Professional Documents
Culture Documents
2010
Amerika (CDC)
kematian CAD/thn
330.000 di luar RS / UGD
250.000 di luar RS
Insidens
0,55 kematian/1000 pop/thn
Indonesia (Depkes)
Penyebab kematian utama
sistem sirkulasi (26,4%)
Penyakit Penyebab
Kematian Umum di
Indonesia
26,4%
18,9%
Sistim sirkulasi
= henti jantung
16%
History of Modern
CPR
1950
1960
1974
1993
SAFAR
Pengendalian jalan napas
& Pernapasan buatan
KOUWENHOVEN
Kompresi jantung tertutup
International Liaison
Committee on Resuscitation
(ILCOR)
HSFC
RCSA
BACKGROUND
Data2 tentang angka survival sewaktu
100 per
menit
Ratio 15:2
rescuer
Time taker by AED for analysis
A fall in coronary perfusion pressure
A deterioration in waveform of VF
A decrease of successful outcome after DC shock
Remove check
breath and
assess
circulation
RATIO 30:2
(less
ventilation)
AED
compressions
VQ mismatch (need less Vt)
Increases intrathoracic pressure
Decreases venous return
Prevents adequate filling
DECREASES CARDIAC OUTPUT
Gastric insufflation
Hyperventilation is bad.
Kelompok pasien
yang ditolong
Kecepatan ventilasi
(napas/menit)
Kelompok 1 (n=7)
37 + 4*
Kelompok 2 (n=6)
22 + 3*
Kelompok 3 (n=13)
30 + 3.2
Why AED?
Witnessed vs Unwitnessed
Witnessed Collapse//Cardiac Arrest
AED first
Unwitnessed arrest
CPR first (2 minutes or 5 cycles), then AED
Eksternal
Trauma,
keracunana dll
Henti Jantung
Saat di EKG:
asistol
100%
?%
40%
Henti
jantung/par
u
Henti
jantung
VT/VF
Saat di EKG:
VT/VF
Electrical phase
AED first
VF early defibrillation (class I)
Each passing minute decreased survival
by 8-10%
Circulation 1997
Chicago Airport
AED within 1 minute anywhere in the
airport
Survival approaching 50% (10/18) for VF
Collapse
Survival
Collapse
Survival
to defibrillation 3 min
to discharge 74%
to defibrillation 3 min
to discharge 49%
NEJM 2000
Circulation 2002;106
Circulatory phase
CPR first
First provide oxygen delivery (chest
compression/ventilation) followed by
defibrillation
Survival
24%
30%
JAMA 1999;281
4%
22%
JAMA 2002;289
B(n=104
46%
56%
0.1
ROSC
B(n=55)
P-value
ROSC
38%
58%
P<0.03
Survival to discharge
4%
22%
P<0.003
1-yr survival
4%
20%
P<0.003
JAMA 2003
Background
There is a striking disparity in survival outcomes
Meta-analysis
So???.
Remove open
airway and
rescue breath
time
consuming
AED
AUTOMATED EXTERNAL DEFIBRILATOR
Rescuer Proficiency
Chain of Survival
0
0
0
2
Early
Access
Early
CPR
Early
Defibrillation
5
0
0
2
Early
Advanced
Care
0
1
0
2
Call for help
Chest
Defibrillation Advanced
Compression
Life Support
Post-Cardiac
arrest Care
Capnography
Capnography is recommended for
intubated patients.
This tool is used as an additional indicator
of proper tube placement, monitoring CPR
quality and detecting ROSC.
cardiac care.
Hypothermia treatment studies are showing
improvement with neurological, hemodynamic
and metabolic function in the ROSC patients.
Transportation to most appropriate hospital
with comprehensive post-cardiac arrest
treatment.
Post cardiac care should include prevention,
treatment of possible multiple organ
dysfunction.
ACLS Algorithm
Call for
help!
Start CPR give
02 -Attach
monitor/
defibrillator.
ROS
C
Post-Cardiac Care
Drug Therapy
Advanced
Airway
Treat
Reversible
Causes
ST Elevation Myocardial
Infarction
Neonatal Resuscitation
No changes in sequence with the neonates.
ABCs, unless known cardiac etiology.
3:1 compression to ventilation ration.
Post resuscitation therapeutic hypothermia.
Delay in cord clamping.
Adult Stroke
Stroke is the third leading cause of death in
Terima kasih
Resources/References
American Heart Association,
http://www.heart.org.
Inland Counties Emergency Medical
Agency, http://www.sbcounty.gov/icema.
American Stroke Association,
http://www.strokeassociation.org.
Any questions please contact Patty Eickholt
RN, BSN, PHN, MICN, CEN at ICEMA. 909388-5823.
AHA
ERC
Check response
Open airway
30 chest compressions
Check breathing
2 rescue breaths
DEFIBRILASI
Attach AED
SWITCH ON AED
30
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK INDICATED
POSISI RECOVERY
CPR IN CHILDREN
Teknik CPR dewasa
dapat digunakan
pada anak
Kompresi cukup 1/3
tebal dada
rescuer
Time taker by AED for analysis
A fall in coronary perfusion pressure
A deterioration in waveform of VF
A decrease of successful outcome after DC
shock
Impedance
Threshold Valve
Anesth
Analg 2001
Circulation 2003;108:2201
Circulation 2000
(4.8/4.8/4.8 ms)
Adult, Swine (18-28 kg), VF model
Results
JACC 2003
Summary
Criticall point in Basic Life Support
Place greater emphasis on chest
compression
Avoid hyperventilation
Time-sensitive model
More sophisticated CPR device
AED