Bab I.First Aid: PPSDM Migas

No.
Dokumen FR-BDMDP-02
FIRST AID No. Revisi 0

Tgl. Berlaku 1 September 2017
PPSDM MIGAS Halaman 1 dari 31
BAB I.FIRST AID
1.1. Introduction
Providing immediate assistance / action to victims who have had accidents, injuries or who
suddenly experience illness that require basic medical care. Basic Life Support is a
treatment action that is based on the rules of medical science that can be owned by lay
people or special people who are trained to provide first aid, the limit is the certificate held
by first aid agents.
With Purpose :
1. Keep the victim/patient alive
2. Making condition the victim are stable.
3. Decrease the pain,inconveniences, dan anxiety.
1.2 Communication Place and Access Assessment

Aiming to obtain a general picture of the events faced and the factors that support or
inhibit first aid and assess the danger that might occur to the helper or victim / patient.
REMEBER : “DO NOT BECOME THE NEXT VICTIMS, PROTECT YOURSELF FIRST
AND USE YOUR SELF PROTECTIVE EQUIPMENT”.
LANGKAH-LANGKAH PENOLONG :
1. Do control.
2. Knowing danger situations.
a. Notice immediately what is being faced.
b. If there are witnesses who see the incident and ask how the accident could occur and
how many victims
c. If there probably injury to the victim said it “ DON’T MOVE ”.
d. Ask for help Radio Operator or the other communication tools to Call For Help. “DON’T
MOVE THE VICTIM EXCEPT THERE IS DANGER SITUATION”.
COMMUNICATION ACSESS must be done immediately when finding a victim or when
we have an accident using a radio operator, a traditional communication tool
(Kenthongan), yells for help, so that the person who hears it immediately helps do first
aid.
Dokumen ini milik Pusat Pengembangan Sumber Daya Manusia Minyak dan Gas Bumi “PPSDM MIGAS”, isi dari dokumen ini tidak diperkenankan untuk
digandakan atau disalin seluruh atau sebagian tanpa izin tertulis dari Pusat Pengembangan Su,mber Daya Manusia Minyak dan Gas Bumi “PPSDM MIGAS”
No. Dokumen FR-BDMDP-02

1.3 Awareness Assessment

Before we doing first aid, the helper must immediately to awarness assess to the victim’s
condition.
1. The Victim Awareness.

If we find the victim’s in the lying condition and unconscious,
the helper immediately to call the victim’s and slaps the
shoulder and said it “mr/mrs” to check awareness.
2. Check the pulse.

The helper must checks the carotid pulsed in the neck area,
which is two fingers from the adam’s apple toward the back.
Do it 5-10 second quickly. The location of checking the pulse
is the easiest :
a. Radial Pulse – Location on the wrist
b. Carotid Pulse – Location on the neck
c. Femoral Pulse – Location on groin
d. Brachialis Pulse - Being in the armpit (Baby) Every time
the heart beats, you can feel the pulse in the arterial system.
3.Victim’s Condition.
After have response and pulse, check the condition of victim’s by seeing bruises or bleeding
sored. The victim’s fully awareness was marked with the victim’s can spell the name without
reminded the helper, whereas if the victim cannot spell this name himself the victim’s is not
fully awareness / has a disturbance in his brain area.
1.4. Pre-hospital service ( before in hospital ) or help on the scene.
In general, everyone may do first aid, but inappropriate assistance will worsen the situation
of the victim, first aid can be done by several groups, including:
1.Common People :

This group is not trained or has little knowledge of first aid or just imitates what he has
seen and what he has heard.
2.Spescial lay people.
A person who does not have a medical education background but is trained specifically in
first aid matters.
Example : Red cross ten, Scout, Ambulance Driver, Police, Security dan mining company
workers or other private companies.
3.Medic
People who have a medical education background and has attended training in the field
of first aid emergency patients and has a certificate from the training.
1.5. Basic Life Suport
When someone drowns or has an accident or has a heart attack, suddenly another person
who sees it immediately pushes his chest and gives mouth-to-mouth breath. This may not
exist in Indonesia, the person who drowned was not even given artificial breath but instead
hit the stomach to remove the water. Actions like the above, abroad are common and often
done, because most of the residents there have been given education to carry out artificial
breathing actions and an indication of when these actions are needed. Artificial Breath also
called Heart Lung Resuscitation or Basic Life Aid or CPR (Cardio Pulmonary Resuscitation),
is a simple emergency action without using a tool to save one's life in a very short time. BLS
provide oxygen intake and blood circulation to the body system, especially those that are
very vital and sensitive to lack of oxygen such as the brain and heart. The speed of finding a
victim is very necessary because people who experience stop breathing and cardiac arrest
take less than 5 minutes, victims experience stop breathing and cardiac arrest / no
breathing and no pulse called clinical death, victims of stopping breath and cardiac arrest for
5 minutes do not get help, the victim will experience brain damage, whereas after 10
minutes there is no help, the victim will die biologically. Damage in the form of disability and even
death. This rescue will be very useful if done as soon as possible and as best as possible. It's better to
be helped, even though it's not perfect than being left without help. At the time of stopping
breathing, the oxygen content in the blood is still available a little, the heart is still able to
circulate it into important organs, especially the brain, if the situation is given breathing

