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Lethal Arrhythmias

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aritmia letal


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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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• 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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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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• 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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Toxins Tension Pneumothorax Tamponade Thrombosis : Coronary Thrombosis : Pulmonary Trauma

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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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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


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• Trans cutaneous or Trans Venous pacemaker• Atropine (0.5 mg) may be tried Epinephrine 0.5 -1 mg /kg bw

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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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• 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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• 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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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 :

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• Setelah 2 siklus RJP terdapat gambaran seperti berikut

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Contoh Kasus

• Wanita 40 tahun datang ke UGD karena sesak nafas

• Setelah dipasang monitor tampak gambaran EKG

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