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8/10/2019 Slide Jurnal Anestesi
1/27
Terry L. Vanden Hoek, Ketua; Laurie J. Morrison; Michael Shuster; Michael
Donnino; Elizabeth Sinz; Eric J. Lavonas; Farida M. Jeejeebhoy; Andrea Gabrielli
Presented by:
Susi Muharni Risma
Raihanun Nisa Dinur
Cut Chairani
Maulina Fusya
Supervisor:
dr. Yusmalinda Sp.An
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Bronchoconstriction
Airway inflammation
Mucous plugging
Pathophysiology
WheezingClinical aspect
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Primary Therapy
Oxygen
Inhaled 2-Agonists
(Albuterol,Levalbuterol)
Corticosteroids
(Methylprednisolone,
Dexamethasone)
Adjunctive Therapy
Anticholinergics
Magnesium Sulfate
Epinephrine or
Terbutaline
Ketamine
Heliox
Methylxanthines
Leukotriene
Antagonists
Inhaled Anesthetics
Assisted Ventilation
Noninvasive Positive-
Pressure Ventilation
Endotracheal Intubation
with Mechanical
Ventilation
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Airway
Fluid resuscitation
Vasopressor
Antihistamin
Extracorporeal
support ofcirculation
Airway
Circulation
(Epinephrine IM
0,2-0,5 mg)
Tachycardia
Faintness cutaneous
Flushing
Urticaria
Pruritus
Stridor, wheezingCardiovascular
colaps
Hypersensitivity
reaction
DefinitionSigns &
Symptomps
ACLSModifications
BLSModifications
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Place the patient in the full left lateral position
Give 100% oxygen
Establish intravenous access above the diaphragm
Asses for hypotension
Consider reversible causes of critical illness and
treat conditions that may contribute to clinical
deterioration as early as possible.
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Airway (ETT or supraglottic
airway, bag-mask
ventilation)
Circulation
Defibrillation
Positioning (left-lateral tilt
position)
Airway (bag-mask
ventilation,suctioning)
Breathing (oxygenation,ventilation,monitor
oxygen saturation)
Circulation (Chest
compressions)
Defibrillation (AED)BLS
Modification
ACLS
Modification
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Problem in
pregnancy
Cardiac Disease
Myocardialinfarction
Atherosclerotic
Congenital heart
disease
Magnesium Sulfate
Toxicity
Cardiac effects
(bradycardia,
hypotension,
cardiac arrest)
Neurological effects (loss of
tendon reflexes, severe
muscular weakness,
respiratory depression)
Gastrointestinal
symptoms
(nausea,vomiting)
Preeclampsia/
eclampsia
Organ systemfailure
Pulmonary
embolism/Amniotic
Fluid Embolism
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Henti Jantung
pada Ibu yang
Tidak Segera
Membaik
dengan BLS
dan ACLS
Seksio sesariadarurat< 5
menit
Jika uterus gravid
di atas umbilikus
> kompresiaortocaval >
mengganggu
hemodinamik
Pertimbangkan
histerektomi
Hipotermia
terapeutik
sebagai
perawatan post
henti jantung
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No modifications to standard BLS or ACLS care havebeen proven efficacious, although techniques may
need to be adjusted due to the physical attributes of
individual patients
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Emergencyechocardiography
may be helpful in
determining the
presence of
thrombus or PE
ACLS
Modification
Fibrinolytics
Percutaneous
mechanical
thrombectomy
Surgical
embolectomy
Pulmonary
Embolism
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Potassium(K+)
HyperkalemiaHypokalemia
Sodium
(Na+)
Unlikely to lead
to cardiac arrest
Magnesium
(Mg++)
Hypermagnesemia
(>2,2 meq/L)
Hypomagnesemia
( Calcium gluconate [10%]15-30 mL IV 2-5 minutes
->Bolus MgSO4 IV 1-2 gr
ElectrolyteDisturbance
Use of calcium chloride [10%] 5-10 mL or calciumgluconate [10%] 15-30 mL IV over 2-5 minutes is
suspected as the cause of cardiac arrest
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Definition
Serum potassium
concetration >6,5
mmol/L
Commonly
from
Renal failure
Release of
potassium from
cells
Manifesta-
tion
Flaccid paralysis,
paresthesia, depressed
tendon reflexes, orrespiratory difficulties
ECG: Peaked T wave
(tenting), flat P wave,
prolonged PR interval,
widened QRS
complexs, deep S
wave, and merging of Sand T waves
CausedArytmia
Cardiac arrest
Hyperkalemia
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Stabilize myocardial cell membrane:Calcium chloride (10%): 5 to 10 mL (500 to 1000 mg) IV over 2 to 5 minutes
or calcium gluconate (10%): 15 to 30 mL IV over 2 to 5 minutes
Shift potassium into cells:
Sodium bicarbonate: 50 mEq IV over 5 minutes Glucose plus insulin: mix 25
g (50 mL of D50) glucose and 10 U regular insulin and give IV over 15 to 30