assistance, the heart needs oxygen is available for metabolism and cardiac arrest can be
prevented.
BLS delay Chance of sucsess (Life)

1 minute 98 from 100 victim’s
Cases that cause cardiac arrest and respiratory arrest can occur anytime, anywhere and to
anyone. Therefore, the success or failure of CPR depends on the speed with
which the action is taken and precisely the technique performed.
Indicated :
1.Stop Breathing : Drowning, stroke,heart attack, chocking, airway obstructions
2.Cardiac arrest
- Febrile ventricle  Blood flow to the heart stopped pumping.
- Asistole  Blood pressure weakens, so that pumping by the heart stops /
decreases.
- Electromechanical dissociation  One of the organs stops, so that it can stop
the blood flow to the heart.
1.6. Respiratory System’s

The main purpose of the respiratory system is the body needs oxygen. The anatomy of the
respiratory system consists of:
1. Nose and mouth.
2. Airway (pharing, laring, Trachea)
3. Pulmonary (bronchus, bronchiolus, alveolus) .
4. Respiratory muscle’s (diaphragma and chest muscle’s )
How physiology we breathe? Initially the breathing muscles will contract. The diaphragm will
go down, and the chest muscle develops the chest cage. Because of the negative pressure
inside the chest cage, the lungs also expand so that the air is sucked into the lungs. Until
the oxygen alveoli we breathe will experience an exchange with carbon dioxide as a result

of metabolism. But not all oxygen will be absorbed by the body. From every air we breathe,
only about 4% is absorbed by the body, the remaining 16% -17% will be released through
breath (Note: Oxygen levels in free air are only 21%). So that our breath is still enough
oxygen to do breath relief. Breathing is controlled by the respiratory control center in the
brain stem. The main goal of treating respiratory disorders is to make it easier for patients to
breathe freely.
Some principles of handling respiratory disorders include :
a. Position the chest higher than the abdomen (sitting or half sitting, with or
without backrest). The goal is for the internal organs below the diaphragm to
go down slightly following the direction of gravity. This makes the diaphragm
free to move down so that breathing becomes easier. This position is not done
when :
 suspected injury to the neck or spine
 hip fracture or upper limb fracture (thigh) nearing the pelvis is suspected.
 the patient is unconscious
b. Slightly elevate the stretcher on the head. But must be careful, not too high
and make sure the patient is properly fixed.
c. Don't talk too much, sometimes we talk to people to calm their sufferers or try
to divert attention from their pain. But in cases of respiratory problems, we
should be a little as possible asking the sufferer because breathing is difficult,
what else is talking about.
1.7. Bleeding System

The circulatory system consists of three main components heart, blood vessels and
blood. In the human body relative blood is always in the blood vessels except when it
enters the tissue to exchange food and oxygen with the body's residual combustion and
carbon dioxide.
Heart ( cor ) is a cavity, a muscular organ that pumps blood through blood vessels by
repetitive rhythmic contractions.

Figure 3 : The anatomy of Heart

The term cardiac means relating to the heart, from Greek cardio to the heart. The heart is
one of the organs that play a role in the circulatory system. Serves as a blood pumping
device that pumps blood throughout the body. The left side receives blood that is rich in
oxygen after being processed from the lungs to then be circulated throughout the body. The
right side receives blood from the body and continues to the lungs to be re-enriched with
oxygen.
1.7.1. Source of bleeding

Bleeding occurs when blood comes out of a blood vessel by various causes such as injury
or disease.
Based on the source of bleeding:
A. Artery Bleeding ( Artery )
B. Vein Bleeding ( Vena )
C. Capiller Bleeding (Capillary)
A. Artery
Is a blood vessel that carries blood rich in oxygen throughout the body. The blood that
comes out is fresh red and radiates from the injured body. Bleeding to the arteries can
cause a critical condition, because blood is pumped out at speeds exceeding the average.
As a result, the victim will lose a lot of blood.

