TATA LAKSANA

- Pada umumnya terapi aritmaia adalah :

o Mengembalikan irama jantung yang normal (rhytm control)
o Menurunkan frekuensi denyut jantung (rate contol)
o Mencegah terbentuknya bekuan darah
- Aritmia sendiri dapat diterapi dengan beberapa hal di bawah ini :
a. Jika FV terjadi, maka defibrilasi harus segera dilakukan
b. Bila defibrilasi tidak berhasil, maka harus segera dilakukan resusitasi jantung paru dan
obat-obatan.
c. Obat-obatan yang dapat diberikan adalah epinefrin bila pola vibrilasi ventrikelnya
halus. Epinefrin dapat membuat fibrilasi menjadi kasar, sehingga memudahkan untuk
mengkonversi defibrilasi. Natrium bikarbonat diberikan untuk mengatasi asidosis akibat
berkurangnya perpindahan respirasi. Epinefrin dan Natrium bikarbonat saling berlawanan
apabila dicampur, oleh sebab itu harus diberikan terpisah.
d. Tekanan darah disokong dengan vasopressor. Masase jantung eksternal dan ventilasi
tidak boleh dihentikan selama resusitasi sebelum 5 detik.

Before any defibrillation, remove all patches and ointments from the chest wall because
they create a risk of fire or explosion. The patient must be dry and not in contact with
metallic objects. Rescuers must remember to ensure the safety of everyone around the
patient before each shock is applied.
If defibrillation reestablishes coordinated myocardial contraction, a period of low cardiac
output (ie, postcountershock myocardial depression) may ensue. Recovery of cardiac
output may take minutes to hours.
Defibrillation causes serum creatine phosphokinase levels to increase in proportion to the
amount of electric energy delivered. If customary voltage is used to defibrillate a patient,
the proportion of myocardial fraction (CK-MB) should remain within reference ranges
unless an infarction has caused myocardial injury.
Although the precordial thump is less appropriate for VF than for VT, it actually is
appropriate in neither. Use it only for witnessed, monitored arrests in which no
defibrillator is immediately available.
In acute ventricular fibrillation (VF), drugs (eg, vasopressin, epinephrine, amiodarone)
are used after 3 defibrillation attempts are performed to restore normal rhythm.
Amiodarone can also be used on a long-term basis in patients who refuse an implantable
cardioverter-defibrillator (ICD) or who are not candidates for an ICD. However,
amiodarone has not been shown to be of value for primary prevention of VF in patients
with a depressed left ventricular (LV) ejection fraction.


Dear Dr. Sandra Junglen

Good Afternoon, My name is Chairil Anwar, I became an accompanying lecturer of my
students from Medical Faculty of Sriwijaya University who join the DAAD Study Visit
for Groups of Foreign Students to Germany program.

I am very pleased that you and University of Bonn are willing to accept our invitation to
become a host for this DAAD Study Visit Program. We are planning to join this program
around March 1st-10th 2015. We would like to discuss about the neglected tropical
disease. However, this program requires LoA from your university, which includes the
specific topic and all of the activities there, either lecture, discussion, or detailed
presentation related to the topic. Therefore, we ask for your willingness to send the LoA
for us. This attachment below is the example of LoA from several universities and
institutions for my colleague, Dr-Phil Arinafril who already joined this program in June
2014. Can we start to discuss the schedule along with the activities that we are going to
do?


Dear .....,
Good afternoon, my name is Chairil Anwar. I am a lecturer at Medical Faculty of
Sriwijaya University. I am currently accompanying my students from Medical Faculty of
Sriwijaya University who join the DAAD Study Visit for Groups of Foreign Students to
Germany program.
My students and I are planning to join this program around March 1st-10th, 2015. We
have received Letter of Acceptance from ..