Dc Shock: Dr Buyung Span Dr Ruddi Span

DC SHOCK Dr Buyung SpAn Dr Ruddi SpAn

DC shock Oles dulu paddles dengan jelly ECG tipis rata, baru kemudian : 1. Switch ON Pasang paddles pada posisi apex dan parasternal (boleh terbalik)

sternum

apex

2. Charge 360 Joules (Non-synchronized)

DC shock

Ucapkan dengan keras :

Awas semua lepas dari pasien! nafas buatan berhenti dulu bawah bebas, samping bebas, atas bebas, saya bebas!

3. Shock!! (tekan dua tombol paddles bersama)

Lepas paddles dari dada, lanjutkan chest compression. 4. Segera pijat jantung lagi 2 menit baru raba lagi/ baca lagi ECG

sternum

apex

apex

Position

of the paddles electrodes sternum on thorax of an infant apex

Size of paddle electrode - 4.5 cm diameter for infants and small children - 8-12 cm diameter larger children

Jelly kurang rata, menekan paddles kurang kuat - luka bakar

INDICATIONS

Defibrillation (Non-Synchronized DC Shock): VF Pulseless VT Recommended joule: 360 J

7

INDICATIONS

Synchronized DC Shock (Only with unstable hemodynamic): AF Atrial Flutter SVT VT with pulse (despite of medication)

start with 50 J

start with 100 J Infant and Children: 2 J/kg 8

DO NOT SHOCK!!! Asystole Pulseless Electrical Activity Bradicardia Heart Block Stable hemodynamic with AF, Atrial Flutter, SVT, & VT with pulse

9

VF / pulseless VT

1). a single shock Defibrilation strategy

Biphasic 150-200 Joule Monophasic 360 Joule

CPR 30 : 2 2 MINUTES, 30 : 2 NO

Check ECG Check pulse

2). a single shock

Biphasic 150-360 Joule Monophasic 360 Joule

Adrenaline

YES

ROSC 2 MINUTES, 30 : 2

Recovery of Spontaneous Circulation

VF/ VT Intubasi : as soon as possible, without stop CPR Cardiac arrest

CPR -1 30 : 2 CALL FOR HELP PASANG MONITOR

Pijat >100x/menit Nafas 8-10x/menit

adrenalin VF / VT

2 menit

2 menit 2 menit

a single shock CPR-2

adrenalin

a single shock

a single shock

CPR-3

CPR-4

adrenalin Adrenaline: 1 mg, iv, repeated every 3-5 minutes

Evaluasi CPR : tiap 2 menit

2 menit

Amiodaron

a single shock CPR-5

a single shock

CPR-6

Amiodaron is the first choice 300 mg, bolus. Repeated 150 mg for reccurrent VT/VF. Followed by 900 mg infusion over 24 hours LIDOCAIN. Do not exceed a total dose of 3 mg/kg, during the first hour.

TERIMA KASIH