ACLSAdvanced Cardiac Life Support

Pre-Test

TRUE or FALSE?TRUE or FALSE?

Unresponsive victims should receive CPR.

Chain of Survival

Can I get AIDS from doing CPR?

Let’s hope not

There has never been a documented case of AIDS transmitted by CPR.

*10.1016/j.resuscitation.2005.09.016

Is it safe to perform CPR in patient with present heart beat?

YES

It is not dangerous to perform chestcompressions even if the heart is

stillbeating. You cannot make a patientany worse than he or she already is.

*Circulation. 2007;116:e566-e568

Will CPR always save a life?

NO

In fact, most instances of CPR for cardiac arrest are

unsuccessful.

Can I kill someone if I do CPR incorrectly?

NO

Remember, the person in cardiac arrest is already clinically dead. CPR can only help.

A.

B.

C.

D.

E.

The following are signals of a heart attack:

Nausea or vomiting

Pale or bluish skin color, moist or sweaty skin

Sudden and persistent chest pain or discomfort

Breathing difficulty

All of the above

TRUE or FALSE?TRUE or FALSE?

The main dish of VF is defibrillation?

A.

B.

C.

D.

E.

After witnessing sudden cardiac arrest, which number do you tap in your cellphone?

08195521xxx

08157936xxx

0274-587333

0274-420118

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A kind of training for physician Established by AHA, in Indonesia by PERKI Rarely taught in medical school

Overview ACLS

BLS Cardiac Arrest Tachycardia Bradycardia Acute Coronary Syndrome (ACS) Hypotension, shock, acute pulmonary

edema Drugs in ACLS Defibrillation principles

Materials

Science overview

“Good ACLS begins with Good BLS”

BLS Algorithm 2005

BLS Algortihm 2010

ACLS 2005

ACLS 2010

DEFIBRILLATION

Why so important? The leading cause of cardiac arrest is

ventricular fibrillation (VF) The most effective treatment for VF is

defibrillation Every 1 minute delay will drop the succesful

rate as much as 10%

Backgrounds

What happen in VF and pulseless VT?

Heart stops beating no circulation oxygen will depleted in less than 90 seconds

Myocardial Ischemia cell energy depleted

Early Defibrillation Concept

If defibrillation is performed when myocardial energy is depleted, the chance of myocardium can contract after asystole period is very little

Early Defibrillation Concept

What is defibrillator?A device that can produce controlled Direct Current Shock

How does it works?It is simple, it SHUT DOWN and RESTART the heart

Technical concept

VF, Pulseless VT defibrillation Other tachyarrythmia : VT, VT torsade de

pointes, atrial flutter, atrial fibrillation, supraventricular tachycardia synchronized cardioversion

Indication

Biphasic is more advantageous The energy needed is lower Prevent myocardial damage

Biphasic vs Monophasic

Sternal paddle: right parasternal below the right clavicle

Apex paddle:in the apex, left mid axillar

Paddles

Letakkan penderita pada posisi aman di tempat yang teduh dan kering dan sirkulasi udara yang baik. Bila dada penderita basah, sebaiknya keringkan dulu.

Operator dan peralatan normalnya di sisi kiri penderita

Nyalakan defibrillator agar dalam kondisi siap, tentukan energi yang diberikan

TATA LAKSANA DEFIBRILASI

Beri jelly yang cukup banyak pada paddle, kemudian ratakan pada kedua paddle.cukup banyak untuk menutupi kedua permukaan paddle, tapi tidak boleh berlebihan, supaya tidak terjadi hubungan pendek

Lakukan pengisian defibrillator (charge)

Tempelkan kedua paddle sesuai tempatnya masing-masing. Beri tekanan sekitar 25 pound (12 kg) secara mantap. Pastikan permukaan paddle menempel dengan baik pada dinding dada tanpa ada rongga diantaranya

Pastikan irama jantung penderita adalah irama VF atau VT tanpa pulsasi

Sebelum melakukan shock berikan aba-aba pada seluruh anggota tim untuk tidak bersentuhan dengan pasien maupun tempat tidurnya sambil memastikan diri sendiri juga tidak bersentuhan. Contoh aba-aba:- I’m going to shock on three- One, I’m clear- Two, you are clear- Three, everybody clearLihat lagi apakah semua sudah aman

Lihat monitor untuk memastikan irama belum berubah

Segera tekan tombol discharge secara bersamaan untuk melepaskan energi listrik ke pasien, sambil tetap menekan paddle dengan mantap ke dinding dada pasien

Segera angkat paddle lanjut RJP 5 siklus nilai ulang irama jantung

The End

Wassalamu’alaykum warrohmatullohi wabarokatuh

Let’s go back there, we miss those place, don’t we?