NURSING SEMINAR
Management Lethal Arrhythmia :
New Insight for Nurse Role In Era
Pandemi COVID
Di Sampaikan Oleh :
Ns. Sugiyono. S.Kep. M.Kep. C.T
Supported by :
Curiculum Vittae
• Nama : Ns. Sugiyono.S.Kep. M.Kep. C.T
• Moto : “Selalu Menuju Perbaikan dan Keep Spirit ,
Belajar, Amal, Ibadah”
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• Profesion :
Ners Emergency RSPJNHK, Dosen Keperawatan, Trainer
BLS/BTCLS/ACLS/EKG , Hypnoterapist Profesional.
Riwayat Pendidikan dan Training
School
SPK PPNI SEMARANG 1999-2002
UNIVERSITAS NGUDI WALUYO SEMARANG 2002-2006
PROGRAM PROFESI NERS 2006-2007
MAGISTER KEPERAWATAN (S2) 2018-2020
On SPESIALIS PROGRAM (Sp.KMB) 2020
Training
Basic Cardivascular 20110
Advace Cardiovascular 2017
Electrocardigrafi 2017
ACLS/BTCLS 2020
OVERVIEW
Latar Belakang
Anatomi KV dan sistem konduksi
Konsep Aritmia dan arhtmia lethal
Managemen Suden cardiac arrest
pada Arhrtmia lethal
Nursing Consideration
Kesimpulan
BACKGROUND
As nurses, we need to be prepared in the even
of a lethal arrhythmia ; a deadly heart rhythm
When a patient suffers a lethal arrhythmia
every few second count, Are you ready ?
Will you able to make the quick decisions
necessary to save your patients life?
How U can asses in Pandemi Covid 19?
• The 2017 update of cardiovascular statistics from the AHA
estimated the total annual burden of outof-hospital cardiac
arrest at 356,500
• SCA (Sudden Cardiac Arrest) and its most common
consequence SCD (Sudden Cardiac Arrest), constitute major
public health problems, accounting for approximately 50% of
all cardiovascular deaths.
• Approximately half of patients with out-of-hospital cardiac
arrest with the first rhythm identified as VF and who survive
to hospital admission have evidence of acute MI (AMI) (27).
Of all out-of-hospital cardiac arrests, >50% will have
significant coronary artery lesions on acute coronary
angiography
PEA vs. VF/VT in Sudden Cardiac Arrest
• The initial rhythm was VF/VT in 48% of
patients and PEA in 25%. Overall, 13% of
patients survived to hospital discharge;
https://www.jwatch.org/em201101070000003/2011/01/07/fact
ors-associated-with-pea-vs-vf-vt-sudden
Indicates sudden cardiac death with
Ariytmia Lethal.
DEFINISI ARITMIA
Adalah gangguan denyut jantung yang meliputi frequensi, irama dan
konduksi yang dapat ditimbulkan oleh karena gangguan pengeluaran /
pembentukan impuls maupun gangguan sistem hantaran / konduksi
atau keduanya.
Klasifikasi aritmia ( sesuai dengan prognosis )
Aritmia minor
Ini tidak memerlukan tindakan segera sebab tidak mengganggu
sirkulasi dan tidak berlanjut ke aritmian yang serius, biasanya tidak
memerlukan teraphi
Aritmia mayor
Dapat menimbulkan gangguan penurunan curah jantung & dapat
berlanjut ke aritmia yang mengancam jiwa. Memerlukan tindakan
segera dan teraphi
Aritmia mengancam jiwa
Aritmia yang memerlukan resusitasi segera untuk mencegah kematian
Faktor penyebab aritmia antara lain
sebagai berikut :
Hipoksia Physiological
Pathological:
Iskemia Valvular heart disease.
Rangsangan susunan saraf Ischemic heart disease.
otonom Hypertensive heart
diseases.
Obat-obatan Congenital heart disease.
Gangguan keseimbangan Cardiomyopathies.
elektrolit dan gas darah Carditis.
RV dysplasia.
Regangan dinding otot Drug related.
jantung Pericarditis.
Kelainan struktur sistem Pulmonary diseases.
konduksi Others.
Mechanism of Arrhthmogensis
1. Disorder of impulse formation.
a) Automaticity.
b) Triggered Activity.
1) Early after depolarization.
2) Delayed after depolarization.