B. Vein
Is a blood vessel that transports blood from the entire body back to the heart. The blood
coming out flows spontaneously and is dark red.
C. Capillary
Arteries will be divided into smaller vessels so that they can reach closer to the skin. The
blood that comes out is very little and sometimes only in the form of bleeding points.
1.7.2. Type of Bleeding
Bleeding is divided into 2 types :
A. External Bleeding (Open), if the skin is also injured so that blood can come out of the
body and appear to be outside the body.
B. Internal Bleeding (Closed), if the skin is not damaged so that blood cannot flow
directly out of the body.
A. External Bleeding
To help estimate how much blood has come out of the patient's body, what is used is the
complaint of the victim and vital signs. If the victim's complaint has led to symptoms and
signs of shock, the helper must suspect that blood loss occurs in significant amounts.
External bleeding emergency assistance as follows :
1. Place a clean or sterile thick cloth such as a handkerchief, a towel or a sheet of cloth
directly on the injured area. Then press gently in the palm of your hand. If there is no
cloth, use your hands or fingers to press.
2. Continue pressing with constant pressure.
3. Do not remove the cloth used to press the wound.
4. If the blood has filled the fabric, do not remove it, but add it with a new cloth and place it
on top, then continue holding it with your hands again.
5. If the bleeding stops or decreases, use a bandage to tie it to the wound cover cloth.
6. The bandage strap is not too tight to avoid stopping arterial blood flow.
7. Try to wound in the position above the heart organ.
8. Using Torniquet
Tourniquet is only used in emergency situations where there is no other way to stop
bleeding. Tourniquet is applied as close as possible to the bleeding point.

B. Internal Bleeding
Deep bleeding can range from small scale to life-threatening sufferers. Blood loss cannot be
observed in internal bleeding.
If someone is hit by a blow, fall or other accident, we suggest that this possibility should be
anticipated. First Aid and Emergency Management.
Symptoms of internal bleeding are:
- Victims of vomiting are dark like coffee or deep red
- Blood coughing is fresh red and or foamy
- Black stools mixed with red blood - The face looks pale
- The body is cold or the skin feels moist
- Eyes Glow
- Enlarged stomach
- Anxiety
- Thirst
- Fear
- Confusion
Relief Emergency internal bleeding :
- Take care of the victim to keep breathing smoothly
- Keep the victim calm to avoid shock
- Don't move the victim if you have a wound in the head, neck and spine
- If there is no indication of injury and no shock, move it to sleep
- Do not give food or drink (in conditions of complete unconsciousness, aspiration or the
entry of food or drinks in the respiratory tract).
- Check the victim at any time if he experiences shock (the pulse is quickly weak or not
palpable, blood pressure drops).
1.8. SHOCK
Shock is a condition that arises where the body's circulatory system is disrupted so that it
cannot meet the body's needs. In this situation the body's vital equipment will lose fluid and
substances that it needs. The causes of shock are numerous and varied, knowing the truth
about the cause will greatly help his help.

Figure 4 : Recovery Position to bleeding
Symptoms include: :
1. Change in skin color
The skin is pale or grayish and feels cold and moist.
2. Pulse and breathing are irregular, fast and superficial.
Rapid pulse (<140 x / minute) then weakens, slowly & disappears.
3. The patient's eyes look sluggish and the view is empty, the pupils are wide so that the
black part in the center looks big.
4. Unconsciousness, dizziness, feeling anxious and thirsty.
5. The victim's lips look dry and there are complaints of thirst.
6. The victim’s look weak and fatigue.
Shock Management
Always consider the victim’s injury or to experience shock.
 Monitor the general condition and unconscious victims.
 Let the conscious victim to choice the comfortable positions.
 Don’t move the victim if it’s not needed
 Keep your head so that the neck doesn't move much
 Keep the victim’s body temperature.
1.9. Injuries due to burning

Is a type of wound, tissue damage or tissue loss caused by a source of heat or high cold
temperatures, electricity sources, chemicals, light, radiation. The types of injuries can be
diverse and have different treatments depending on the type of tissue affected by burns, the
severity, and the complications that occur due to these injuries. Burns can damage muscle
tissue, bones, blood vessels and epidermal tissue which results in damage that is in a
deeper place than the end of the innervation system.

