Ppt - Ppgd Ekg Perawat 2011 Rev
Transcript of Ppt - Ppgd Ekg Perawat 2011 Rev
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ELECTROCARDIOGRAMELECTROCARDIOGRAMPENANGANAN PENDERITA GAWAT DARURAT
PERHIMPUNAN KEDOKTERAN GAWAT DARURAT
INDONESIA
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Jantung
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Sistem Konduksi Jantung
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Electrocardiogram - ECG• Electrocardiogram :
Rekaman (gram) aktivitas listrik
(electro) sel-sel otot jantung(cardio) yang sampai ke permukaantuu!
• "on invasi#
• $uda!% mura!% cepat
• Seder!ana% cukup ermakna
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Electrocardiogram
&eragai kelainan yang dapat dinilai dariECG :
• 'emesaran ruang jantung
• ipertro otot jantung
• *ritmia + gangguan irama
• Gangguan aliran pemulu! dara! koroner
• Kematian otot jantung - lokasi• Gangguan elektrolit
• ,ain-lain (miscellaneous)
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ECG + . Sandapan :
Sandapan Ekstremitas (/)Sandapan 0ada (/)
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Sandapan Ekstremitas :Sandapan Standard (1)
Sandapan *ugmentasi (1)
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ECG + 2 Sandapan :Sandapan Kanan ()
Sandapan 'osterior (.)
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Kertas ECG
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Konversi
kotak kecil 3 4%45 detik
kotak esar 3 2 kotak kecil 3 4%.
detik detik 3 677 Kotak esar 3 677 Kotakkecil
menit 3 77777 Kotak esar 3 77777 Kotakkecil
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8 ,ayak &aca 8
9dentitas : "ama% umur% se% (ras)% tanggal% ;aktu
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*nalisis Gamaran EKG
- 9rama : reguler + ireguler
- <rekuensi : normal + cepat + lamat
- Gelomang ' : ada + tidak ada
- 9nterval 'R : normal + memanjang +
memendek
- Gelomang =RS : lear + sempit
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Sistematika memaca
EKG• 9rama >)
• <rekuensi denyut jantung ? regularitas
• $or#ologi gelomang '• 9nterval 'R
• $or#ologi kompleks =RS
• $or#ologi segmen S@
• $or#ologi gelomang @• $or#ologi gelomang A
• 9nterval =@c
• Rhythm
• Rate & regularity
• P wave morphology
• PR interval• QRS complex
morphology
• ST segment morphology
• T wave morphology • U wave morphology
• QTc interval
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9rama
• R-R interval% '-' interval
• @eratur (reguler) : interval sama
• @idak teratur (ireguler) : interval tidak
sama
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<rekuensi + R (@eratur)
Fre!e"#i
144BBBBBB
kotak esar R-R
BB BB244B BBBB
kotak kecil R-R
Kecepatan standar .2mmDdetik
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<rekuensi + R (@idak
@eratur)Fre!e"#i
• Strip / detik :
komp7 =RS 4
• Strip . detik : komp7 =RS 2
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*ksis
*ksis : jumla! total seluru! arus listrik yang
terentuk di ventrikel saat depolarisasi
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*ksis F
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Normal Si"!# R$%t$m &NSR'Irama Si"!# Normal
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*ritmia
Tidak memenuhi kriteria NSRTidak memenuhi kriteria NSR Aritmia Aritmia
(Disritmia)(Disritmia)
Gangguan pembentukan impulsGangguan pembentukan impulsGangguan penghantaran impulsGangguan penghantaran impuls
Sumber impuls : SA node, atrium,Sumber impuls : SA node, atrium,
AV node (un!tion), "entrikel AV node (un!tion), "entrikel
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Sinus &radycardia (S&)
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Sinus @ac!ycardia (S@)
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Sinus *rr!yt!mia
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*trial <irillation (*<)
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*trial <lutter (*#)
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*trial <irillation + *trial
<lutterFre!e"#i
• /4 Dm : slo; response (SHR)
• /4-44 Dm: normo response ("HR)
• I44 Dm : rapid response (RHR)
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Supraventricular @ac!ycardia (SH@)
• 9rama teratur% R I 24 Dm• Gelomang ' kecil% kadang (-)
• 9nterval 'R memendek atau (-)%
• Kompleks =RS 4%. detik (sempit)
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Supraventricular @ac!ycardia
(SH@)
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*trial @ac!ycardia (*@)
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Junctional R!yt!m (JR)
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Accelerated (!"ctio"al R$%t$m
&Acc (R'
