ASUHAN KEPERAWATAN

WIDE COMPLEX TACHYCARDIA

WORKSHOP I I I S MZ AO IOL MvCI H

NAN
RNEL P E L AT I H A N
WORKSHOP I I I S MZ AO IOL MCI H
NAN
RNEL P E L AT I H A N

CURICULUM VITAE
• Name : II Ismail, S. Kep., Ners., M. Kep
• Place and date of birth : Tasikmalaya 04 April 1978
• Telephone : Hp 081380009221
• Email : ismail_pjnhk78@yahoo.com
• Office Address : RS Jantung Harapan Kita
• Current Position : IGD RS Jantung Harapan Kita

EDUCATION TRAINING EXPERIENCES :

AKPER Manggala Husada Jakarta th 2000 • Kardiologi dasar Di RS PJNHK Thn 2001
Universitas Muhammadiah Jakarta • Pelatihan EKG Di RS PJNHK Thn 2003
Magister Keperawatan UMJ
WORKING EXPERIENCES:
• Pelatihan ACLS Di RS PJNHK Thn 2015,
1. RS DHARMAIS Thm 2000-2001 • Pengakuan Pengajar Keperawatan Tingkat Nasional PPNI 2013.
2. IGD RS PJNHK Thn 2001 ‒ Sekarang • Pelatihan TOT BTCLS Thn 2009
3. Pengajar di DIKLAT RS PJNHK • Pelatihan emergency nursing thn 2011
4. Clinical Instruktur di IGD RSPJNHK
5. Penanggung Jawab di IGD RSPJNHK • TOT Emergency nursing
6. Duty Manager di RSPJNHK • TOT Kardiovaskular
7. Pengajar di Uiv Muhamadiah • Pelatihan ACLS AHA
8. Yayasan GTC ( Global Training Centre )
9. Pembicara Seminar atau Workshop Organisasi : KETUA INKAVIN
OUTLINE

01 PENGERTIAN 02 JENIS TAKIKARDI QRS LEBAR

ALGORITMA ASUHAN KEPERAWTAN

03 TAKIKARDI QRS 04 PASIEN DENGAN TAKIKARDI
LEBAR QRS LEBAR
01 Introduction
 01 Definitions
• Tachycadia : defined as an arrhythimia with a heart rate typically
100/min or greather
• Symptomatic tachycardia: signs and symptons due to the rapid heart
rate
• The rate takes on clinical significance at its extremes and is more likely
attributable an arrhthimia if the heart rate is 150/ min or greater
• It is unlikely that symptoms of instability are caused primarily by the
tachycardia when the heart rate is less than 150/ min unless the
patient has impaired ventrikular function
 02 Rhythms for tachycardia

•Sinus tachycardia
•Atrial flutter
•Atrial fibrilation
•Supraventrikular tachycardia (SVT) QRS
•Monomorphic Ventricular Tachycardia (VT) LEBAR
•Polymorphic (VT)
“The 2020 American Heart Association Guidelines for CPR and ECC”

MANAJEMEN
TAKIKARDI QRS
LEBAR dengan
NADI
 MANAJEMEN TAKIKARDI

03/03/23
 03
Managing Tachycardia :
The Tachycardia
Algorithm
Manajement Algorithm Adult Tachycardia

Assess appropriatess for clinical condition

§ BLS
§ Primary
§ Secondary Assessments to guide your approach
Identify and Treat the Underlying Cause
§ Maintain patent airway ; assist breathing as nacessary
§ Give oxygen (if Hypoxemic)
§ Use cardiac monitor to identify rhythm (BP & Oxymetry)
§ Establish IV access
§ Obtain a 12-Lead ECG if available
Persistent Tachycardia Causing :
§ Hypotension?
§ Acutely altered mental status?
§ Signs of shock?
§ Ischemic chest discomfort?
§ Acute heart failure?
 Persistent Tachycardia Causing :
§ Hypotension?
§ Acutely altered mental status?
§ Signs of shock?
§ Ischemic chest discomfort?
§ Acute heart failure?

YES NO

UNSTABEL STABLE
Unstable Tachycardia
Synchronized Cardioversion

§ Consider sedation
§ If regular narrow complex, consider
adenosin

AF : 120 JOULE
SVT : 50 JOULE
VT : 100 JOULE
Unstable Tachycardia
Synchronized Cardioversion
Stable Adult Tachycardia
§ Wide QRS Complex is 0.12 second or more
§ Narrow QRS Complex is Less than 0.12 second
 Wide QRS Complex is 0.12 second or more
Consider :

§ Adenosine only if regular and monomorphic

§ Anthiarrhythmic infusion
§ Expert consultation

Anthiarrhythmic infusion
§ Bolus 150 mg selama 10 menit (diencerkan dengan
dextrose 5% ….20 cc)
§ Maintenance 1mg/menit selama 6 jam (360mg/6 jam)
dalam 3 tahap:
Ø Pertama 150 mg / 2,5 jam
Ø Kedua 150 mg / 2,5 jam
Ø Ketiga 6 mg / 1 jam
NB masing-masing diencerkan dengan dektrose 5%
menjadi 50 cc.
“The 2020 American Heart Association Guidelines for CPR and ECC”

MANAJEMEN
TAKIKARDI QRS
LEBAR Tanpa NADI
 Kolom 2 EKG VF/VT tanpa Nadi
Kolom 3
1. Sesegera Mungkin Defibrilasi
2. Jika Defibrilasi belum bisa di kerjakan lakukan RJP
Kolom 4 RJP 2 Menit / 5 Siklus ( 30 : 2 )
Waktu 2 mnt

1.Setelah Defibrilasi lanjutkan RJP mulai dari siklus awal

2.Pasang IV akses
3.Siapkan Epinefrin 1 mg
4.Siapkan LMA/ETT
Kolom 5 EKG VF/VT tanpa Nadi
Kolom 6
1. Lakukan Defibrilasi ke 2
Waktu 2 mnt

2. Setelah Defibrilasi lanjutkan RJP selama 2 menit mulai dari siklus

awal
3. Berikan Epinefrin 1 mg siapkan Amiodaron 300 mg diencerkan
dengan dektrose 5% menjadi 50 ML
4. Pasang LMA/ETT RJP Kompresi 100-120 : Ventilasi 10 X/mnt
Kolom 7 EKG VF/VT tanpa Nadi
Kolom 8
1.Lakukan Defibrilasi ke 3
Waktu 2 mnt

2.Setelah Defibrilasi lanjutkan RJP selama 2 menit Kompresi 100-120 :

Ventilasi 10 X/mnt
3.Berikan Amiodaron 300 mg dan siapkan Epinefrin 1 mg
4.Tangani Penyebeb yang dapat dipulihkan
5.Lanjut ke Kolom 5 jika masih VF/VT tanpa nadi
ASUHAN KEPERAWATAN
PASIEN DATANG DENGAN KELUHAN BERDEBAR-DEBAR
DISERTAI SESAK NAPAS, BP: 78/62 MMHG, RR: 26X/MNT, HR: 200X/MNT, SATURASI
94%. PASIEN ADA RIWAYAT PINGSAN. BERIKUT EKG DI IGD
HASIL PENGKAJIAN DARI KASUS DIATAS
A :?
B :?
C :?

APAKAH PASIEN STABIL/TIDAK ?

APA DIAGNOSA KEPERAWATAN YANG

TEPAT ?

APA RENCANA KEPERAWATAN

SELANJUTNYA ?
P E L AT I H A N

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