Figure 5 : The degrees of wound Burning

A burn victim can experience various kinds of complications: fatal ones include shock,
infection, electrolyte imbalance (electrolyte inbalance) and respiratory distress problems. In
addition to complications in the form of physical, burns can also cause severe emotional
(trauma) and psychological distress due to disability due to burns and scars (scar).
1.9.1. Classification of Degrees of Burns
The classification of the degrees of burns that are widely used in the medical world is kind
"Superficial Thickness", "Partial Thickness" and "Full Thickness" where the division is based
on the extent to which burns cause injury to the epidermis, dermis or subcutaneous layer of
the skin. The classification of wounds is used to guide medication and predict prognosis.
New Old
Depth the wound burning Clinicaly
Classification Classification
Painfull like stung,

Superficial
First degree Epidermis erythema & blisters
thickness
(Liquid bubbles)
Blisters (liquid bubbles),

Partial thickness Epidermis Superficial Clear liquid when the
Second degree
— superficial (Lapisan papillary) dermis bubble is broken , and
painfully

Up to white layer, Not to pain

Partial thickness Deep (reticular) like superficial seconde
— deep dermis degree. difficult to distinguish
from full thickness
Heavy, the presence of

The dermis and body
Third or fourth eschar like melted skin,
Full thickness structure under the dermis
degree colored liquid, no pain
Fascia, Bone or Muscle
sensation
Tabel 1. Describe from classification of burns.

Burns must also be classified according to TBSA (total body surface area), taking into
account areas with partial thickness or full thickness burns (Superficial thickness burns are
not widely used).
The area of burns in the world of medicine estimates the area of burns that are widely used
is to use the rule of Nine method from wallace by dividing the body of a person affected by
burns into several areas.
First Aid :
1. If the victim is still burning, put out the fire using a blanket, bed cover, carpet, jacket or
other material. Do not remove clothing that is attached to the wound.

2. Sometimes the victim has difficulty breathing, especially if the wound is on the neck,
face and around the mouth, it can also be due to inhaling smoke, do an examination to
make sure the victim can breathe.
3. Attached a wet cloth or cold water to reduce the temperature in the wound area. Don't
use ice water for wounds on the face, hands and feet because it can cause shock.
4. Stream cold water on the affected part.
5. If the burn is due to chemicals, drain the water continuously for 20 minutes or more.
6. Remove clothes that are attached to the victim's body.
7. Cover the wound with a disposable sterile wound cover.
8. If the burns to the eye make sure both eyes are closed
9. If the fingers are burned, then wrap each finger separately.
Note :
• Don't smear the wound with lotion, soy sauce, butter or oil.
• Don't break bubbles due to burns.
• Do not use ointments, antiseptic liquids or ice.

BAB II. CARDIAC PULMONARY RESUSCITATION TECHNIC
2.1. Definition :
As an action taken to free the airway and provide circulation to stop breathing and cardiac
arrest where the heart fails to perform its function.
Cardiopulmonary resuscitation measures
are given only to people who experience
respiratory arrest and cardiac arrest
caused by a cause.
Airway obstruction is a factor that is often
experienced by people who are not aware
of the blockage caused by the base of the
tongue.
2.2. Cardiopulmonary Resuscitation Phase

Basic life support has often been introduced in emergency situations. In its development, the BLS
method has always undergone improvements. BLS is very useful for saving lives, given the
simple circulation and artificial breathing. CPR is a lifesaving effort on a series of cardiac
arrest. Cardiac arrest is a leading cause of death in several countries. Occurs both outside
the hospital and inside the hospital. It is estimated that around 350,000 people die per year
due to cardiac arrest in America and Canada. This estimate does not include those who are
estimated to have died from cardiac arrest and have not had time to be resuscitated.
Although efforts to conduct resuscitation have not always been successful, more
lives have been lost due to non-resuscitation. Most victims of cardiac arrest are
adults, but thousands of babies and children also experience it every year.
Cardiac arrest will remain a major cause of premature death, and small
improvements in its rescue efforts will be thousands of lives that can be
saved every year.
2.2.1. Step by step to Cardiacpulmonary Resuscitation