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Idio)e"tric!lar R$%t$m &I*R'
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*ccelerated 9dioventricular
R!yt!m (*cc 9HR - *9R)
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*e"tric!lar E+tra#%#tole &*ES'
Premat!re *e"tric!lar Co"tractio"&P*C'
• 9rama tidak teratur% karena ada extrasystole
• R tergantung irama dasar
• Gelomang ' (-)% 9nterval 'R (-)
• Kompleks =RS I 4%. detik (lear)
HES uni#ocal% multi#ocal
HES coupled% triplet% consecutive (Salvo)
HES igeminal% trigeminal% uadrigeminal
HES R on @
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Hentricular Etrasystole (HES)Ani#ocal
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Hentricular Etrasystole (HES)$ulti#ocal
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Hentricular Etrasystole (HES)Coupled
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Hentricular Etrasystole (HES) @riplet
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Hentricular Etrasystole (HES)&igeminal
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Hentricular Etrasystole (HES)=uadrigeminal
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Hentricular Etrasystole (HES)R on @
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Hentricular <irillation (H<)
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*e"tric!lar Fi,rillatio" &*F'
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Hentricular @ac!ycardia (H@)
• 9rama teratur% R I44 Dm
• Gelomang ' (-)% 9nterval 'R (-)
• Kompleks =RS I 4%. detik (lear)
• $onomorp!ic% Torsade de Pointes
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@orsade de 'ointes
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Hentricular *systole
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<irst 0egree *H &lock
• 'erlamatan atauostruksi transmisi
impuls dari atriumke ventrikel(conduction delayin the AV junction)
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<irst 0egree *H &lock
• 9rama teratur% R umumnya /4-44 Dm
• Gelomang ' normal% ' : =RS 3 :
• 9nterval 'R memanjang% I 4%.4 detik% konstan
• Kompleks =RS 4%. detik (sempit)
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Second 0egree *H &lock
• Seagian impuls dariatrium ter!amatsecara total pada *Hnode dan gagal untukditeruskan ke ventrikel
• Seagian gelomang' tidak diikutikompleks =RS
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Seco"d Degree A* -loc
Mo,it. T%/e 0 &We"ce,ac$'
• Secara anatomisumumnya!amatan eradapada daera! 8di
atasL *H junction
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Seco"d Degree A* -loc Mo,it. T%/e 0 &We"ce,ac$'
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Seco"d Degree A* -loc
Mo,it. T%/e 1 • Secara anatomis
umumnya
!amatan eradapada daera! 8dia;a!L *H
junction
S d D A* -l
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Seco"d Degree A* -loc T%/e 1
• 9rama atrial teratur% irama ventrikel tidak teratur• <rekuensi * I <
• Gelomang ' normal% ada satu atau lei!gelomang ' tidak diikuti kompleks =RS• 9nterval 'R normal atau memanjang% namun
konstan• Kompleks =RS sempitDlear
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@!ird 0egree *H &lock
• antaran impulster!amat secara
total dari atriumke ventrikel
• ,okasi :
- AV junction
!undle o" #is
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@!ird 0egree *H &lock (@*H&)
• 9rama teratur• <rekuensi * I <% #rekuensi ventrikel tergantung
dari mana aktivitas erasal ( AV node $ Pur%inje'er )
• Gelomang ' entuk dan ukuran normal% adaeerapa gelomang ' yang tidak diikutikompleks =RS
• 9nterval 'R tidak dapat diukur karena tidak ada
!uungan antara gelomang ' dengan kompleks=RS
• Kompleks =RS sempit D lear tergantung darimana aktivitas erasal
,ear : dari ventrikel% sempit : dari *H node
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T$ird Degree A* -loc &TA*-'
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'enyakit Jantung Koroner
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02I#c$emia12I"3!r% 4 Ac!te i"5arctio"62I"5arctio" 4 Old
i"5arctio"
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9sc!emia + (9njury) + 9n#arction
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S@ 0epresi
30-40% error rate5-10% error rate Very low error rate
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1-30 minutes
A day or so
1 hour or so
Later changes
A few hours
A few months
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Evolusi
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,okasi
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"ormal EKG
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Diag"o#i# ECG 7
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