minutes
Nebulized albuterol: 10 to 20 mg nebulized over 15 minute
Promote potassium excretion:
Diuresis: furosemide 40-80 mg IV
Kayexalate: 15 to 50 g plus sorbitol per oral or per rectum
Dialysis
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Alters thefunction of a
cellular
receptor, ion
channel,
organelle, or
chemicalpathway
Respiratory
depressionHypotension
Alteration of
cardiac
conduction
Single dose activated charcoal can be
administered within 1 hour of
poisoning
Multiple dose activated charcoal forpatient who have ingested a life
threatening amount of specific toxins
(carbamazepine, dapson,
phenobarbital,quinine or theophylin)
Charcoal should not be administered
for ingestion of caustic substances,
metals or hydrocarbon
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Naloxone administration should begin
with a low dose (0.04 to 0.4 mg)Opioid Toxicity
FlumazenilBenzodiazepines
High-dose insulin, or IV calciumsalts.-Blockers
Dopamine alone or in combination with
isoproterenolGlucagon
Insulin high dose
Calcium Channel Blockers
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One vial of antidigoxin Fab is
standardized to neutralize 0.5 mg of
digoxin
Digoxin
1 mL/kg of sodium bicarbonate solution(8.4%, 1 mEq/mL) IV as a bolus.Cocaine
Sodium bicarbonate boluses of 1 mL/kg
VasopressorCyclic Antidepressants
Consider 1.5 mL/kg of 20% long-chain
fatty acid emulsion as an initial bolus
epeated every 5 minutes untilcardiovascular stability is restored
Local Anesthetic Toxicity
A treatment regimen of 100% oxygen
and hydroxocobalamin, with or without
sodium thiosulfate
Hyperbaric Oxygen
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Modifikasi BLS
Multisystem trauma: jaw thrust
should be used instead of a head tilt
chin lift to stablish a patent airway
Ventilation should be provided
with a barrier device, a pocket mask
Stop any visible hemorrhage using
direct compression and appropriate
dressings
CPR and defibrillation as indicated
Modifikasi CLS
cricothyrotomy
VF and pulseless a
VT are treated with
CPR and
defibrillation
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Rewarm the victim immediately, passive rewarming
is generally adequate for patients with mild
hypothermia. Patient with moderate with a
perfusing rhythm, external warming techniques are
appropriate. Patient with severe hypotermia
successful rewarming with active external warming
techniques
Patients with mildhypothermia (34C[93.2F]),moderate (30C to34C [86F to 93.2F]),severe hypothermia (30C[86F])
Focus on interventions thatprevent further loss of heatand begin to rewarm thevictim immediatelyvasopresor (epinefrine orvasopresin)
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Causes of
avalanche-
related
death
Asphyxia
Trauma
Hypothermia
Combination
of the 3
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Recovery
From the
Water
Airway Breathing Circulation
The routine use of abdominal thrusts orthe Heimlich maneuver for drowning
victims is not recommended
If vomiting occurs, turn the victim to the
side and remove the vomitus using yourfinger, a cloth, or suction
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Electrical Shock
Tetanic skeletal muscle
contractions
Ventrikel fibrilation
Lightining Strikes
Simultaneously depolarizing the
entire myocardium
Respiratory arrest (thoracic
muscle spasm and suppressionof the respiratory center)
Producing extensive
catecholamine release
(hypertension, tachycardia)
Brain hemorrhages, edema, andsmall-vessel and neuronal injury
Hypoxic encephalopathy
Standard BLS resuscitation care -> early intubation should be performed for
patients with evidence of extensive burns -> Fluid administration should beadequate
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Mechanical CPR
During PCI
Cough CPR
Intracoronary
Verapamil
Emergency
Cardiopulmo
nary Bypass
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Rapid diagnosis and drainage of the pericardial fluid are
required to avoid cardiovascular collapse. Pericardiocentesisguided by echocardiography is a safe and effective method
of relieving tamponade in a nonarrest setting
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Cardiac surgery
Ventricularfibrillation,
hypovolemia,
cardiac
tamponade, or
tension
pneumothorax
Resternotomy
and internal
cardiac
compression
Extracorporeal
membraneoxygenation and
cardiopulmonary
bypass +
Pharmacological
Intervention
(epinephrine and
antiarrhythmics)
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THANK YOU
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