CARDIOPULMONARY

RESCUCITATION
C

DEPARTEMEN ANESTESIOLOGI & TERAPI

INTENSIF
FK ULM – RSUD ULIN
RESUSITASI KARDIOPULMONER

• BAGAIMANA MENILAI
GANGGUAN DAN
MEMBEBASKAN JALAN
NAPAS
• BAGAIMANA
MEMBERIKAN NAPAS
BUATAN
• BAGAIMANA
MEMBERIKAN
KOMPRESI
JANTUNG LUAR
ISTILAH
• CPR = CARDIO PULMONARY RESUSCITATION

• CPCR = CARDIO PULMONARY CEREBRAL

RESCUCITATION

• CPR = CPCR = RJPO

• KJL = KOMPRESI JANTUNG LUAR

• PJL = PIJAT JANTUNG LUAR

• RE = KEMBALI

• RESUSITASI: FUNGSI 
MENGEMBALIKAN JANTUNG,
PARU, OTAK PADA :
• HENTI
JANTUNG
• HENTI NAFAS
• HARUS SEGERA DILAKUKAN  MENGHENTIKAN
PROSES MENUJU KEMATIAN
ALASAN KENAPA HARUS SEGERA MEMULAI CPR:

• BETTER CHANCE OF SURVIVAL

• KERUSAKAN OTAK DIMULAI DALAM 4-6 MENIT

• KERUSAKAN OTAK MENETAP JIKA DIBIARKAN

10 MENIT TANPA CPR
KAPAN TIDAK
MELAKUKAN CPR?
• SITUATIONS WHERE ATTEMPTS TO PERFORM CPR WOULD PLACE THE
RESCUER AT RISK OF SERIOUS INJURY OR MORTAL PERIL

• OBVIOUS CLINICAL SIGNS OF IRREVERSIBLE DEATH (EG, RIGOR MORTIS,

DEPENDENT LIVIDITY, DECAPITATION, TRANSECTION, OR
DECOMPOSITION)

• A VALID, SIGNED, AND DATED ADVANCE DIRECTIVE INDICATING THAT

RESUSCITATION IS NOT DESIRED, OR A VALID, SIGNED, AND DATED DNAR
ORDER
PENTING UNTUK DIPERHATIKAN !
SEBELUM MELAKUKAN PERTOLONGAN PERHATIKAN:

1. LINGKUNGAN ATAU TEMPAT KEJADIAN

2. RESIKO BAGI PENOLONG DAN KORBAN
3. MEKANISME TRAUMA

• JANGAN MEMINDAHKAN KORBAN TERBURU-BURU KECUALI KORBAN

DALAM KEADAAN BAHAYA,
• JIKA ANDA HARUS MEMINDAHKAN KORBAN LAKUKAN DENGAN CEPAT
LINGKUNGAN DAN RESIKO

AMATI SITUASI YANG DAPAT MEMBAHAYAKAN KESELAMATAN DIRI ANDA DAN ORANG LAIN
MISALNYA ARUS LISTRIK, API, ASAP, PUING2 BANGUNAN
Mekanisme Trauma
AMERICAN HEART
ASSOCIATION GUIDELINES
•FOR
BLS CPR 2015
• ACLS
• PULSELESS ARREST
• BRADYCARDIA
• TACHYCARDIA
• POST CARDIAC ARREST CARE
CHAIN OF SURVIVAL
AHA 2015
 “CHAIN SURVIVAL”
IN-HOSPITAL CARDIAC ARREST (ICHA)

• SURVEILLANCE FOR CARDIAC ARREST

• ACTIVATE CODE (MULTIDICIPLINARY TEAM)

• INITIATE CPR BY PROFESIONAL PROVIDERS

• EARLY DEFIBRILLATION

• INTEGRATED POST CARDIAC ARREST CARE

 “CHAIN OF SURVIVAL”
OUT-OF HOSPITAL CARDIAC ARREST (OCHA)

• IMMEDIATE RECOGNITION OF CARDIAC ARREST

AND
ACTIVATION OF THE EMERGENCY RESPONSE SYSTEM

• EARLY CPR THAT EMPHASIZES CHEST COMPRESSIONS

• RAPID DEFIBRILLATION IF INDICATED

• EFFECTIVE ADVANCED LIFE SUPPORT

• INTEGRATED POST CARDIAC ARREST CARE

THE BLS SURVEY INCLUDES FOUR STEP:

THE BLS SURVEY IS THE STARTING POINT FOR ALL ACLS

MANAGEMENT

• CHECK FOR A RESPONSE

• CALL FOR HELP AND TO BRING AN AED
• CHECK CIRCULATION
• CHECK RHTHM
THE PRIMARY ASSESMENT, uses the ABCDE model

• Airway – use the least advanced airway possible tio maintain the airway
and oxygenation
• Breathing – monitor tube placement and oxygenation using
waveform capnography
• Circulation – medications, CPR, fluids and defibrillation
• Differential Diagnosis – treat reversible causes
• Disability – neurological assessment “AVPU” (Alert, Verbal.
Pain, Unresponsive)
• Exposure – looking for signs of trauma, bleeding, burns, or medical alert
bracelets
 THE SECONDARY ASSESSMENT