When American Heart Assocation (AHA) establishes the first guidelines for resuscitation in 1966
(CPR) initially "A-B-C" which is:
A Opend the airway victim’s ( Airway ).
B provide breathing assistance.
C provide chest wall compression (Circulation ).
However, the risk is to have a significant delay (approximately 30 seconds) to provide the
chest wall compression needed to maintain oxygen-rich blood circulation. In the 2010
American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care, the AHA emphasized the focus of basic life assistance
on:
1. Immediate recognition of sudden cardiac arrest [SCA].
2. Activation of emergency response system
3. Early cardiopulmonary resuscitation
4. Rapid defibrilation if indicated.
In the 2010 AHA Guidelines, the AHA rearranges the steps of CPR from "A-B-C" to "C-A-
B" in adults and children, it is possible for each helper to start chest compression
immediately.
Since 2008, the AHA has recommended untrained (lay) helpers who alone carry out
"Hands Only CPR" or CPR without providing breathing assistance to adults who suddenly
collapse.

Everyone can be a helper to victims who suddenly experience cardiac arrest. CPR skills
and their application depend on the training that has been undertaken, the experience and
confidence of the helper. Chest compression is the foundation of CPR so that any helper,
trained or not, must be able to provide chest compression to every victim of cardiac arrest.
Because of its importance, chest compression must be the first priority action for any victim
of any age. Trained helpers must provide chest compression combined with ventilation
(breathing relief). While highly trained helpers are expected to work together in the form of
teams in providing ventilation and chest compression.
This new guideline also contains other recommendations based on published evidence, i.e:
 Immediate recognition of sudden cardiac arrest is based on the examination of
unresponsive conditions and the absence of normal breathing (such as, the victim is
not breathing or just gasping / panting). Helper may not spend more than 10 seconds
doing a pulse check. If the pulse cannot be ascertained in 10 seconds, it is
considered that there is no pulse and CPR must be started or use an AED (automatic
external defibrillator) if available.
 This change in CPR applies to adult, child and infant victims but not to newborns.
 “Look, Listen and Feel " has been removed from the basic life support algorithm.
 The amount of chest compression is at least 100 times per minute
 Helper continues to do CPR until return of spontaneous circulation (ROSC)
 The compression depth for adult victims has been changed from 1½ - 2 inches to at
least 2 inches (5 cm)
 Increased focus to ensure that CPR is provided with high-quality based on :
 The compression speed and depth are given adequately and allow full chest recoil
between compression.
 Minimize interruptions when giving chest compression Avoid excessive ventilation.
2.3. Step of Basic Life Support

Basic life support circuits are basically dynamic, but there should be no steps that
are missed for optimal results. Following is the basic life aid algorithm based on the
2010 American Heart

Association Guidelines for Cardiopulmonary Resuscitation and Emergency

Cardiovacular Care, namely:


2.3.1. Response
Make sure the situation and situation of the victim by calling the name / general designation
loudly accompanied by touching or shaking the shoulders steadily. This procedure is
referred to as the "touch and talk" technique. This is enough to wake a person to sleep or
stimulate someone to react. If there is no response, chances are the victim is unconscious.
There are 3 levels of level of consciousness, namely:
 Full awareness: conscious, oriented towards self, time and place

 Half conscious: sleepy or confused / dazed
 Unconscious: not responding
If the victim responds
Help :
In the recovery position where it is found and avoid the possibility of the risk of other injuries can occur.
If the victim not responds
 Shout For Help

 Adjust the position of victim’s. The
Victim’s should be lie on a hard and flat
surface. If it is foung not in the supine
position, lie on the victim with “log roll”
technic, simultaneously the head, neck,
and back

 Position The helper. Kneel parallel to

the patient's shoulder so that it can
effectively provide cardiac pulmonary
resuscitation (CPR).
 Carotid Pulse Check
The AHA Guideline 2010 does not
emphasize carotid pulse examination
as a mechanism for assessing cardiac
arrest because helpers often have
difficulty detecting pulse. If in more than
10 seconds the carotid pulse is difficult
to detect, chest compression must be
started. Lay helpers do not have to
check carotid pulse. Consider cardiac
arrest if the patient is suddenly
unconscious, not breathing or breathing
but not normal (only gasping).
2.3.2. Circulation Compressions

Consists of two stages:
1. Ensure the presence or absence of the victim's heart rate.
The presence or absence of the victim's heart rate can be determined by
touching the carotid artery in the victim's neck area, with two or three fingers
(index and middle fingers) the helper can feel the middle of the neck so that
the trachea is felt, then the two fingers are shifted to the right or left side 1-2
cm gently touch for 5 - 10 seconds.
If the pulse is palpable, the rescuer should re-examine the victim's breathing
by making a close maneuver of the chin head to assess the victim's breathing.
If you don't breathe, do breathing aid, and if you breathe, keep the airway.

