Documente Academic
Documente Profesional
Documente Cultură
Penyakit Jantung
Penyebab Kematian No. 1 di Dunia
Penyakit Paru
6.3
Kecelakaan
AIDS
9.7
Kanker
12.6
19.3
Penyakit Infeksi
Peny. Jantung
22.3
0
10
15
20
25
30
Nyeri dada
Sesak Nafas ~ eodema
Berdebar
Syncope
DLL
Di AS
IMA baru 1/20 detik (1,5 juta/tahun)
Dana yang dikeluarkan 14 milyar $
Di Indonesia
EKG
Oksigen
Aspirin
Clopidogrel
Nitrat
Morfin
Symptom
Call to
Recognition Medical System
Prehospital
ED
CCU
Cath Lab
PUSKESMAS
sing
a
e
r
Inc
of
s
s
Lo
tes
y
c
Myo
AdjustedRR[95%CI]:
1.075[1.011.16]
7.5%increasedriskofdeathforeach30mindelay
Everyminutedelaycounts:notonlyforthrombolysis,butalsoforprimaryPCI
Time is Myocardium
Not PCI
capable
Onset of
symptoms of
STEMI
9-1-1
EMS
Dispatch
EMS on-scene
Encourage 12-lead ECGs.
Consider prehospital fibrinolytic if
capable and EMS-to-needle within
30 min.
GOALS
5
min.
Patient
8
min.
EMS
Dispatch
1 min.
InterHospital
Transfer
EMS
Triage
Plan
PCI
capable
EMS Transport
Prehospital fibrinolysis
EMS transport
EMS-to-needle
EMS-to-balloon within 90 min.
within 30 min.
Patient self-transport
Hospital door-to-balloon
within 90 min.
MANAGEMENT
Anti Ischemic
Nitrate
Morphine Sulfate
Beta Blocker
Calsium Channel Blocker
Revascularization Strategy
Statin
ACE Inhibitor
CARDIOGENIC
PULMONARY
EDEMA
NONCARDIOGENIC PULMONARY
EDEMA
History
Acute cardiac event
Usually
S3 gallop
Present
Absent
Present
Absent
Crackles
Wet
Dry
Usually absent
Present
Electrocardiogram
Ischemia/infarction
Usually normal
Chest x-ray
Perihilar distribution
Peripheral distribution
Cardiac enzymes
May be elevated
Usually normal
>18 mm Hg
<18 mm Hg
Intrapulmonary shunting
Small
Large
<0.5
>0.7
Physical Examination
Laboratory Tests
DIAGNOSTICS OF ALO
Physical findings :
Tachypnea
and tachycardia
Sitting upright, agitated
Central cyanosis
Very anxious and
diaphoretic
Hypertension due to
hyperadrenergic state
Rales +, ronchi & wheezing
also maybe +
S3 +, jugular venous
distension +
Hydrostatic
Pressure
18 mmHg
Capillary
Lumen
A. Interstitial Edema
Alveoli
Stage II
Alveoli
Hydrostatic Pressure
> 25 mmHg
Capillary Lumen
Systemic
Vens
Pressure
Hydrostatic Pressure
> 28-30 mmHg
Capillary Lumen
Acute Clinical signs of Hypoperfusion / Hypotensi, Shock, Cong Heart failure , acute pulmonary edema
Start IV
Assess vital signs
Order 12-lead ECG
Pulmonary Assess ABCs
airways
Attach Monitor, pulse oximeter, Review history
Order portable chest x-ray
Edema / Secure
Administer oxygen
and automatic blood pressure Perform physical examination
Hypotension /
Shock
Algorithm
Volume problem
Pump problem
<70 mm Hg
Signs and symptoms of shock
Norepinephrine
0.5-30 ug/min IV or
Systolic BP 70-100 mm Hg
Signs and symptoms of shock
Dopamine
5-20 ug/kg per min IV
Systolic BP 70-100 mm Hg
Dobutamin
2 - 20 ug/min IV or
What is the
Blood
pressure [BP]
Second-line actions
Nitroglycerin IV if BP> 100 mm Hg
Nitroprusside IV if BP> 100 mm Hg
Dopamine if BP70 - 100 mm Hg
Dobutamine if BP>100 mm Hg
Positive end-expiratory pressure (PEEP)
Continuous positive airway pressure (CPAP)
Rate problem
Too Slow
Too Fast
Systolic BP >100 mm Hg
Further diagnostic /
therapeutic considerations
Pulmonary artery catheter
Intra-aortic balloon pump
Angiography for AMI / ischemia
Additional diagnostic studies
HEART FAILURE
Maintenance
Furosemit
Spironolacton
ACE Inhb / ARB
B Bloker
Nitrat
Digitalis
Palpitasi :
Sinus Takikardia
Extra Systole
Atrial Fibrilasi
Supraventrikular Takikardia
Ventrikel Takikardia
PENYEBAB TERSERING
Sick Sinus Syndrome
Bradikardia
Blok
Dll
No
Type II second-degree AV block
or
Third-degree AV block?
Yes
Intervention Sequence
Atropine 0.5 1.0 mg
Transcutaneous pacing if available
Dopamine 5-20 g/kg per minute
Epinephrine 2-10 g/min
Isoproterenol 2-10 g/min
Yes
No
Observe
PENYEBAB TERSERING
Noncardiac ???
Asystole
Ventrikel Fibrilasi
TERIMA KASIH