TEKNIK RESUSITASI JANTUNG PARU

AMERIKA

Adult BLS Algorithme

2

Departemen Anestesiologi RSUP Fatmawati

EROPA

Adult BLS Algorithme

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Departemen Anestesiologi RSUP Fatmawati

Universal Cardiac Arrest Algorithm

International Liaison Committee on Resuscitation

ILCOR
Konsensus 2005
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Do we still need to check pulse ???
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The old (2005) algorithm   Remove open airway and rescue breath  time consuming AED AUTOMATED EXTERNAL DEFIBRILATOR .

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Universal Algorithm CPR 2010 .

BLS HEALTHCARE PROVIDER ALGORITHM .

Rescuer Proficiency .

Chain of Survival .

00 0 2 Early Access Early CPR Early Defibrillation 5 0 0 2 10 0 2 Call for help Early Advanced Care Chest Defibrillation Advanced Post-Cardiac Compression Life Support arrest Care .

. Airway.  This applies for adults.  Adult Chain of Survival.New Sequence for 2010  “Chest compressions. Breathing” (CAB) is the new order of operations from American Heart Association. pediatrics and infants. excluding newborns. Newborn arrest are most likely respiratory and should use the ABC sequence.

Rationale of changes 2010  A large number of witnessed cardiac arrest are patients going into a ventricular fibrillation. or pulseless ventricular tachycardia. and provide blood flow to the heart muscle quickly.  The CAB method allows the responder to save time.  A lay person is more likely to give CPR if chest compressions are the priority. Early chest compressions and defibrillation are key components to the patient’s survival. .

Rate of 100/min. .  Start chest compression before opening the airway.Basic Life Support  Hands-Only (Compressions only) CPR for the untrained lay person.  Allowing the chest to recoil between compressions with a depth of 2 inches. Can be guided by dispatcher on the phone. CAB.

BLS Adult Algorithm .

CPR should be continued until return of spontaneous circulation (ROSC) or termination of resuscitative efforts.Cardiopulmonary Resuscitation and Emergency Cardiovascular Care  Any unnecessary interruptions in chest compressions.  Healthcare providers should take no longer than a 10 second pulse check to determine if pulses are present. decreases the effectiveness of the CPR. .  Chest compression and rescue breathing at a rate of 30:2.

The rescuer should learn through training these are atypical presentations of a cardiac arrest and alert responders to these findings.Role of the Lay Person Rescuer  Initial recognition of the victim is imperative to quick treatment. The lay person should assume that the victim is in a cardiac arrest. A patient having a cardiac arrest may have gasping respirations or even have seizure like activity. person is unresponsive.  Lay persons should call EMS when finding unconscious victim and should not attempt to check for a pulse. suddenly collapses. not breathing normally or not at all. 2. . 1. and 3.

cardioversion and defibrillation for symptomatic tachycardia are all proven methods to help the chain of survival.  Electrical Therapies-Pacing in bradycardia.CPR Devices and Techniques  No device other than the defibrillator has proven to have long-term survival from in the field cardiac arrest.  CPR prior to defibrillation improves outcomes in cardiac arrest. No precordial thump. .

Capnography  Capnography is recommended for intubated patients. monitoring CPR quality and detecting ROSC.  This tool is used as an additional indicator of proper tube placement. .

 Hypothermia treatment studies are showing improvement with neurological.Advanced Cardiac Life Support  New fifth link in the chain of survival is post cardiac care. treatment of possible multiple organ dysfunction.  Transportation to most appropriate hospital with comprehensive post-cardiac arrest treatment. .  Post cardiac care should include prevention. hemodynamic and metabolic function in the ROSC patients.

ROS C Post-Cardiac Care •Drug Therapy •Advanced Airway •Treat Reversible Causes .ACLS Algorithm Call for help! Start CPR –give 02 -Attach monitor/ defibrillator.

 Advanced notification to the receiving hospital are key elements of the treatment and care of a patient having a STEMI. with interpretation by EMS providers and information relayed to Base Station. .ST Elevation Myocardial Infarction  Prehospital 12 Lead electrocardiogram.

Pediatric Basic Life Support  American Heart Association reports that 5% to 15% of pediatric cardiac arrest are related to ventricular fibrillation.  Studies have also shown that resuscitation from asphyxia benefit from combination of chest compression and ventilations. The CAB method is to be used. .  Compression only CPR is to be used with bystanders who have not been trained with giving ventilations or do not feel comfortable doing so.

LANGKAH-LANGKAH BANTUAN HIDUP DASAR Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 25 .

JANGAN MENJADI KORBAN BERIKUTNYA ! Pastikan keamanan Lingkungan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Penolong Korban Orang2 disekitar Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 26 .