2. Provides circulation assistance.

If it has been ascertained that there is no heart rate, then circulation
assistance can be given or what is called external cardiac compression,
carried out with the following technique:
 With the index finger and middle finger the helper traces the right or
left ribs so that they meet the sternum.

 From the meeting of the ribs (sternum bone) measured approximately 2

or 3 fingers up. The area is a place for putting helper hands in providing
circulation assistance.
 Place both hands in that position by stacking one palm over the other,
avoiding fingers touching the victim's chest wall, fingers can be
straightened or crossed.
 With the body perpendicular, the helper presses the chest wall of the
victim with energy from his weight regularly 30 times (in 15 seconds =
30 times compression) with a depth of emphasis ranging from 1.5 - 2
inches (3.8 - 5 cm).
 The pressure on the chest must be completely removed and the chest
left to expand back to its original position each time doing chest
compression. The time interval used to release compression must be
the same as when doing compression. (50% Duty Cycle).

 Hands should not be separated from the surface of the chest and or
change the position of the hand when releasing compression.
 The ratio of circulation and breathing assistance is 30: 2 (Every 15
seconds = 30 compressions and 2 breaths), carried out either by 1 or 2
helper.
When we stop the CPR ?

 Area becomes unsafe
 More expert staff has arrived
 Signs of life appear
 Signs of dead: bluish purple turgor skins, pupil dilatations
 The helper tired or 30 minutes has no response
2.3.3. Airway
Make sure the airway is open and clean which allows the victim to breathe
 Clearly the airway
 Check the sound breathing and chest wall movement
 Check and clean the oral cavity with finger swept, can be coated with
gauzed to absorb liquid
 Opened the airway
 Gentl lift the victim’s forehead and chin (head tilt and chin lift) to
open the airway :
1. Head Tilt & Chin Lift

a. Lay the victim on his back on a flat, hard surface
b. Place the palm of the hand on the victim's forehead
c. Pressing the forehead slightly points forward with the palm
d. Place the tip of the index finger and middle finger of the other hand under the tip of the
patient's jawbone

e. Raise the head and hold / press the victim's forehead simultaneously until the patient's
head is in the position of extension.
2. Jaw Trust
a. Lay the victim on his back on a flat, hard surface.
b. Push the vertical ramus of the left and right mandible forward so that the lower
teeth row is in front of the upper teeth row
c. Using the thumb goes into the victim's mouth and together with the other fingers pulls the
victim's chin forward, so that the muscles of the tongue's hold are stretched and lifted.
d. Maintaining the victim's mouth position remains open
Take whatever objects are visible
In infants, the head position must be normal
Check life signs: response and breath sounds
Do not over-stretch, enough to open the airway, because it can result in
neck injury.
Use the head tilt-chin lift to open the airway to the victim without any head and neck trauma.
Use jaw thrust if there are indications of cervical injury.

If you have difficulty giving effective artificial breath, check if there is still blockage in the
victim's mouth and correct the position of your head and lift up the inadequate chin :
If the victim breathes spontaneously and normally again but is still unconscious,
change the position of the patient to recovery position, if the patient vomits no
aspiration occurs .
Be aware of the possibility of the patient experiencing a stop breathing again, if it happens
immediately the victim is stretched and do artificial breathing again.
When available, use Automated External Defibrillator (AED). If you don't have chest
compressions.
If due to an artificial breath condition cannot be given, still do compression because in the body
there is still oxygen
Double check circulation.
Re-check is stopped if normal breathing has returned, don't stop multi-resuscitation
resuscitation
Make sure the emergency team has been summoned
Make sure someone has taken the tool that needs to be used
Make changes every 2 minutes to avoid fatigue
Avoid time gaps in excessive personnel changes
Airway Obstruction Due To Foreign Objects

Airway obstruction because foreign objects often occurs in children and adults. In adults,
meat or other foods most often cause choking and clogging. Conditions in children can get
worse with very varied causes. Acute airway obstruction should be suspected in young children / infants
who suddenly experience respiratory failure with severe coughing, choking and stridor sounds. Partial
blockages allow the patient to still be able to breathe, but the quality of the breathing is uncertain, usually
the victim will spontaneously cough strongly to remove the blockage. If partial obstruction of the
airway occurs, but respiratory signs are ineffective, it must be treated the same as total
airway obstruction. In total obstruction, the victim cannot breathe, speak or cough. So the
victim holds his own neck. The oxygen concentration decreases and over time can be unconscious and
may die if not helped.

