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Dr.

Erwin Sukandi, SpPD, K-KV, FINASIM

Nama: Tn/Ny…………………. Umur : … tahun

Tanggal: ../../.... Pukul : ………

RSMH Palembang

Interpretasi: ………………………………………………………………………………………………………………………………………… ………………………………………………

 Irama  Aksis  HR  Gel. P  Interval PR  Gel. Q, R, S  Interval QRS  Interval QT  Segmen ST  Gel. T  Gel. U

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1500 RR (Ktk kecil) atau 300 RR (ktk sdg) .

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2.2 million Americans Prevalence increases with age Increased mortality secondary to stroke Classifications • 75.000 strokes/year in US • First episode • Recurrent (paroxysmal) • Persistent . Common.

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 Causes • Advancing age • Uncontrolled htn • CAD • CHF • Valvular heart disease Acute pulmonary process (PE)  Hyperthyroidism  Acute alcohol intoxication  Illicit narcotic abuse  .

Absence of P waves IRREGULARLY IRREGULAR Atrial rates 350-750 Ventricular rate varies • Controlled versus rapid response Up to 30% decrease in cardiac output • No “atrial kick” .

then oral load  Diltiazem (Cardizem) 10 to 20 mg SLOW IV push • Digoxin may be used in chronic setting .Treatment Rate • Goals: rate control and anticoagulation control • Beta-blockers and Ca channel blockers  Metoprolol (Lopressor) 5mg IV q 5 min times 3 doses.

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MI. CHF. Htn. COPD.Regular atrial activity Sawtooth pattern Single irritable foci in atria initiates impulse Atrial rate 250-300 Causes: • Slower than in a-fib • No underlying cardiac disease • CAD. hypoxia. PE. thyrotoxicosis. alcohol . digitalis toxicity.

Treatment • Ventricular rate control Beta Blockers or Ca channel blockers • ER/admission Atrial overdrive pacing Ablation Adenosine may be helpful in diagnosis • Transiently blocks AV node .

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Ventricular Fibrillation Marquette Electronics Copyright 1996 .

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Ventricular Asystole Marquette Electronics Copyright 1996 .

Rhythm strip recording of ECG revealing that paroxysmal attacks of atrial fibrillation always terminated with a long ventricular asystole .

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ABC’s ↓ HIGH QUALITY CPR ↓ Secure the airway.0 mg (Repeat every 3 – 5 min to a max of 3 mg) . provide 02 ↓ IV or IO access ↓ Epinephrine 1 mg* (Repeat every 3 –5 minutes) ↓ If the rhythm is Bradycardia. <60 Atropine 1.

The 5 H’s and the 5 T’s. *You may consider Vasopressin instead of the first or second dose . BVM support of the airway is acceptable until advanced airway can be placed. and then stabilize Rate. and Blood Pressure Note: Repeated unsuccessful intubation attempts are not recommended. while beginning drug therapy Hypoxia Toxins/overdose Hypovolemia Thromboemboli (coronary/pulmonary) Hyper/hypokalemia Trauma Hypothermia Tension pneumothorax Hydrogen ion/acidosis Tamponade (cardiac) Hypoglycemia ↓ Consider fluid bolus. Rhythm. 200-300cc. maintain adequate ventilations. may repeat if lungs remain clear ↓ Once perfusing rhythm is restored.

ABC’s.0 mg OR Vasopressin 40u (one time only instead of 1st or 2nd epi dose) ↓ Atropine 1 mg ↓ Epinephrine 1 mg ↓ Atropine 1 mg ↓ Epinephrine 1 mg ↓ . EFFECTIVE CPR ↓ SECURE AIRWAY ↓ IV/IO access ↓ Epinephrine 1.

quality of life! .Several factors should be considered when making the decision to terminate resuscitation efforts on a patient in extended Asystole: Down Time Rigor Mortis Cold Water Drowning Chronic Medical Conditions Age Skin Temperature Blood Pooling Trauma And most importantly……….

360j if monophasic) ↓ Continue CPR immediately w/o pulse rhythm check ↓ Secure the airway without prolonged intubation attempts And establish IV or IO with Saline or LR ↓ Vasopressin 40 Units I.ABC’s ↓ Start HARD. EFFECTIVE CPR If un-witnessed code or down time > 4 minutes. DURING CPR . 2 minutes of CPR prior to defibrillation ↓ Defibrillate 200 j biphasic (or device specific dose. FAST.V.

V.OR Epinephrine 1 mg I.5 mg/kg I. breathing and vital signs.1. (Repeat every 3 – 5 minutes) ↓ Defibrillate 200-360 joules (Repeat every 1 – 2 minutes) ↓ Amiodarone 300 mg I. rhythm and blood pressure. or hyperkalemia) Consider Magnesium Sulfate 1 – 2 grams I. Provide medication appropriate for heart rate. . (if Torsades is present) Upon return of spontaneous circulation (ROSC): Assess airway. Consider hanging a maintenance anti-arrhythmic drip upon ROSC to prevent reoccurrence of V-Fib.V.V.V. tricyclic overdose. OR Lidocaine 1 . (May repeat to a max of 3 mg/kg) ↓ Defibrillate 200-360 joules ↓ Consider Sodium Bicarbonate 1meq/kg (acidosis.

200. and review patient’s history. 360 joules (Consider Sedation) ↓ Cardizem 0. provide oxygen.Assess ABC’s ↓ Secure airway.5 – 5 mg .25 mg/kg OR Verapamil 2. 300. consider synchronized cardioversion @ 100. pulse oximetry ↓ Start IV ↓ Revised 9/2009 10 Obtain 12 lead EKG if possible. especially history of possible A-fib or A-flutter ↓ If determined a new onset.

(You can always apologize later) If AF has been present for >48 hours.*Note: never delay cardioversion in lieu of sedation if the patient is unstable. Electrical cardioversion and the use of antiarrhythmic agents should be avoided unless the patient is unstable or hemodynamically compromised. . a risk of systemic embolization exists with conversion to sinus rhythm unless patients are adequately anticoagulated for at least 3 weeks.

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Which one is more tachycardic during this exercise test? TERIMA .