Status terminal

Fibrilasi ventrikel primer Asistol primer Anoksia alveolar Asfiksia obstruksi/apnea Eksanguinasi Gagal paru Syok Gagal otak 2-3 menit

0 menit

5-12 menit MATI KLINIS Mati panorganik

? ?

Henti sirkulasi

5 mt ?

10 mt

15 mt

20 mt

SIRKULASI PULIH KEMBALI Napas spontan Napas spontan Napas spontan Apnea .

Sadar

Sadar/Stupor

Tidak Sadar

Tidak Sadar

Neurologis normal .

Neurologis defisit .

Status vegetatif EEG abn

Mati otak EEG isoelektrik

First A - B - C - D
Airway: Open the airway Breathing: Provide positive pressure ventilation Circulation: Give chest compressions Defibrilation: Shock VF/pulseless VT

Second A - B - C - D
Airway: Establish advanced airway control Perform endotracheal intubation Breathing: Assess the adequacy of ventilation via endotracheal tube Provide positive-pressure ventilations Circulation: Obtain IV access to administer fluids and medications Continue CPR Provide rhythm-appropriate cardiovascular pharmacology Differential Diagnosis: Identify the possible reasons for the arrest. Construct a differential diagnosis to identify reversible causes that have a specific therapy.

CPR, ONE RESCUER On the following screen, you will see an action sequence integrating the basics of CPR. This sequence will help to structure your decision making process during an emergency. It first adresses AIRWAY, then BREATHING, then CIRCULATION, the famous ABCs of CPR. The first sequence is for ONE resquer; the second sequence is for TWO resquers. CPR with foreign body obstruction, FBO, will be treated in the section dealing with foreign body obstruction.

Are you OK? Gently shake the victim. Establish UNRESPONSIVENESS

Establish whether victim is responsive if no response, CALL 911

If NO RESPONSE, call for HELP. Instruct bystander to dial 911.

Open airway using head tilt-chin lift or jaw thrust. LOOK, LISTEN, FEEL for breathing.

In unconscious victim, the muscles in the tongue may relax, causing the tongue to block the airway

Head tilt and chin lift may open airway

If NOT breathing, give two slow, full breaths. The two breaths should take a full five (5) seconds.

Opening airway using head tilt and chin lift during rescue breathing

Chest must rise

LOOK to verify that the chest RISES. If chest does NOT rise reposition head. Is a PULSE present?

Assess whether victim is breathing by looking for chest movement, Listening for breath sounds, and feeling breath against ear or cheek

Determine if pulse exists by checking carotid artery located between Adams apple and neck muscle

If pulse present, give two slow, full breaths. The two breaths should take a full five (5) seconds.

Opening airway using head tilt and chin lift during rescue breathing

Chest must rise

If NO PULSE, give 15 rapid, forceful cardiac compressions. The compressions must take only 10 - 12 seconds to complete!

Cardiac compression started by locating point two fingers above xyphoid process

For adults, the correct chest compression is 1.5 to 2 inches, or 4 to 5 cm

Give TWO slow, full breaths, and verify that the chest rises. Then give 15 more cardiac compressions. Repeat this cycle two more times for a total of four (4) cycles.

Opening airway using head tilt and chin lift during rescue breathing

Chest must rise

For adults, the correct chest compression is 1.5 to 2 inches, or 4 to 5 cm

Stop and quickly check for breathing and pulse. IF NO BREATHING AND NO PULSE: Continue CPR until help arrives. IF PULSE PRESENT BUT NO BREATHING: Begin resque breathing at the rate of 15 breaths per minute. Each breath must take 2 seconds. IF PULSE PRESENT AND BREATHING: Congratutation! You saved the patient.

AIRWAY VENTILATION DURING TWO RESCUER CPR 1. Each ventilation requires two (2) seconds 2. Verify that chest rises. 3. Second rescuer is in position for chest compressions. 4. For adults, the sequence is one (1) ventilation for every five (5) compressions.

