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Cardiorespiratory arrest

TANDA DAN GEJALA


o Tanda- tanda cardiac arrest menurut Diklat Ambulans Gawat Darurat
118 (2010) yaitu:

a. Ketiadaan respon; pasien tidak berespon terhadap rangsangan suara,


tepukan di pundak ataupun cubitan.
b. Ketiadaan pernafasan normal; tidak terdapat pernafasan normal
ketika jalan pernafasan dibuka.
c. Tidak teraba denyut nadi di arteri besar (karotis, femoralis, radialis).
Sometimes other signs and symptoms precede sudden
cardiac arrest. These may include fatigue, fainting,
blackouts, dizziness, chest pain, shortness of
breath, weakness, palpitations or vomiting. But
sudden cardiac arrest often occurs with no
warning.
Prior to cardiac arrest, some patients report the following symptoms
or warning signs in the weeks before the
event:
Chest pain
Weakness
Pounding in the chest
Feeling faint

Diagnosis

Clinical evaluation

Cardiac monitor and ECG

Sometimes testing for cause (eg, echocardiography, chest x-ray, or chest


ultrasonography)

Diagnosis is by clinical findings of apnea, pulselessness, and unconsciousness. Arterial


pressure is not measurable. Pupils dilate and become unreactive to light after several
minutes.
A cardiac monitor should be applied; it may indicate ventricular fibrillation (VF),
ventricular tachycardia (VT), or asystole. Sometimes a perfusing rhythm (eg, extreme
bradycardia) is present; this rhythm may represent true pulseless electrical activity
(electromechanical dissociation) or extreme hypotension with failure to detect a pulse.
The patient is evaluated for potentially treatable causes; a useful memory aid is "Hs and Ts":

H:Hypoxia, hypovolemia, acidosis (hydrogen ion), hyperkalemia


or hypokalemia, hypothermia,hypoglycemia

T:Tablet or toxin ingestion, cardiac tamponade, tension


pneumothorax, thromboembolism (massive pulmonary embolus), trauma

Unfortunately, many causes are not identified during CPR. Clinical examination, chest
ultrasonography, and chest x-ray can detect tension pneumothorax. Cardiac
ultrasonography can detect cardiac contractions and recognize cardiac tamponade, extreme
hypovolemia (empty heart), right ventricular overload suggesting pulmonary embolism, and
focal wall motion abnormalities suggesting MI. Rapid bedside blood tests can detect abnormal
levels of K or glucose. History given by family or rescue personnel may suggest overdose.

DIAGNOSIS BANDING
o Heart attack (Miocardial Infark)

penatalaksanaan
o

CPR

Defibrillation

When possible, treatment of primary cause

Postresuscitative care

Rapid intervention is essential.


CPR (see see Cardiopulmonary Resuscitation (CPR) in Adults) is an organized, sequential
response to cardiac arrest; rapid initiation of uninterrupted chest compressions ("push hard
and push fast") and early defibrillation of patients who are in VF or VT (more commonly
adults) are the keys to success.
In children, who most often have asphyxial causes of cardiac arrest, the presenting rhythm is
typically a bradyarrhythmia followed by asystole. However, about 15 to 20% of children
(particularly when sudden cardiac arrest has not been preceded by respiratory symptoms)
present with VT or VF and thus also require prompt defibrillation. The incidence of VF as the
initial recorded rhythm increases in children > 12 yr.
Primary causes must be promptly treated. If no treatable conditions are present but cardiac
motion is detected or pulses are detected by Doppler, severe circulatory shock is identified,
and IV fluid (eg, 1 L 0.9% saline, whole blood, or a combination for blood loss) is given. If
response to IV fluid is inadequate, most clinicians give one or more vasopressor drugs
(eg, norepinephrine, epinephrine, dopamine,vasopressin); however, there is no firm proof
that they improve survival.
In addition to treatment of cause, postresuscitative care typically includes methods to optimize
O2delivery, antiplatelet therapy, and therapeutic hypothermia.

PENCEGAHAN
o There's no sure way to know your risk of sudden cardiac
arrest, so reducing your risk is the best strategy. Steps to
take include regular checkups, screening for heart
disease and living a heart-healthy lifestyle with the
following approaches:

Don't smoke, and use alcohol in moderation (no more than


one to two drinks a day).

Eat a nutritious, balanced diet.

Stay physically active.

If you know you have heart disease or conditions that make you
more vulnerable to an unhealthy heart, your doctor may
recommend that you take appropriate steps to improve your health,

such as taking medications for high cholesterol or carefully


managing diabetes.
In some people with a known high risk of sudden cardiac arrest
such as those with a heart condition doctors may recommend
anti-arrhythmic drugs or an implantable cardioverter-defibrillator
(ICD) as primary prevention.
If you have a high risk of sudden cardiac arrest, you may also wish
to consider purchasing an automated external defibrillator (AED) for
home use. Before purchasing one, discuss the decision with your
doctor. AEDs can be expensive and aren't always covered by health
insurance.
If you live with someone who is vulnerable to sudden cardiac arrest,
it's important that you be trained in CPR. The American Red Cross
and other organizations offer courses in CPR and defibrillator use to
the public. Being trained will help not only your loved one but also
those in your community. The more people who know how to
respond to a cardiac emergency, the more the survival rate for
sudden cardiac arrest can be improved