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    Pembimbing: Dr. Ali Haedar, SP - EM: Fakultas Kedokteran Universitas Brawijaya

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    noval hlf
    The document describes a case of a 71-year-old female farmer presenting with chest pain, shortness of breath, and palpitations who was diagnosed with supraventricular tachycardia, heart failure, and a non-ST-elevation myocardial infarction based on her symptoms, physical exam findings, EKG, bloodwork, and response to treatment with antiarrhythmic and antiplatelet medications. She was admitted to the cardiology department for further management of her acute coronary syndrome and arrhythmia.

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    Pembimbing: Dr. Ali Haedar, SP - EM: Fakultas Kedokteran Universitas Brawijaya

    Uploaded by

    noval hlf
    56 views26 pages
    The document describes a case of a 71-year-old female farmer presenting with chest pain, shortness of breath, and palpitations who was diagnosed with supraventricular tachycardia, heart failure, and a non-ST-elevation myocardial infarction based on her symptoms, physical exam findings, EKG, bloodwork, and response to treatment with antiarrhythmic and antiplatelet medications. She was admitted to the cardiology department for further management of her acute coronary syndrome and arrhythmia.

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    materi acls

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    ACLS (1)

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    The document describes a case of a 71-year-old female farmer presenting with chest pain, shortness of breath, and palpitations who was diagnosed with supraventricular tachycardia, heart failure, and a non-ST-elevation myocardial infarction based on her symptoms, physical exam findings, EKG, bloodwork, and response to treatment with antiarrhythmic and antiplatelet medications. She was admitted to the cardiology department for further management of her acute coronary syndrome and arrhythmia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views26 pages

    Pembimbing: Dr. Ali Haedar, SP - EM: Fakultas Kedokteran Universitas Brawijaya

    Uploaded by

    noval hlf
    The document describes a case of a 71-year-old female farmer presenting with chest pain, shortness of breath, and palpitations who was diagnosed with supraventricular tachycardia, heart failure, and a non-ST-elevation myocardial infarction based on her symptoms, physical exam findings, EKG, bloodwork, and response to treatment with antiarrhythmic and antiplatelet medications. She was admitted to the cardiology department for further management of her acute coronary syndrome and arrhythmia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    ACLS

    Pembimbing :
    Fakultas Kedokteran
    Universitas Brawijaya dr. Ali Haedar, Sp.EM
    Case Report
    IDENTITY

    Nama : Mrs. P
    Age : 71 y.o
    Address : Poncokusumo, Kab. Malang
    Job : Farmer
    Religion : Islam
    Registration No : 11602991
    Examination : April 4th 2017 at 11.40 AM
    PRIMARY SURVEY

    A : Patent, Additional breathing sound (-)


    B : RR 28x/m, regular, simetrical chest expantion, retra
    tion (-), SatO2 96%
    C : BP 100/60 mmHg, PR 170 x/menit, regular stron
    g, acral warm, CRT < 2 detik
    D : GCS 456, pupil round isokor 3mm/3mm
    E :Axilarry Temp 36C

    Triage Priority : P1
    INITIAL TREATMENT

    A :-
    B : O2 10 lpm via NRBM Sat O2: 9
    6%
    C : IVFD NaCl 0,9% 20 dpm
    D :-
    ANAMNESIS
    Autoanamnesa
    Chief Complain : Chest Pain
    History of Present Illness :
    Chest pain since 4 days before admission. Chest pain in middle section of
    cest and spread to left shoulder (-), jaw (-), chin (+) for 30 minutes.
    Patient felt like shooting pain when patient doing activity. Morning before
    admission, patient felt her chest beat fast and sweated out. Nausea (-)
    vomit (-) sweated out (-) out of breath when doing heavy activity, like
    walking.

    History of Past Illness:


    History SVT since 1 year ago, and have monthly control in cardiology
    department
    ANAMNESIS
    History Past Illness::
    HT (+) since >10 years ago, DM (-), asthma (-), TB (-)
    Medication :
    Patient doesnt know drugs she routine use
    Family Disease:
    No family with HT, asthma (-), TB (-)
    Social History:
    Patient work as farmer
    Physical Examination
    Moderately ill Height: 150 cm Weight: 60 kg
    GCS 456 Bmi 26,67 kg/m2
    BP=100/60mm PR 170 x/m, regular, RR = 30 tpm Tax :360C
    Hg

    Head Conjunctiva Anemis (-) Pupil isokor 3/3mm


    Sklera Ikterik (-)
    Neck JVP R + 2 cm H20, semi Enlage of Lymph
    Fowler Node (-)
    Thoraks Ictus invisible & palpable at ICS VI MCL S
    Cor RHM ~SL D, LHM ~ ictus
    S1 S2 normal, Irregular, murmur (-), gallop (-)
    Pulmo Simetris Stem fremitus Sonor + + v v Rh - - Wh - -
    D=S
    + v v - - - -
    +
    + v v - - - -
    +
    Abdomen Flat, soefl, bowel sound + N, liver span 8 cm. Traubes space timpani,
    Shifting dullness -
    EKG ( 11/ 01/2017)

