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Syndromes Algorithm
Syndroms Suggestive of Ischemia or Infarction
EMS assessment and care and hospital prepartion*
Oxygen
Aspirin (If O sat< 94% Activate Cardiac Pain
2
12–Lead ECG Control
160–325 mg or O Sat>90%
2
Cath Lab
with COPD)
Aspirin Nitroglycerin
Check Vital Physical If O2 sat<94% Pain
IV Access 160–325 mg Sublingual or
Signs Exam Start Oxygen (If not already taken) Control spray
ECG Interpretation**
Reperfusion goals:
Door-to-balloon inflation (PCI)*** Admit to monitored bed Assess risk status Continue
goal of 90 minutes ASA heparin, and other therapies as indicated If no evidence of ischemia or
Door-to-needle (fibrinolysis) ACE inhibitor/ARB; HMG CoA reductase inhibitor (statin therapy) infarction by testing, can
goal of 30 minutes Not at high risk: cardiology to risk stratity discharge with follow-up
* O’Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O’Neil BJ, Travers AH, Yannopoulos D. “Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”. Circulation. 2010;122(suppl 3):S787-S817. http://circ.ahajoumals.org/content/122/18_suppl_3/S787
**Afolabi BA, Novaro GM, Pinski SL, Fromkin KR, Bush HS. Use of the prehoapital ECG improves door to balloon times in ST segment elevation myocardial infarction irrespective of time of day or day of week. Emerg Med J. 2007;24:588-591
*** O’Connor, RE AL, Ali, brady , WJ, Ghaemmaghami CA, Menon V, Welsford M, shuster M. . Part 9: acute coronary syndromes: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care. Circulation 2015;132(suppl2):S483-S500
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
Start CPR
Give Oxygen Attach Monitor/Defibrillator
2 minutes Return of Spontaneous
Circulation (ROSC)
Check Post-Cardiac
Rhythm Arrest Care
If VF/VT
Shock
Drug Therapy
IV/IO access
Epinephrine every 3–5 minutes
uous CPR
Continuous CPR
Consider Advanced Airway
Quantitative waveform capnography
Contin
Mo
nitor y
CPR Qualit
* Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O’Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: adult advanced cardiac life support. 2015 American
Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015 132 (suppl 2):S444-S464
** Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB Minimally Interrupted cardiac resuscitation by emergency medical services for out of hospital cardiac arrest. JAMA 2008;299:1158-1165
***Dorian P, Cass D, Schwartz B, Cooper R. Gelaznikas R, Barr A. Amiodarone as compared with Lidocaine for shock resistant ventricular fibrillation N Engl J Med 2002;346:884-890.
**** Dorges V, Wenzel V, Knacke P, Gerlach K, Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients. Crit Care Med. 2003;31:800-804
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
Start CPR
1 Give Oxygen
Attach Monitor/Defibrillator
4
CPR 2 min flush NaCl 20
cc, angkat
10 Epinephrine every 3–5 min
IV/IO access Consider advanced airway,
tangan capnography
Rhyhm Shockable?
12
Rhyhm Shockable?
5 Shock
If no signs of return of
spontaneous circulation
(ROSC), go to 10 or 11.
CPR 2 min
Epinephrine every 3-5 min CPR 2 min
6 Consider advanced airway, Treat reversible causes 11
capnography
If ROSC, go to Post-
Cardiac Arrest Care.
* Link MS, Atkins DL, Plassman RS, Halperin HR, SAmson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE. “Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing:
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”. Circulation. 2010;122(suppl 3): S706-S719.
http://circ. ahajournals.org/content/122/18_suppl_3/S706
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
Atropine IV Dose:
First dose: 0.5 mg bolus
Repeat every 3–5 minutes
Maximum: 3 mg
If atropine ineffective:
Transcutaneous pacing**
OR
Dopamine IV infusion:
2–10 mcg/kg per minute
OR
Epinephrine IV infusion:
2–10 mcg per minute
Consider:
Expert consultation
Transvenous pacing
* Dorges V, Wenzel V, Knacke P, Gerlach K, Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients. Crit Care Med. 2003;31:800-804
** Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE. “Part 6: electrical therapies: automated external defibrillators, defillation, cardioversion, and pacing:
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”. Circulation. 2010; 122(suppl 3):S706-S719. http://circ.ahajournals.org/content/122/18_suppl_3/S706
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
Follow Commands ?
