You are on page 1of 39

Abdul Qodir

Epidemiology
 Cardiac arrest occurs both in and out of the hospital.
 In the US and Canada, approximately 350 000
people/year (approximately half of them in hospital)
 Basic Life Support = BLS
= Jalan napas + Napas bantuan + Compresi jantung (A-B-C)
 Advanced Life Support = ALS
= Drug (+ Fluid) + EKG + Defibrilasi
 Cardiopulmonary Resuscitation = CPR

Semua tindakan akut/segera


untuk menghentikan proses
yang menuju kematian
Key Principles in Resuscitation

 Pengenal dan pengaktifan sistem tanggap darurat


 CPR berkualitas tinggi secepatnya
 Defibrilasi cepat
 Layanan medis darurat dasar dan lanjutan
 Bantuan hidup lanjutan dan dan perawatan pasca
serangan jantung
Immediate recognition of cardiac arrest and
activation of the emergency response system
 If a lone rescuer finds an unresponsive adult (no
movement or response to stimulation)  Activating
the Emergency Response System
 If the victim also has absent or abnormal breathing
(only gasping), the rescuer should assume the victim is
in cardiac arrest.
Pulse Check
 The lay rescuer should not check for a pulse
 The healthcare provider should take no more than 10
seconds to check for a pulse and, if the rescuer does not
definitely feel a pulse within that time period, the rescuer
should start chest compressions.

1-2-3-4-5
6-7-8-9-10
C : Circulation
 Kompresi dada dulu baru berikan ventilasi
 Titik tumpu kompresi dada pada setengah bagian bawah
sternum
 Bila belum di intubasi atau dipasang LMA, maka setiap
kompresi dada 30 diselingi 2 ventilasi (rasio 30:2)
 Bila sudah di intubasi Campresi dada 100-120 kali/menit
dan ventilasi 10 kali/menit
 Beri kesempatan dinding toraks untuk “ re-coil” setelah
Kopresi dada
C : Chest Compressions
 Langsung letakan tangan
pada setangah bagian
bawah sternum
 Compresi dada 30X
 Disusul dengan napas 2 X X
C : Chest Compressions
Posisi penolong
 Tegak lurus di atas dada pasien dengan siku lengan lurus
menekan setengah bagian bawah sternum
C : Chest Compressions
 Compresi dada dan napas buatan
 Saat kompresi dada, hitung dengan suara keras :
Satu-dua-tiga-empat-lima-enam-tujuh-delapan-sembilan –SATU
Satu-dua-tiga-empat-lima-enam-tujuh-delapan-sembilan –DUA
Satu-dua-tiga-empat-lima-enam-tujuh-delapan-sembilan -TIGA

30 x Kompresi : 2 Ventilasi
C : Chest Compressions
Rescuers should focus on delivering high-quality CPR:
 Providing chest compressions of adequate rate (100-
120/minute)
 Providing chest compressions of adequate depth
- adults: a compression depth of at least 2 inches (5 cm)-2,4
inches (6 cm)
- infants and children: a depth of least one third the
anterior-posterior (AP) diameter of the chest or about 1 1⁄2
inches (4 cm) in infants and about 2 inches (5 cm) in
children
C : Chest Compressions
 Allowing complete chest recoil after each compression
 Minimizing interruptions in compressions
 Avoiding excessive ventilation
 If multiple rescuers are available, they should rotate
the task of compressions every 2 minutes.
A : Airway
 Napas berhenti, 4-5 menit kemudian: Jantung
berhenti, peredaran darah (sirkulasi) berhenti

 Beberapa detik kemudian otak mengalami kerusakan


karena hipoksia dan beberapa menit kemudian
kerusakan otak irreversible.
 Jika pasien mengalami kekurangan oksigen (hipoksia)
sebelumnya batas waktu menjadi lebih pendek

 BLS yang dilakukan dengan cara yang benar


menghasilkan CO 30 % dari normal
B: Breathing
 Deliver each rescue breath over 1 second
 Give a sufficient tidal volume (500 to 600 mL or 8-10
mL/kg) to produce visible chest rise
 Use a compression to ventilation ratio of 30 chest
compressions to 2 ventilations.
 When an advanced airway ( endotracheal tube, LMA is
in place during 2-person CPR, give 1 breath every 6 to 8
seconds without attempting to synchronize breaths
between compressions (this will result in delivery of 8
to 10 breaths/minute).
 There should be no pause in chest compressions for
delivery of ventilations
BLS Dos and Don’ts of Adult High-Quality CPR
Rescuers Should Rescuers Should Not
Perform chest compressions at a rate of Compress at a rate slower than 100/min
100-120/min or faster than 120/min
Compress to a depth of at least 2 inches Compress to a depth of less than 2
(5 cm) inches (5 cm) or greater than 2.4 inches
(6 cm)
Allow full recoil after each compression Lean on the chest between
compressions
Minimize pauses in compressions Interrupt compressions for greater than
10 seconds
Ventilate adequately (2 breaths after 30 Provide excessive ventilation
compressions, each breath (ie, too many breaths or breaths with
delivered over 1 second, each causing excessive force)
chest rise)
Adult BLS
Algorithm
Cardiac arrest = carotis (-)
Check EKG !!

