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

Introduction
This journal discuss 15 spesific cardiac arrest situations such as:

Asthma
Anaphylaxis
Pregnancy
Morbid obesity
Pulmonary embolism
Electrolyte imbalance
Ingestion of toxic
substances
Trauma

Accidental
hypothermia
Avalanche
Drowning
Electric
shock/lightning strikes
Percutaneous
coronary intervention
(PCI)
Cardiac tamponade
cardiac surgery.

Cardiac Arrest Associated with

Asthma
Pathophysiology

Management of Asthma

Cardiac Arrest Associated

with Anaphylaxis
Hypersensitivity reaction

Cardiac Arrest Associated with Pregnancy

Masalah pada ibu

hamil

Penyakit jantung

Keracunan
magnesium sulfat

Infark miokard

Kelainan jantung

Aterosklerotik

Neurologis

Penyakit jantung
bawaan

gastrointestinal

Preeklampsia/
eklampsia

kegagalan organ
bahkan sistem

Edema pulmonal/
Emboli cairan
ketuban

Henti Jantung pada Ibu yang Tidak Segera Membaik

dengan BLS dan ACLS

Pertimbangkan
histerektomi

Seksio sesaria
darurat< 5
menit
Henti
Jantung
pada Ibu
yang Tidak
Segera
Membaik
dengan BLS
dan ACLS

Jika uterus gravid

di atas
umbilikus>
kompresi
aortocaval>
mengganggu
hemodinamik

Hipotermia
terapeutik
sebagai
perawatan
post henti
jantung

Cardiac Arrest in the Morbidly Obese

Tidak ada modifikasi BLS standar atau perawatan

ACLS yang terbukti berkhasiat, meskipun teknik
mungkin perlu disesuaikan dengan fisik pasien.

Cardiac Arrest Associated with

Pulmonary Embolism

Ekokardiografi darurat
Modifikasi
untuk diagnosa
ACLS
emboli pulmonal

Fibrinolitik
Trombektomi
Emboli
mekanik perkutan
Pulmonal
Embolektomi bedah

Cardiac Arrest Associated with Life

Threatening Electrolyte Disturbances
Kalium

Hiperkalemia
Hipokalemia
(pemberian
bolus kalium)

Sodium
(Na)
Electrolyte
Electrolyte
Disturbanc
Disturbanc
e
e

tidak
menyebabkan
henti jantung

Hipermagnesemi -> Calcium gluconate [10%]

Magnesi a(>2,2 mEq/L) 15-30 mL IV 2-5 minutes
um
(Mg) Hipomagnesemia
->Bolus MgSO4 IV 1-2 gr
(<1,3 mEq/L)
Use
Diduga
of akibat
calcium chloride [10%] 5-10 mL or
penggunaan kalsium
Kalsium calcium
gluconate
klorida atau
kalsium [10%] 15-30 mL IV over 2-5
minutes
glukonat is suspected as the cause of cardiac

Definisi

konsentrasi
kalium serum
> 6.5 mmol/L

Etiologi:

gagal ginjal,
Obat-obatan

Hyperkalemia
Klinis

akibat

aritmia
henti jantung

flaccid paralysis,
paresthesia, depresi
refleks tendon dalam,
atau kesulitan pernapasan
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

ACLS Modifications in Management of Severe

Cardiotoxicity or Cardiac Arrest Due to
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

Cardiac Arrest Associated With

Toxic Ingestions

Alters the function of a cellular receptor, ion channel, organelle, or chemical pathwa

Single dose activated charcoal can be administered within 1 hour of poiso

Opioid Toxicity

Digo

Toxidromes

Cardiac Arrest Associated

With Trauma

Cardiac Arrest in Accidental

Hypothermia
Patients with mild
hypothermia (34C
[93.2F]),moderate (30C
to 34C [86F to 93.2F]),
severe hypothermia (30C
[86F])

Focus on interventions
that prevent further loss of
heat and begin to rewarm
the victim immediately
vasopresor (epinefrine or
vasopresin)

Cardiac Arrest in Avalanche

Victims

Caridac Arrest in Drowning

If vomiting occurs, turn the victim to the

side and remove the vomitus using your
finger, a cloth, or suction
The routine use of abdominal thrusts or
the Heimlich maneuver for drowning
victims is not recommended

Cardiac Arrest Associated with

Electric Shock and Lightning Strikes
Electrical Shock

Standard BLS resuscitation care -> early intubation should be performed for
patients with evidence of extensive burns -> Fluid administration should be
adequate

Cardiac Arrest during

Percutaneous Coronary Intervention
Cough CPR

Cardiac Arrest caused by

Cardiac Tamponade
Rapid diagnosis and drainage of the pericardial

Cardiac Arrest following

Cardiac surgery Cardiac Surgery

THANK YOU