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ACLS 2010
dr. Rainhard Octovianto
Puskesmas Kecamatan PasarRebo
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v
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Misconception
ACLS 200 vs ACLS 2010
1. A!"!C C!A!"
2. #denti$cation o% A&ona' (asp
). Activation o% *mer&enc+ S+stem,. *mphasis on hi&h -ua'it+ CPR
. Compression 100/ min Min100/ min
. Pu'se check a%ter CPR
. 3ands on'+ CPR su&&estion
4. One he'per vs 5eam Resuscitation
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A!"!C C!A!"
• 200 Air6a+ 7 "reathin& 7 Circu'ation
• 2010 Circu'ation 7 Air6a+ 7 "reathin&
• 8h+ 9 – Most patient o% cardiac arrest :; < Pu'se'ess
:5 A!"!C a'&orithm de'a+s ear'+ compression< de$bri'ation
– Research resuscitation startin& 6ith )0compression instead o% venti'ation comes 6ithbetter output
– Research de'a+ in chest compression in
cardiac arrest reduced surviva' rate
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#denti$cation o% A&ona'(asp
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#denti$cation o% A&ona'(asp
• 200 CPR on'+ be &iven to patient 6ithapneu respirator+ arrest
• 2010 CPR be &iven to patient 6ith
apneu or &aspin& on'+
• 8h+ 9
–:arious cardiac arrest cases start 6ith a&ona'&asp instead o% respirator+ arrest apneu
– Research ear'+ compression on &aspin&patient increase surviva' rate
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Activation o% *mer&enc+S+stem
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Activation o% *mer&enc+S+stem
• 200 Activated as soon as $ndin& anunconscious patient
• 2010 Activated as respirator+ arrest or
&aspin& is con$rmed on an unconsciouspatient.
• 8h+ 9 – Most patient o% cardiac arrest comes 6ith
unconsciousness and respirator+ arrest or&aspin& 2 pieces o% ke+ in%ormation is re-uired
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*mphasis o% 3i&h =ua'it+CPR
• 200 >ot mentioned
• 2010 ?
– Minimum 100 /min
– Minimum depth o% cm – Per%ect chest recoi'
– Minimum interruption
– Prevent 3+perventi'ation
• 8h+ 9
– 3i&h -ua'it+ CPR increase surviva' rate
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Minimum compression o% 100/min
• 200 Chest compression o% appro/imate'+100/min
• 2010 Chest compression o% min 100 /min
• 8h+ 9 – Research More %re-uenc+ o% compression
associated 6 better surviva' rate
– Minimum compression o% 100/min is one o%man+ aspects o% hi&h -ua'it+ CPR a'' must beper%ormed to achieve best resu't
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Pu'se Check a%ter CPR
• 200 due to an+ circumstances per%ormpu'se check a%ter c+c'e o% CPR
• 2010 carotid pu'se check on'+ to be
per%ormed i% the monitor doesn@t sho6 :; :5or As+sto'e
• 8h+ 9
– Most o% :; :5 and As+sto'e cases comes 6ithoutpu'se
– A'6a+s per%orm minimum interruption %or chestcompression ru'es
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One 3e'per vs 5eamResuscitation
• 200 no diBerence bet6een onehe'per and team resuscitation
• 2010 a ne6 venti'ation techni-ue%or one he'per < no c+c'e app'ied onpatient 6ith patent air6a+ support
• 8h+ 9 – A'6a+s per%orm minimum interruption %or
chest compression ru'es
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Cardiac Arrest Algorithm
Cases ?1.:entricu'ar ;ibri''ation2.Pu'se'ess :entricu'ar 5ach+cardia
).As+sto'e,.Pu'se'ess *'ectrica' Activit+
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Shockab'e
>on ! Shockab'e
:; :5
As+sto'e P*A
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What if ROSC occurs ?
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Air6a+<
"reathin&
Circu'atio
n3 < 5
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3 < 5
3 ?
1.3+pothermia 5hermometer
2.3+po/ia O2 Saturation
). 3+povo'emia 3b vs 35
,. 3+po3+perka'emia
*'ectro'it
. 3+dro&en Acidit+ "(A
>on!#nvasive
#nvasive
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3 < 5
5
1. 5ension Pneumothora/
2. 5amponade Cardiac). 5hrombosis Pu'monar
,. 5hrombosis Cardiac
. 5o/in
Ph+sica' */am
< Ront&enPh+sica' */am "'ood Ana'+sis <
*K("'ood Ana'+sis
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Acute Coronary SyndromeAlgorithm
Cases ?1.nstab'e An&ina DAPE2.>on ! S5 *'evation Miocard #n%ark
D>S5*M#E).S5 *'evation Miocard #n%arkDS5*M#E
. nse > m ni li
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#OL
"'oodAna'+sis
*K( < Fra+
MO>A
2. Pain uality 10!10". #eels li$e chest
%eing com&ressed! %urned
'. Pain refers tonec$ ( shoulder (
mandi%le ore&igastric
). Occurs duringresting
*. Accom&anied +ithnausea ( ,omiting
( headache -s+eating
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;ibrino'+tic Check'ist1. aemoragicStro$e
2. /schemicStro$e > "
hr ( "onths3
". /ntracranial4umor
'. A5
#acial4rauma " onths
Aorta
6issection
1. assi,eA%dominal7leeding
2. ClottingPro%lem
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5hank Gou