Try to make adult or child victims cough effectively. An attempt to remove another blockage
is done if the cough is not effective in removing the blockage and the signs of the breathing
disorder are getting worse and there is a stridor sound.
Maneuver Heimlich
Maneuver Heimlich.
It is an action to increase the pressure of the diaphragm suddenly, forcing air in the lungs to
come out quickly so that the airway plug can be pushed out. The beat can be repeated 6-10
times to clear the airway. Consider damage to organs under the upper abdomen and lower thorax.
This jerking is given after the possibility of a blockage cannot be taken manually easily, or
with the taking technique instead causing the object to deepen.
The patient is conscious and stands up :

Stand behind the victim
- Circle the upper waist (see illustration) with the helper's hand
- Place the clenched hand supported by the other hand just
below the xypoideus process (repeat)
- Hold your fist tightly
- Pull our hands to press with a loud pounding towards the
back of the victim.
- Repeat the activity separately with strong movements
- In cases of obesity or pregnancy, give chest compression
- Bila pasien tidak sadar, baringkan dengan posisi
terlentang
Patients who are supine / unconscious

- Spread the patient
- Helper kneels between the victim's thighs.
- Place one hand on the midline of the abdomen, above the
umbillicus (navel) and some distance below the sternum
(middle chest), the second hand is placed in the first hand.

- Press downward forward and stomp.

- Repeat until 6-10 times. This position can be used if the helper is too short compared to
the victim.
Manuver to himself
- Place your hand in a position like the illustration
- Press towards the top
- If it doesn't work it can be emphasized at the edge of the table / edge
- Repeat until 6-10 times
Blockage airway :
Tilting the patient to one side
Take out any object seen in the mouth
Take the loose / loose tooth
Leave the full denture in place
Clean Breath Path :
Keep the airway open and check for normal breathing
If in a few minutes there is a sound like gurgling, or coughing with chest and
abdominal movements, treatment is still like not breathing, because breathing is not
effective.
2.3.4. BREATHING
The principle is to provide 2 times the ventilation per 10 seconds after compression.
Consists of 2 stages :
1. Make sure the victim does not breathe.

By looking at the movement of the rise and fall of the chest, hearing the sound of
breath and feeling the victim's breath. For that the helper must bring the ear close
to the victim's mouth and nose, while still maintaining the airway open. This
procedure should not exceed 10 seconds.
2. Give breathing assistance.
If the victim does not breathe, breathing assistance can be done by mouth,
mouth to nose or mouth to the stoma (a hole made in the throat) by giving breath
as much as 2 gusts, the time needed for each blow is 1.5 - 2 seconds and the
volume of air exhaled is 7000 - 1000 ml (10 ml / kg) or until the victim's chest
appears to expand. Helper must take a deep breath when exhaling to get enough
air volume. The oxygen concentration that can be given is only 16-17%. Helper
also must pay attention to the response of the victim after being given breath
assistance.
How to provide breathing assistance :

Mouth to mouth
Respiratory assistance using this method is the right and effective way to give air to the
lungs of the victim. When mouth-to-mouth breath is carried out, the helper must take
deep breaths first and the helper's mouth should be able to cover the victim's mouth
properly so that there is no leak while exhaling and the helper must cover the victim's
nostrils with the thumb and index finger to prevent air from returning from the nose. The
air volume given to most adults is 700 - 1000 ml (10 ml / kg). Excess air volume and the
rate of inspiration that is too fast can cause air to enter the stomach, resulting in gastric
distension.

