<![CDATA[Background: A patient with Spontaneous Intracerebral Hemorrhage (sICH) has a high risk of experiencing arrhythmia and can cause cardiac arrest.Objective: To determine the nursing problem, management, and nursing role of sICH patient with arrhythmia in the Emergency Department. Case report: A 54-year-old woman came to the ER with GCS E1V2M5, blood pressure 162/106 mmHg, HR 62 times/minute regularly, SpO2 98%, RR 22 times/minute, and a history of sudden loss of consciousness, seizures and vomiting. The previous complaint of headache was denied. Positive Babinski reflex and lateralization to the right were found. After 2 hours of treatment in the ER, the patient experienced arrhythmia and cardiac arrest. CPR was performed for 3 cycles then ROSC with blood pressure of 54/30 mmHg.Outcome: The main nursing problem is a risk of ineffective cerebral tissue perfusion and decreased cardiac output. Acute management of sICH in the ER includes hemostasis management, ICP management, and monitoring. When a patient has cardiac arrest with an asystole rhythm, treatment is carried out according to AHA guidelines, then ROSC with a BP of 54/30 mmHg. Management of hypotension is directly carried out by administering vasopressors regarding the sICH experienced by the patient. Nursing interventions are carried out include management of sICH, management of asystole, and management of post-ROSC hypotension. Conclusion: The acute management of sICH, cardiac arrest, and post ROSC in the ER had been carried out according to the existing algorithm by the nurses as per their roles. At the end of the intervention, the patient had experienced a decrease in consciousness to coma with GCS E1V1M1, BP 133/93 mmHg, MAP 106 mmHg, SpO2 100% with ventilator mode PSIMV PC 14 I: E 1: 2 PEEP 5 FiO2 90 RR 14. This could be caused by complications experienced by the patient in the form of cardiac arrest which was supported by a history of hypertension.INTISARILatar belakang: Pasien dengan kondisi Spontaneous Intracerebral Haemorrhage (sICH) memiliki risiko tinggi untuk mengalami aritmia dan dapat menyebabkan cardiac arrest.Tujuan: Mengetahui masalah keperawatan, penatalaksanaan, dan peran perawat dalam pengelolaan pasien stroke hemoragik dengan aritmia, di Instalasi Gawat Darurat RSA UGM, Yogyakarta.Laporan kasus: Seorang wanita usia 54 tahun datang ke IGD dengan GCS E1V2M5, tekanan darah 162/106 mmHg, HR 62 kali/menit reguler, SpO2 98%, RR 22 kali/menit, serta riwayat penurunan kesadaran mendadak, kejang, dan muntah. Keluhan nyeri kepala sebelumnya disangkal. Ditemukan refleks Babinski positif dan lateralisasi ke kanan. Setelah 2 jam perawatan di IGD, pasien lalu mengalami aritmia dan cardiac arrest. Dilakukan RJP 3 siklus, kemudian ROSC dengan tekanan darah 54/30 mmHg.Hasil: Masalah keperawatan utama, yaitu risiko tidak efektifnya perfusi jaringan otak dan penurunan curah jantung. Penatalaksanaan akut sICH di IGD yang dilakukan berupa manajemen hemostasis, manajemen ICP, dan monitoring. Saat pasien mengalami cardiac arrest dengan irama asystole, dilakukan tata laksana sesuai panduan AHA, lalu ROSC dengan TD 54/30 mmHg. Manajemen hipotensi langsung dilakukan dengan pemberian vasopressor berkenaan dengan sICH yang dialami pasien. Intervensi keperawatan yang dilakukan di antaranya manajemen sICH, manajemen asystole, dan manajemen hipotensi post ROSC. Simpulan: Tata laksana akut sICH, cardiac arrest, dan post ROSC di IGD sudah dilakukan sesuai dengan algoritma yang ada dan perawat telah melaksanakan intervensi sesuai dengan perannya. Di akhir intervensi, pasien mengalami penurunan kesadaran menjadi koma dengan GCS E1V1M1, TD 133/93 mmHg, MAP 106 mmHg, SpO2 100% dengan ventilator mode PSIMV PC 14 I:E 1:2 PEEP 5 FiO2 90 RR 14. Hal tersebut dapat disebabkan karena komplikasi yang dialami pasien berupa cardiac arrest dan riwayat hipertensi yang dialami pasien.]]>
