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ACLS 2010

dr. Rainhard Octovianto


Puskesmas Kecamatan Pasar
Rebo

Misconception
ACLS 2005 vs ACLS 2010
A-B-C C-A-B
Identification of Agonal Gasp
Activation of Emergency System
Emphasis on high quality CPR
Compression + 100x / min Min
100x / min
6. Pulse check after CPR
7. Hands only CPR suggestion
8. One helper vs Team Resuscitation
1.
2.
3.
4.
5.

A-B-C C-A-B
2005 Airway Breathing Circulation
2010 Circulation Airway Breathing
Why ?
Most patient of cardiac arrest VF & Pulseless
VT A-B-C algorithm delays early compression
& defibrilation
Research resuscitation starting with 30
compression instead of ventilation comes with
better output
Research delay in chest compression in
cardiac arrest reduced survival rate

Identification of Agonal
Gasp

Identification of Agonal
Gasp
2005 CPR only be given to patient with
apneu / respiratory arrest
2010 CPR be given to patient with
apneu or gasping only
Why ?
Various cardiac arrest cases start with agonal
gasp instead of respiratory arrest / apneu
Research early compression on gasping
patient increase survival rate

Activation of Emergency
System

Activation of Emergency
System
2005 Activated as soon as finding an
unconscious patient
2010 Activated as respiratory arrest or
gasping is confirmed on an unconscious
patient.
Why ?
Most patient of cardiac arrest comes with
unconsciousness and respiratory arrest or
gasping 2 pieces of key information is required

Emphasis of High Quality


CPR
2005 Not mentioned
2010 :
Minimum 100 x/min
Minimum depth of 5 cm
Perfect chest recoil
Minimum interruption
Prevent Hyperventilation

Why ?
High quality CPR increase survival rate

Minimum compression of 100x/min


2005 Chest compression of approximately
100x/min
2010 Chest compression of min 100 x/min
Why ?
Research More frequency of compression
associated w/ better survival rate
Minimum compression of 100x/min is one of
many aspects of high quality CPR all must be
performed to achieve best result

Pulse Check after CPR


2005 due to any circumstances perform
pulse check after 5 cycle of CPR
2010 carotid pulse check only to be
performed if the monitor doesnt show VF , VT
or Asystole
Why ?
Most of VF , VT and Asystole cases comes without
pulse
Always perform minimum interruption for chest
compression rules

One Helper vs Team


Resuscitation
2005 no difference between one
helper and team resuscitation
2010 a new ventilation technique
for one helper & no cycle applied on
patient with patent airway support
Why ?
Always perform minimum interruption for
chest compression rules

Cardiac Arrest Algorithm


Cases :
1.Ventricular Fibrillation
2.Pulseless Ventricular Tachycardia
3.Asystole
4.Pulseless Electrical Activity

Shockable

VF

VT
Non - Shockable

Asystole

PEA

What if ROSC occurs ?

Airway
&
Breathing

Circulatio
n
5H & 5T

5H & 5T
5H :
1. Hypothermia
Thermometer
2. Hypoxia O2 Saturation
3. Hypovolemia Hb vs HT
4. Hypo/Hyperkalemia
Electrolit
5. Hydrogen / Acidity BGA

NonInvasive
Invasiv
e

5H & 5T
5T
1. Tension Pneumothorax
Physical Exam
2. Tamponade , Cardiac & Rontgen
3. Thrombosis PulmonarPhysical Exam ,
4. Thrombosis Cardiac Blood Analysis &
EKG
5. Toxin
Blood Analysis

Acute Coronary Syndrome


Algorithm
Cases :
1.Unstable Angina (UAP)
2.Non - ST Elevation Miocard Infark
(NSTEMI)
3.ST Elevation Miocard Infark
(STEMI)

1. Onset > 20 min


2. Pain quality 10/10
3. Feels like chest
being compressed
/ burned
4. Pain refers to
neck , shoulder ,
mandible or
epigastric
5. Occurs during
resting
6. Accompanied with
nausea , vomiting
, headache &
sweating

IOL

MONA
Blood
Analysis ,
EKG & Xray

1. Haemoragic
Fibrinolytic Checklist
Stroke

Facial
Trauma <
3 Months

Aorta
Dissecti
on

2. Ischemic
Stroke (> 3
hr , < 3
Months)
3. Intracranial
Tumor
4. AVM

1. Massive
Abdominal
Bleeding
2. Clotting
Problem

Thank You