PASTIKAN KORBAN TIDAK SADAR Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 27 .

• Ulangi pemeriksaan berkala. 28 . • Cari hal yang tidak beres.PERIKSA KESADARAN Guncangkan bahu dengan lembut Tanya: ”apakah anda baik-baik saja?” Jika ada respons: • Jangan ubah posisi korban.

jika korban tidak respon Panggil BANTUAN Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 29 .

keadaan korban. apa yg sudah dilakukan. lokal lain) ✓ sebutkan: ‣ ID penelpon. jumlah korban. 118 (atau no. informasi Jangan hentikan 30:2 sampai ada indikasi stop BHD penting lain 30 Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) .aktifkan sistem pelayanan emergensi Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan ✓ telp. apa Evaluasi setiap 2 menit yg terjadi. lokasi.

BUKA JALAN NAFAS Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 31 .

bunyi nafas terdengar keras atau megap-megap Nafas agonal = tanda henti jantung !! 32 32 .MENILAI PERNAFASAN NAFAS AGONAL Pada > 40% kasus henti jantung. berat. terjadi segera Nafas pendek.

2X NAFAS BUATAN Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 33 .

NAFAS BUATAN Pencet hidung korban Penolong tarik nafas normal Bibir penolong menutupi mulut korban dgn erat Tiupkan udara nafas sampai dada korban bergerak terangkat 1 tiupan = 1 detik Biarkan dada korban mengempis spontan Ulangi 34 34 .

30x KOMPRESI JANTUNG Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan i Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 35 .

bergantian 36 .Departemen Anestesiologi RSUP Fatmawati KOMPRESI DADA • Letakkan pangkal telapak tangan di pertengahan bawah tulang dada • Letakkan tangan yang lain diatas punggung tangan yang satunya • Jari-jari boleh dikepal atau dibuka • Kompresi dada – Laju kompresi 100x per menit – Kedalaman 4-5 cm – Kompresi konstan diselingi relaksasi • Jika mungkin.

Departemen Anestesiologi RSUP Fatmawati 30 2 37 37 LANJUTKAN BHD .

Pastikan keamanan Periksa kesadaran Periksa apakah ada tanda-tanda sirkulasi: Bergerak Bernafas Batuk dll Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 38 .

..STOP BHD JIKA . bukan intoksikasi obat atau hipotermia...      Kembalinya sirkulasi dan ventilasi spontan Pasien dialihrawatkan kpd yg lebih berwenang Penolong lelah atau keselamatannya terancam Adanya perintah DNAR Jika 30’ setelah ACLS yang adekuat tidak didapatkan tanda-tanda kembalinya sirkulasi spontan (asistole yang menetap). Pastikan keamanan Periksa kesadaran Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2) Evaluasi setiap 2 menit Jangan hentikan 30:2 sampai ada indikasi stop BHD 39 .

Departemen Anestesiologi RSUP Fatmawati tanda-tanda kematian yang irreversibel : Kaku mayat Lebam mayat Dekapitasi Pembusukan 40 .

TEMPATKAN DALAM POSISI “RECOVERY” 41 .JIKA KORBAN MULAI BERNAFAS NORMAL LAGI.

42 .

Algoritma nakes 2010 .

2 important ECG pattern during cardiac arrest (no carotid pulse) VF / VT pulseless = characteristic waves    shockable . do DC-shock immediately in VT with pulse (+) → DC-shock is not required. do DC shock  when in Asystole = no wave (flat ECG)  UN-shockable  PEA = EMD = any wave may appear  UN-shockable . doubt.

CPR | chest compression 100 x /minute breaths 8-10 x /minute synchronize 30:2 (either one or two rescuers) | early DC shock intubated/ LMA (check rhythm) | | VF/VT | DC shock Asystole / PEA (non-VF/VT) | continue CPR 2 minutes .

UN-shockable Cardiac Arrest Pattern ECG 2. shockable Asystole Coarse Ventriculer Fibrilation Fine Ventriculer Fibrilation PEA VT pulseless EMD if VT pulse. it’s mean no arrest .1.

ROSC Quick Diagnosis Cardiac Arrest occurence The principle of CPR .

Perubahan “guidelines 2010”  Defibrilasi merupakan bantuan hidup dasar  Urutan A-B-C-D. diikuti langsung KJL . harus bisa ditentukan <10 detik  Kompresi jantung dilakukan dengan cepat (kec 100x/menit) dan keras/dalam dengan fase relaksasi  Defibrilasi dilakukan hanya 1 kali. menjadi C-A-B-D kecuali pada kasus henti jantung yang disebabkan karena hipoksia  Tidak ada periksa pernapasan secara khusus  Cek irama jantung.

Perhatian!!! .

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