VT/VF pulsesless = ada gelombang khas


Shockeble rhythm, harus segera DC-shock

Asystole = EKG flat, tidak gelombang


UN- shockeble
PEA = ada gelombang mirip EKG normal
UN- shockeble
INDICATIONS of SHOCK
 Defibrillation (Non-Synchronized DC Shock):
 VF
 Pulseless VT
Recommended joule: 360 J

19
INDICATIONS of SHOCK
 Synchronized DC Shock (Only with unstable
hemodynamic):

 AF
 Atrial Flutter start with 50 J
 SVT

 VT with pulse
start with 100 J
(despite of
Infant and Children: 2 J/kg
medication)

20
DO NOT SHOCK!!!
 Asystole
 Pulseless Electrical Activity
 Bradicardia
 Heart Block
 Stable hemodynamic with AF, Atrial Flutter, SVT, &
VT with pulse

21
UN- shockeble
UN- shockeble
ASYSTOLE/PEA
Intubation (LMA) Compresi 100
As soon as possible, without stop compretion X/men
Napas 8-10 X/ men
Cardiac Evaluasi Evaluasi Evaluasi Evaluasi
ASYSTOLE
arrest
2 menit 2 menit 2 menit 2 menit
CPR : CPR : CPR : CPR : CPR : CPR :
130:2 2 3 4 5 6
Epinefrin Epinefrin Epinefrin 3
CALL
FOR
HELP
Evaluasi CPR: tiap 2 menit
PASANG
MONITOR EKG
DC
VT/ Ventricular tachycardia

Carotis (+) Carotis (-)

Amiodaron 300 mg bolus A single shock 360 joules


Atau CPR 30:2 2 menit
Lidocain 1 mg/kg BB IV Management VT/VF
VF/VT-pulseless
Intubation (LMA) Compresi 100 X/men
As soon as possible, without stop compretion Napas 8-10 X/ men
3’ 3’
Adrenalin Adrenalin Adrenalin
Cardiac VT/VF
arrest X 2010
2 menit 2 menit 2 menit 2 menit
A single shock-I A single shock-II A single shock-III A single shock-V
AMIODARON
CPR : 1 CPR : 2 CPR : 3 CPR : 4 A single shock- IV
30:2 CPR : 6
CPR : 5
CALL Amiodaron is the first choice 300 mg, bolos.
Adrenalin 1 mg IV
FOR Repeated 150 mg for reccurrent VT/VF.
Repeated every 3-5
HELP Followed by 900 mg infusion over 24 hours
minutes
PASANG Or LIDOCAIN 1 mg/kg. Can be repeated. Do
MONITOR EKG not exceed a total dose of 3 mg/kg, during
Evaluasi CPR: tiap 2 menit the firs hours
Defibrilltion
 CPR dilakukan sambil menunggu datangnya DC shock

De-FIBRILLATION/ DC shock
- DC shock sedini mungkin (sebelum 5-10 menit)
- 360 joules 1 X (dulu 3 X shock, Repeated shock)
(jika DC shock biphasic 150-200 joule)

• Setelah a sigle shock, segera lakukan CPR lag 2


menit tanpa check EKG sudah ROSC
• Baru setealah 2 menit CPR, berhenti sebentar
untuk check EKG apakah sudah ROSC
Defibrilltion

paddles
Automated External Defibrillators (AEDs)
DC Shock
1. Oles dulu paddles dengan
jelly EKG tipis rata.
2. Switch ON
Pasang paddles pada posisi
apex dan prasternal
3. Tempelkan di dada, baru :
Charge 360 Joules
(Non-synchronized)
Ucapakan dengan keras :
Awas semua lepas pasien
- Napas buatan berhenti dulu
- Bawah bebas, atas bebas, saya bebas

4. Shock
(tekan dua paddles bersama)
Lepas paddles dari dada, lanjutkan chest comprestion

5. Segera kompresi jantung lagi


Bila berhasil ROSC
 Lanjutkan oksigenasi, kalau perlu napas bantuan
 Hipotensi
 diatasi dengan inotropik dan obat vaso-aktif)
 (adrenalin, dopamin, debutamin)
 Tetap di infus untuk jalan obat cepat
 Terapi aritmia
 Koreksi elektrolit, cairan, gula darah. Dsb
 Awasi di ICU
 Awas cardiac arrest sering terulang lagi.
Bila setalah ROSC, lalu cardiac arrest lagi
 Ikuti algoritme semula
 Bila perlu DC shock tetap diberikan 1 x 360 J
(Monophasik) atau 150-200 J 1 x (biphasic) dan
dususul CPR
Reversible Causes
– Hypovolemia
– Hypoxia
– Hydrogen ion (acidosis)
– Hypo-/hyperkalemia
– Hypothermia
– Tension pneumothorax
– Tamponade, cardiac
– Toxins
– Thrombosis, pulmonary
– Thrombosis, coronary
Thank You!!!