuver Adenosine •Drugs – Chemical Cardio version or Rate control.• Anti coagulant.
•If unstable : sync. DCC
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Contoh Kasus
• Laki laki 54 tahun dibawa keluarga ke UGD karena tiba2 kejang
• Tidak ada respons, Tidak bernafas, tidak ada nadi
• 2 siklus RJP tidak ada respons• Alat defib datang, dipasang lead dengan
gambaran :
![Page 48: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/48.jpg)
![Page 49: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/49.jpg)
• Setelah 2 siklus RJP terdapat gambaran seperti berikut
![Page 50: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/50.jpg)
![Page 51: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/51.jpg)
![Page 52: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/52.jpg)
Contoh Kasus
• Wanita 40 tahun datang ke UGD karena sesak nafas
• Setelah dipasang monitor tampak gambaran EKG
![Page 53: Aritmia Letal](https://reader036.fdocuments.in/reader036/viewer/2022081420/563db7d1550346aa9a8e38ce/html5/thumbnails/53.jpg)