2. Disorder of impulse conduction.
a) Block – Reentry.
b) Reflection.
3. Combined disorder.
Mechanism of Arrhthmogensis Takikardia
Arrhythmia Presentation
Palpitation.
Dizziness.
Chest Pain.
Dyspnea.
Fainting.
Sudden cardiac death.
Arrhythmia Assessment
• ECG
• 24h Holter monitor
• Echocardiogram
• Stress test
• Coronary angiography
• Electrophysiology study
What is a lethal Arrhythmia?
Life threatening arrhythmias may
cause sudden cardiac death and are
divided into bradyarrhythmias and
tachyarrhythmias.
Lethal Arrhythmia Rhythm
VT (-)
PEA
ARYTMIA VF
LETHAL
ASISTOLE
langkah sederhana
mengenali aritmia letal
VENTRICULAR TACHYCARDIA
VENTRICULAR TACHYCARDIA
Rate: usually between 100 to 220/bpm, but can be as rapid as
250/bpm
P wave: obscured if present and are unrelated to the QRS complexes.
QRS: wide and bizarre morphology
Conduction: as with PVCs
Rhythm: three or more ventricular beats in a row; may be regular or
irregular.
Ventricular tachycardia almost always occurs in diseased hearts.
Some common causes are:
CAD
acute MI
digitalis toxicity
CHF
ventricular aneurysms.
Patients are often symptomatic with this dysrhythmia.
Irama Teratur
HR 100 – 250 X/menit
VENTRIKEL
TAKHIKARDI Gel. P Tidak ada
(VT) Interval Tidak ada
PR
Gel. Lebar (> 0.12 detik)
QRS
TORSADE DE POINTES
Rate: usually between 150 to 220/bpm,
P wave: obscured if present
QRS: wide and bizarre morphology
Conduction: as with PVCs
Rhythm: Irregular
Paroxysmal –starting and stopping suddenly
Hallmark of this rhythm is the upward and downward deflection of the QRS
complexes around the baseline. The term Torsade de Pointes means "twisting
about the points."
Consider it V-tach if it doesn’t respond to antiarrythmic therapy or
treatments
Caused by:
drugs which lengthen the QT interval such as quinidine
electrolyte imbalances, particularly hypokalemia
myocardial ischemia
Takikardia Ventrikel dan Torsade de Pointes
VENTRICULAR FIBRILLATION
Rate: unattainable
P wave: may be present, but obscured by ventricular waves
QRS: not apparent
Conduction: chaotic electrical activity
Rhythm: chaotic electrical activity
This dysrhythmia results in the absence of cardiac output.
Almost always occurs with serious heart disease, especially
acute MI.
The course of treatment for ventricular fibrillation includes:
immediate defibrillation and ACLS protocols.
Identification and treatment of the underlying cause is also
needed.
Irama Tidak Teratur
HR Tidak dapat dihitung
Ventrikel
Gel. P
Fibrilasi Tidak ada
Interv Tidak ada
al PR
Gel. Tidak dapat dihitung,
QRS bergelombang & tidak teratur
Asystole
• Asystole is also known as flatline. It is a state
of cardiac standstill with no cardiac output
and no ventricular depolarization
Flat line protokol
The following are common
causes of an isoelectric line that
is not asystole:
1. loose or disconnected leads
2. loss of power to the ECG
monitor Cek Elektroda
3. low signal gain on the ECG
monitor.
Cek Lead I, II,
III
Perbesar
Gelombang
Pulseless electrical activity (PEA),
Pulseless electrical activity (PEA), also known
as electromechanical dissociation, refers
to cardiac arrest in which
the electrocardiogram shows a heart rhythm
that should produce a pulse, but does not.
PEA
MANAGEMENT ARITMIA LETHAL
ON CARDIAC ARREST
https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047463
KEY POINT –SCA COVID 19
Role of Nurse in Even lethal
Arrhythmia
Important Considerations in the Evaluation of Patients With
Known or Suspected VA
Summary
• The following case history describes the first instance
of lifesaving defibrillation performed by a nurse in
the absence of a physician
• lethal arrhythmias can occur at anytime, and rapid
nursing assessment and intervention can result in a
successful outcome.
• Quick recognition of lethal arrhythmias and strong
working
• knowledge of up-to-date treatment will lead to the
best outcome possible.
Thank You
9/25/2020 48