Induced Hypothermia**
* Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out of hospital cardiac arrest: a systematic review and metanalysis Circ Cardiovasc Qual Outcomes. 2010;3:63-81.
** Bruel C, Parienti JJ, Marie W, Arrot X, Mild hypothermia during advanced life support, a preliminary study in out of hospital cardiac arrest. Crit Care. 2008;12: R31
*** Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: post-cardiac arrest care: 2015 American Heart Association
Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(suppl2):S465-S482
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
NORMAL ABNORMAL
Both sides of face move equally. One side of face does not move
as well as the other side.
Arm Drift
(patient closes eyes and extends both arms straight out, with palms up for 10 seconds)
NORMAL ABNORMAL
Both arms move the same or both One arm does not move or one
arms do not move at all. arm drifts down compared
with the other.
Abnormal Speech
(have the patient say “you can’t teach an old dog new tricks”)
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
Immediate general assessment and stabilization* Immediate neurologic assessment by stroke team
or designee
Assess ABCs, vital signs
Provide oxygen if O sat <94%
2
Candidate*
* Jauch EC, Cucchiara B, Adeoye O, Meurer W, Brice J, Chan Y-F, Gentile N, Hazinski MF. “ Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitationand Emergency Cardiovascular
Care” . Circulation. 2010;122(suppl 3):S818-S828. http://circ.ahajournals.org/content/122/18_suppl_3/S818
** Tissue Plasminogen Activator for Acute Ischemic Stroke. N Engl J Med. 1995:333(24)1581-1587
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a
B bloker di Indonesia
injeksi hanya
metoprolol Kalau adenosine
(vapressor)
CCB bisa dengan IV access and 12–lead ECG if available. tidak ada bisa
diltiazem inj 15-20 Vagal maneuvers. diganti ATP
mg, 15 mnt lagi 20-25, Adenosine (if regular) dengan dosis 2x
rumatan 5-15 mg/jam β-Blocker or calcium channel blocker. lipat
Consider expert consultation.
Synchronized First dose : 6 mg rapid IV push; First dose : 150 mg over 10 minutes.
Cardioversion** follow with NS flush.
Repeat as needed if VT recurs. Follow
Second dose : 12 mg if required by maintenance infusion of 1 mg/min
Initial recommended doses: for first 6 hours.
Narrow regular : 50–100 J Antiarrhythmic Infusions
Narrow irregular : 120–200 J for Stable Wide-QRS Sotalol IV Dose:
biphasic or 200 J monophasic Tachycardia
Wide regular : 100 J
Wide irregular : Defibrillation
Procainamide IV Dose: 100 mg (1.5 mg/kg) over 5 minutes.
Avoid if prolonged QT.
dose (not synchronized)
20-50 mg/min until arrhythmia
suppressed, hypotension ensues, QRS
TDP termasuk wide iregular duration increases > 50% or
maximum dose 17 mg/kg given.
Maintenance infusion: 1–4 mg/min.
Avoid if prolonged QT or CHF.
* Link MS, Atkins DL, Passman RS, Halperin HR, SAmson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerbenchuk PJ, Kerber RE. “Part 6: electrical therapies: automated external defibrillators,
defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”. Circulation. 2010;122(suppl 3):
S706-S719. http://circ.ahajournals.org/content/122/18_suppl_3/S706
** Scholten M, Szili-Torok T, Klootwijk P, Jordaens L, Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Heart 2003;89:1032-1034
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a