Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Terry L. Vanden Hoek, Ketua; Laurie J. Morrison; Michael Shuster; Michael Donnino; Elizabeth Sinz; Eric J. Lavonas; Farida M. Jeejeebhoy; Andrea Gabrielli Presented by: Susi Muharni Risma Raihanun Nisa Dinur Cut Chairani Maulina Fusya Supervisor: dr. Yusmalinda, Sp.An
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Part 12: Cardiac Arrest in Special Situations2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular CareTerry L. Vanden Hoek, Ketua; Laurie J. Morrison; Michael Shuster; Michael Donnino; Elizabeth Sinz; Eric J. Lavonas;
• EKG: T memuncak, gelombang P yang rata atau tidak ada, interval PR memanjang, kompleks QRS melebar, gelombang S dalam, dan penggabungan gelombang S dan T
akibat• aritmia• henti jantung
Hyperkalemia
Menstabilkan membran sel miokard:
• Kalsium klorida (10%): 5 -10 mL (500 sampai 1000 mg) IV lebih dari 2-5 menit atau kalsium glukonat (10%): 15-30 mL IV lebih dari 2-5 menit
Pergeseran kalium ke dalam sel:
• Natrium bikarbonat: 50 mEq IV lebih dari 5 menit• Glukosa ditambah insulin: campurkan 25 g (50 mL D50) glukosa dan 10 U
insulin reguler dan memberikan IV selama 15 -30 menit• Nebulasi albuterol: 10 -20 mg nebulized lebih dari 15 menit
Meningkatkan ekskresi kalium:
• Diuresis: furosemide 40 -80 mg IV• Kayexalate: 15 -50 g ditambah sorbitol per lisan atau rektum• Dialisis
ACLS Modifications in Management of SevereCardiotoxicity or Cardiac Arrest Due to
Hyperkalemia
Cardiac Arrest Associated WithToxic Ingestions
Alters the function of a
cellular receptor,
ion channel, organelle, or
chemical pathway
Respiratory depressionHypotension
Alteration of cardiac
conduction
Single dose activated charcoal can be
administered within 1 hour of poisoning
Multiple dose activated charcoal for patient who have ingested a
life threatening amount of specific toxins (carbamazepine, dapson, phenobarbital,quinine
or theophylin)
Charcoal should not be administered for ingestion
of caustic substances, metals or hydrocarbon
Opioid Toxicity• Naloxone administration should begin
with a low dose (0.04 to 0.4 mg)
Benzodiazepines • Flumazenil
β-Blockers• High-dose insulin, or IV calcium
salts.
Glucagon• Dopamine alone or in combination
with isoproterenol
Calcium Channel Blockers • Insulin high dose
Digoxin• One vial of antidigoxin Fab is
standardized to neutralize 0.5 mg of digoxin
Cocaine• 1 mL/kg of sodium bicarbonate
solution (8.4%, 1 mEq/mL) IV as a bolus.
Cyclic Antidepressants• Sodium bicarbonate boluses of 1
mL/kg• Vasopressor
Local Anesthetic Toxicity
• Consider 1.5 mL/kg of 20% long-chain fatty acid emulsion as an initial bolus epeated every 5 minutes until cardiovascular stability is restored
Hyperbaric Oxygen• A treatment regimen of 100% oxygen
and hydroxocobalamin, with or without sodium thiosulfate
Toxidromes
Cardiac Arrest AssociatedWith Trauma
Modifikasi BLS
Multisystem trauma: jaw thrust should be used instead of a head tilt– chin lift to stablish a
patent airway
Ventilation should be providedwith a barrier device, a pocket mask
Stop any visible hemorrhage using direct compression and appropriate dressings
CPR and defibrillation as indicated
Cardiac Arrest in Accidental Hypothermia
Patients with mild hypothermia (34°C [93.2°F]),moderate (30°C to 34°C [86°F to 93.2°F]), severe hypothermia (30°C [86°F])
Focus on interventions that prevent further loss of heat and begin to rewarm the victim immediatelyvasopresor (epinefrine or vasopresin)
Cardiac Arrest in Avalanche Victims
Causes ofavalanche-
related death
Caridac Arrest in Drowning
Recovery
From the
Water
Airway
Breathing
Circulation
The routine use of abdominal thrusts or the Heimlich maneuver for drowningvictims is not recommended
If vomiting occurs, turn the victim to the side and remove the vomitus using your finger, a cloth, or suction
Cardiac Arrest Associated withElectric Shock and Lightning Strikes
•Simultaneously depolarizing the entire myocardium•Respiratory arrest (thoracic muscle spasm and suppression of the respiratory center)•Producing extensive catecholamine release (hypertension, tachycardia)•Brain hemorrhages, edema, and small-vessel and neuronal injury•Hypoxic encephalopathy
Standard BLS resuscitation care -> early intubation should be performed for patients with evidence of extensive burns -> Fluid administration should be
Rapid diagnosis and drainage of the pericardial fluid are required to avoid cardiovascular collapse. Pericardiocentesis guided by echocardiography is a safe and effective method of relieving tamponade in a nonarrest setting