Mouth to nose
This technique is recommended if ventilation from the victim's mouth is not possible,
for example in Trismus or where the victim's mouth is seriously injured, and vice versa
if through the mouth to nose, the helper must cover the victim's mouth.
Mouth to Stoma
Patients who have a laryngotomy have a hole (stoma) that connects the trachea
directly to the skin. If the patient has difficulty breathing, ventilation from the mouth
must be done to the stoma.
2.4. CPR Techincal Summary

As a Summary, Helper can follow the following sequence :
1. Assessment of victims
Determine the victim's awareness (touch and shake the victim gently and
steadily) if not conscious, then ;
2. Ask for help and activate the emergency system
3. CIRCULATION chest compressions are performed to replace the heart function
which stops pumping blood, so that air containing oxygen in the lungs can be
circulated throughout the body.
4. AIRWAY
Position the victim.
Open the airway with the head tilt and chin lift method and jaw thrust.
5. BREATHING
The value of breathing to see whether there is adequate breathing or the victim is
not breathing
6. If the adult victim is unconscious with spontaneous breathing, and there is no
neck trauma (spinal trauma) position the victim on Recovery positiotion, while
keeping the airway open.

Petunjuk :
Pilihlah jawaban yang paling benar dari pertanyan berikut
1. Kerusakan otak akibat dari kekurangan suplai oksigen,dapat menyebabkan kematian
otak dalam waktu........
a. 4 – 6 menit
b. 6 – 8 menit
c. 2 – 9 menit
d. 2 – 10 menit
2. Bila anda menemukan korban dewasa tidak sadar,tidak bernafas dan nadi tidak
teraba,Berapakah RJP / CPR yang harus anda berikan jika anda seorang diri
versi AHA 2010 ...
a. 15 kali tekan dada dan 1 kali napas buatan.
b. 30 kali tekan dada dan 2 kali napas buatan.
c. 15 kali tekan dada dan 3 kali napas buatan.

d. 30 kali tekan dada dan 1 kali napas buatan.
3. Apakah posisi yang terbaik bagi korban shock yang masih sadar dan tidak
mengalami cidera leher .....
a. Posisi berbaring setengah duduk.
b. Terlentang,kaki di tinggikan kurang lebih 30 cm dan beri selimut.
c. Posisi pemulihan atau recovery postion.
d. Di biarkan saja.
4. Pada korban yang di duga mengalami cidera kepala maka sebaiknya metode
apa yang di pakai untuk membuka jalan napas si korban....
a. Metode jaw thrust ( Mendorong rahang )
b. Metode head tilt and chin lift ( Menekan kepala dan menggangkat dagu )
c. Metode mouth to mouth ( dari mulut ke mulut )
d. Metode mouth to nose ( dari mulut ke hidung )
5. Dimanakah letak titik tekan untuk melakukan penekanan dada (kompresi jantung
luar ) pada orang dewasa .....
a. Di dada sebelah kiri.
b. Di atas perut.
c. 2 Jari di atas pertemuan Iga paling bawah di tulang dada.
d. Semua benar.
6. Apa yang segera lakukan bila ada korban mengalami luka bakar di muka,warna
hitam sekitar mulut,hidung serta rambut terbakar...
a.Segera membawa ke RS.
b.Tutup luka bakar dengan kain.
c. Mengawasi jalan napas,pernapasan dan sirkulasinya.
d. Panik dan menelpon keluarga.


Bab I.First Aid: PPSDM Migas

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No.

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BAB I.FIRST AID

1.2 Communication Place and Access Assessment

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1.3 Awareness Assessment

1. The Victim Awareness.

2. Check the pulse.

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BLS delay Chance of sucsess (Life)

1.6. Respiratory System’s

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1.7. Bleeding System

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Figure 3 : The anatomy of Heart

1.7.1. Source of bleeding

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Figure 4 : Recovery Position to bleeding

1.9. Injuries due to burning

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Figure 5 : The degrees of wound Burning

Painfull like stung,

Blisters (liquid bubbles),

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Up to white layer, Not to pain

Heavy, the presence of

Tabel 1. Describe from classification of burns.

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BAB II. CARDIAC PULMONARY RESUSCITATION TECHNIC

2.2. Cardiopulmonary Resuscitation Phase

2.2.1. Step by step to Cardiacpulmonary Resuscitation

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2.3. Step of Basic Life Support

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Association Guidelines for Cardiopulmonary Resuscitation and Emergency

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 Full awareness: conscious, oriented towards self, time and place

If the victim not responds

 Shout For Help

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 Position The helper. Kneel parallel to

2.3.2. Circulation Compressions

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2. Provides circulation assistance.

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 From the meeting of the ribs (sternum bone) measured approximately 2

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When we stop the CPR ?

1. Head Tilt & Chin Lift

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Airway Obstruction Due To Foreign Objects

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The patient is conscious and stands up :

Patients who are supine / unconscious

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