THE SECONDARY ASSESSMENT INCLUDES A SEARCH FOR POSSIBLE UNDERLYING

CAUSES FOR THE EMERGENCY AND IF POSSIBLE AFOCUSED MEDICAL HISTORY
“SAMPLE”

• (S) SIGNS AND SYMPTOMS

• (A) ALLERGIES
• (M) MEDICATIONS
• (P) PAST ILLNESSES
• (L) LAST ORAL INTAKE
• (E) EVENTS LEADING UP TO PRESENT ILLNESS
For the last 50 years, American Heart Association
has taught A-B-C
Airway, Breathing, and chest Compressions.

Now, Start in 2010 A-B-C has changed to C-A-B:

Chest Compressions, open the Airway, and give 2
rescue Breaths
PENILAIAN AWAL: CEK RESPON

 A : ALERT
 V : VERBAL
 P : PAIN
 U : UNRESPONSIVE
 POSISI STABIL (RECOVERY POSITION)
• Bila napas memadai dan tidak ada cedera Leher
• Pasien napas spontan adekuat
Jika tidak ada denyut nadi segera lakukan

Pijat Jantung Luar

Ratio 30 : 2
PUSH HARD, PUSH FAST
PIJAT JANTUNG :
1. BERI TEKANAN YANG CUKUP PADA
STERNUM 5 CM (2 INCHI).
2. TEKANAN HARUS CUKUP KUAT.
3. PIJATAN :
• TEGAK LURUS DAN TERATUR.
• TIDAK MENYENTAK.
• TIDAK BERGESER BERUBAH
TEMPAT.
4. FASE PIJATAN & RELAKSASI HARUS
SAMA ( 1 : 1 )
 MINIMAL INTERRUPTION
- MINIMIZE THE FREQUENCY
AND DURATION OF
INTERRUPTIONS IN
COMPRESSIONS
- CPR WITHOUT AN ANDVANCED
AIRWAY, GOAL OF A CHEST
COMPRESSION FRACTION AS HIGH AS
POSSIBLE, WITH A TARGET OF AT LEAST
60%
PENGELOLAAN JALAN NAPAS

Posisi Bebaskan Jalan Napas Head tilt/ Chin Lift

 BREATHIN
•G
MENIUPKAN UDARA KE PARU-
PARU PASIEN PERLAHAN PADA
WAKTU JEDA ANTARA 2
NAPAS.

• MULUT-KE MULUT MULUT KE

HIDUNG

• MATA MEMPERHATIKAN DADA

SAMPAI TERANGKAT.
• NAFAS BUATAN DIBERIKAN 1 DETIK
• VOLUME TIDAL CUKUP  DADA TERLIHAT TERANGKAT
• VOLUME TIDAL NORMAL 8-10 CC/KG  6-7 CC/KG
KAPAN MENGHENTIKAN
CPR?
Restoration of effective, spontaneous circulation

Care is transferred to a team providing advanced life

support

The rescuer is unable to continue because of exhaustion,

the presence of dangerous environmental hazards, or
because continuation of the resuscitative efforts places
others in jeopardy

Reliable and valid criteria indicating irreversible death are

met, criteria of obvious death are identified, or criteria for
termination of resuscitation are met.
 AED (AUTOMATED EXTERNAL DEFIBRILLATION)

• ECG analyzer will detect the rhytm wether to defibrillation if the ECG is VT
or VF type
• Do not touch the patient because the machine will read the wrong ECG
• If the ECG is VF type or VT, the machine will charge power
• If the ECG is asystole type, the machine will give CPR for 2 minutes and
then analyze the new ECG
ADVANCED CARDIAC LIFE
SUPPORT (ACLS)
• PULSELESS ARREST

• BRADYCARDIA WITH PULSE

• TACHYCARDIA WITH PULSE

PULSELESS ARREST
BRADYCARDI
A WITH
PULSE
QUANTITATIVE WAVEFORM CAPNOGRAPHY

• CONFIRMATION AND MONITORING ETT PLACEMENT

• EVALUATING THE EFFECTIVENESS OF CHEST COMPRESSIONS

ETCO2 VALUE IS AT LEAST 10-20 MMHG

• IDENTIFICATION OF ROSC

• FAILURE TO ACHIEVE AN ETCO2 OF GREATER THAN 10 MMHG BY WAVEFORM

CAPNOGRAPHY AFTER 20 MINUTES OF CPR DECIDE TO END RESUSCITATIVE
EFFORT BUT SHOULD NOT USED IN ISOLATION
 CPR QUALITY

• QUANTITATIVE WAVEFORM CAPNOGRAPHY

• IF PETCO2 < 10 MMHG, ATTEMPT TO IMPROVE CPR QUALITY

• INTRA-ARTERIAL PRESSURE
• IF RELAXATION PHASE (DIASTOLIC) PRESSURE <20 MMHG, ATTEMPT TO
IMPROVE CPR QUALITY