    Sinus takikardi, HR 125x/menit, poor R wave progression, LVH


    LAB RESULTS ( 11/01/2017)
    Lab Value Lab Value
    Leucocyte 12.800 4700-11.300/L Na 142 136-145mmol/l
    Diff Tell 1,2/0,4/6 0-4/0-1/51-67/25- K 4,0 3,5-5,0 mmol/l
    3,3/27,4/ 33/2-5 %
    7,7
    Haemoglobin 15,4 11,4-15,1 g/dL Cl 103 98-106 mmol/l
    MCV 93,9 80-93 fl

    MCH 30,4 27-31pg CK-NAC 66 39-308 U/L


    Hematokrit 47,6% 38-42 % CKMB 57 7-25 U/L
    Thrombocyte 319.000 142000- Troponin I 0,015 Positif > 0,1
    420000/L /L
    SGOT 24 0-40 U/L Ureum 30 16,6 - 48,5
    mg/dL
    SGPT 31 0-41 U/L Kreatinin 1,36 < 1,2 mg/dL
    GDS 146 <200
    DIAGNOSIS

    1. SVT
    2. HF st C FC II
    3. NSTEMI

    DISPOSITION Cardiology Departement


    PLANNING THERAPY
    11.45
    Semi-Fowler position
    O2 10 lpm via NRBM
    IVFD NaCl 0,9% 2500cc/24 jam
    Inj : Diltiazem 15 mg bolus 2 minutes
    next 1 mcg/kg/minutes
    12.00
    New Diltiazem inj. 5 mg Rhyme convert to synus rythm 95x
    /minute
    Re-ECG
    Drip diltiazem 1 mcg/kg/minute
    12.05
    Re-SVT bolus 15 mg diltiazem
    PLANNING THERAPY

    14.07
    NaCl 0.9% 100cc + Amiodarone 150 mg completed in 10 min
    14.25
    NaCl 0.9% 100cc + Amiodarone 300 mg completed in 6 hours
    16.00
    Per oral: ASA 320 mg
    Clopidogrel 300 mg
    Furosemid 20 mg
    Spironolacton 25 mg
    PLANNING MONITORING

    Subjective
    Vital Sign
    Respiratory Distress
    Urin Production
    Discussion
    ANAMNESIS
    Case Theory (ESC, 2011)
    Chest pain since 4 days b Pasien with typical ch
    efore admission. Chest p est pain > 20 menit;
    ain in middle section of c Angina de novo kelas
    est and spread to left sho
    II / III based on CCS
    ulder (-), jaw (-), chin (+)
    for 30 minutes when d Angina undergo dest
    oing moderate activities. abilisation
    chest beat fast and sweat Angina Pasca Infark
    ed out. Miokard (2 weeks aft
    er MI)
    Physical Examination
    Case Theory (ACLS 2015)

    Pulse Rate 170 bpm reg


    ular
    TD: 100/60 mmHg
    GCS 456 Tachycardia >100 bpm
    Ictus invisible & palpable at Chest pain
    1 cm lateral to ICS V MCL S
    STABLE Tachycardia
    ECG
    SVT
    ECG
    T Inversion
    Laboratory

    Case Theory (ESC 2011)


    Increase of Troponin I, C NSTEMI Diagnosis
    KMB ECG:
    ST segment Depression a
    nd/or T inversion; with or
    without ST segment eleva
    tion (<20 minutes);
    Persistent Q wave
    Cardiac Marker:
    Increase of troponin I/T le
    vel 2-4 jam after onset.
    Tachycardia Algorithm (ACLS 2
    015)
    ACS Algorithm (ACLS 2015)
    Treatment
    Case Theory (ACLS 2015)
    Diltiazem 15 mg bolus iv
    SVT
    over 2 minutes
    Initial: 0.25 mg/kg IV bol
    Drip Diltiazem 1mcg/kg/mi
    us over 2 minutes
    nute
    Maintenance: 5-10 mg/
    Amiodarone 150 mg drip
    h up to 15 mg/h
    within 100cc NaCl in 10 mi
    nutes Initial: 150 mg IV over 1
    0 minutes
    Amiodarone 300 mg drip
    within 100 cc NaCl in 6 ho Maintenance: 360 mg or
    urs 1 mg/minutes over next
    6h
    Treatment
    Case Theory (PERKI 2014)
    ACS
    1.Bed rest (I-C)
    O2 10 lpm NRBM
    2.O2 supplementation for all patients with
    ASA 320 mg ACS (IIa-C)
    3.Anti Ischemia: Beta-Bloker (I-B); Nitrat (I
    Clopidogrel 300 mg -C), CCB
    Furosemid 20 mg 4.Anti platelet: Aspirin (I-A) + ADP Rec Inh
    ibitor (I-A)
    Spironolacton 25 mg 5.Anti coagulant suggested for all patients
    with antiplatelet therapy. (I-A)
    Patients transferred to Car 6.ACE Inhibitor to prevent remodelling (I-
    diovascular Care Unit A)
    7.Statin should give to all patients with U
    AP/NSTEMI if contraindications not pres
    ent (I-A)

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