Slide Jurnal Anestesi

8/10/2019 Slide Jurnal Anestesi

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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


2/27

Bronchoconstriction

Airway inflammation

Mucous plugging

Pathophysiology

WheezingClinical aspect


3/27

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


4/27

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.


6/27

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


7/27

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


8/27

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


9/27

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


10/27

Emergencyechocardiography

may be helpful in

determining the

presence of

thrombus or PE

ACLS

Modification

Fibrinolytics

Percutaneous

mechanical

thrombectomy

Surgical

embolectomy

Pulmonary

Embolism


11/27

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


13/27

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


14/27

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


15/27

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


16/27

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


17/27


18/27


19/27

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


20/27

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)


21/27

Causes of

avalanche-

related

death

Asphyxia

Trauma

Hypothermia

Combination

of the 3


22/27

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


23/27

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


25/27

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


26/27

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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