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JPFIHA
EDUCATION
1980-1987 Medical, Airlangga University, Surabaya (M.D.)
1995-2001 Residency (Cardiology), Airlangga University, Surabaya
2012-present Post-graduate Programme, Brawijaya University,
Malang
MEDICAL SOCIETIES
2001-present Member, IHA
2009-present Member, HFA-ESC
2014-present Fellow, ASEAN College Of Cardiology
HOSPITAL APPOINTMENTS
2001-present Cardiologist, Sidoarjo General Hospital, Sidoarjo
Hairudi Sugijo, MD
Medical Error
is the fifth leading cause of death in US
Wrong Indication
Wrong Contra-indication
Wrong Dose
Wrong preparation
Wrong Route
Bless
Curse
Epinephrine
Vasoconstriction
Inotropic +
Vasodilatation
Amiodarone
Class III agents significantly prolong the action potential duration (APD) by
blocking IKr , resulting in an increased Effective Refractory Period (ERP),
making ERP greater than the conduction time (CT) around a reentrant
circuit. This effect can prevent or abolish reentry.
Magnesium Sulfate
Magnesium Sulfate
1-2g (2-4ml of 50% magnesium
sulphate) (diluted in 10 mL D5W)
slow IV over 1 - 2 minutes
can be repeated in 5-15 minutes.
maintenance: 1-2 g/hr IV for 12-24
hours
Adverse reactions
Drowsiness, CNS depression,
respiratory depression
Hypotension / Shock
Hypotension / Shock
Norepinephrine (Noradrenaline)
Potent alpha-agonist
Vasoconstriction
Inotropic +
Vasodilatation
Dopamine
Dopamine
Hypotension / Shock
Dobutamine
Hypotension / Shock
Nitroglycerine
Diluted in D5 or NS solution
Symptomatic Bradycardia
Sulfas Atropine
Anticholinergic drug
(parasympatholytic )
competitive antagonist
for the muscarinic
acetylcholine receptor
types M1-M5.
M2 found in the heart
( SA node & AV node )
It is usually not effective in second degree heart block mobitz type 2 and in
third-degree heart block with a low Purkinje or ventricular escape rhythm
Dopamine
Epinephrine
Vasoconstriction
Inotropic +
Vasodilatation
Supraventricular Tachyarrhthmia
Adenosine
Adenosine
Initial dose : 6 mg given as a rapid iv
bolus followed by rapid flush with 20
mL NS
if no conversion within 1-2 minutes
give 12 mg iv. Maximal total dose
30mg.
Don't administer through central line
(may cause asystole)
Don't dilute Adenocard.
should be avoided in patients with
bronchospasm (e.g., asthma).
Diltiazem
Blocks calcium channel
slow
atrioventricular
(AV)
nodal
conduction time and prolong AV nodal
refractoriness
interrupting the re-entry circuit in AV
nodal re-entrant tachycardias and
reciprocating tachycardias, e.g. WolffParkinson-White syndrome (WPW).
Decrease inward calcium current
decrease rate of phase 4 spontaneous
depolarization
slows the ventricular rate in patients
with a rapid ventricular response
during atrial fibrillation or atrial flutter
(AF/FL).
Diltiazem
Diluted in Normal Saline, D5W, or
D5W/0.45% NaCl.
The initial dose should be 0.25 mg/kg
body weight as a bolus administered
over 2 minutes.
If response is inadequate after 15
minutes , a second dose 0.35 mg/kg
body weight administered over two
minutes.
initial infusion rate of Diltiazem
Hydrochloride Injection is 5 - 15
mg/hr.
Digoxin
are potent inhibitors of cellular
Na+/K+-ATPase intracellular
sodium intracellular calcium
via the Na+-Ca++exchange
system calcium bind to
troponin-C contractility
increase vagal efferent activity to
the heart. negative chronotropy
and negative dromotropy.
increases the effective refractory
period within the atrioventricular
node.
Digoxin
diluted with a 4-fold or greater volume of Sterile
Water for Injection, 0.9% NS, or 5% Dextrose
Injection.
Initial dose : 500 mcg of digoxin intravenously.
Additional doses of 250 mcg may be given
cautiously at 6 to 8 hour intervals until clinical
evidence of an adequate effect is noted.
The injectable route is frequently used to achieve
rapid digitalization, with conversion to digoxin
tablets for maintenance therapy.
have a relatively narrow therapeutic safety
window.
side effects : anorexia, nausea, vomiting,
diarrhea,
AV
Ventricular Tachyarrhythmia
Amiodarone
150
mg
IV
(diluted in D5W) over 10 min,
repeat as needed. Followed by
360 mg over the next 6 hours (1
mg/min).
Maintenance infusion: 540 mg
over the remaining 18 hours
(0.5 mg/min).
Lidocaine is a second-line
choice: 1-1.5 mg/kg IV bolus
(diluted in D5W) followed by 14mg/min.
If
torsades
de
pointes
:
Furosemide
Furosemide
Furosemide 0.5-1 mg/kg
IV over 1-2
minutes; may be increased to 80 mg if there
is no adequate response within 1 hour.
a
continuous
furosemide
infusion
is
generally to be preferred to repeated bolus
injections. A rate of 4 mg per minute must
not be exceeded.
In patients with severe impairment of renal
function
(s.creat>5mg/dl),
it
is
recommended that an infusion rate of 2.5
mg per minute is not exceeded.
The recommended maximum daily dose of
furosemide administration is 1,500 mg.
Morphine
Advantage :
Venodilator venous return ventricular
preload
Arteriodilator afterload
Sedative effect
Side effect :
Respiratory depression
severe hypotension
should not be used routinely in the treatment
of acute pulmonary oedema
Dose : IV 14 mg, repeated doses (up to every
5 minutes if necessary). Maximal dose 10 mg
Must be diluted in 5% dextrose
First, Do No Harm
Physicians take an oath to care for their patients
to their full ability, to treat them with respect
and dignity, and treat them as whole persons
Thank You