CHEST COMPRESSIONS DURING TWO RESCUER CPR 1. Five (5) chest compressions in four (4) seconds. 2. Depress sternum 1 to 2 inches, or 4 to 5 centimeters. 3. Second rescuer is in place for airway ventilation.

The leader then gives one (1) rescue breath, and the second rescuer follows with five (5) cardiac compressions. This cycle is repeated eight (8) more times for a total of ten (10) cycles.

Stop and quickly check for breathing and pulse. IF NO BREATHING AND NO PULSE: Continue CPR until help arrives. IF PULSE PRESENT BUT NO BREATHING: Begin rescue breathing at the rate of 15 breaths per minute. Each breath must take 2 seconds. IF PULSE PRESENT AND BREATHING: Congratulation! You saved the patient.

In summary, during two rescuer CPR, one rescuer assumes the leader role and the second rescuer may do any of the following four tasks: Go for help....activate EMS.call 911 Monitor victim during CPR Perform CPR when the leader tires Perform two (2) rescuer CPR as described earlier

Mengakhiri resusitasi
1. Sirkulasi dan ventilasi spontan yang efektif telah timbul 2. Resusitasi diambil alih oleh yang berkompeten 3. Tidak sadar, pernapasan spontan (-), dilatasi pupil 15-30 menit 4. Asistole selama 30 menit setelah RJP dan obat optimal 5. Stadium terminal suatu penyakit 6. Penolong terlalu lelah

Hal-hal baru dalam RJPO

Airway : Jangan neck lift Cukup jaw thrust & chin lift Pasang oro / nasopharynx tube Segera intubasi trachea Breathing : Nafas jangan 800-1200 ml Cukup 2 nafas @ 500-600 ml, dada terangkat Beri sela ekshalasi Beri oksigen 100% lebih dini Circulation : Pijat jantung lebih cepat, 80-100 x / menit Usahakan DC-Shock lebih dini

Hal-hal baru dalam RJPO

Drugs : Adrenaline 1-1-1 / 3-5 Atropin 1-1-1 / 3-5 Na-Bicarb hanya 1 meq/kg dan paling akhir Fibrilation Rx : DC-Shock sedini mungkin Drug-Shock-Drug-Shock 200 -- 200-300 -- 360 Joule # Early access # Early CPR # Early defibrilation # Early ALS

nadi carotis (+) > 60 mmHg nadi radialis (+) > 80 mmHg

VF / VT nadi carotis tak teraba A-B-C sampai defibrilator terpasang 200 J -- 200-300 J -- 360 J

VF / VT
A-B-C intubasi, IV line

PEA

ASYSTOLE

ROSC

Adrenaline 1-1-1 mg tiap 3-5 DC shock 360 J dalam 30-60 Obat klas IIa DC shock 360 J dalam 30-60 POLA : obat-DC-obat-DC

Jaga jalan nafas Bantu nafas Obat u/ tek darah, nadi, irama Lidocain 1,0 - 1,5 mg/kg tiap 3-5 sp 3 mg/kg MgSO4 1-2 gm u/torsades Procainamide 30mg/min Na-bicarb 1 meq/kg

Early defibrilation DC-Shock

Non-Synch

Synchronized

Khusus VF/VT
tidak ada QRS yang baik

SVT / PVC
ada QRS yang baik

DC-Shock Discharge
Tidak menunggu gelombang R

DC-Shock Discharge
Menunggu gelombang R dikenali

PULSELESS ELECTRICAL ACTIVITY ada kompleks ECG tetapi nadi carotis tak teraba Electromechanical Dissociation Idioventricular rhythm / escape Brady-asystolic rhythm A-B-C intubasi, IV line Adrenaline 1-1-1 mg tiap 3-5 Jika bradikardia Atropin 1-1-1 mg tiap 3-5 sampai 3 mg Obat klas IIa SINGKIRKAN :
Hipovolemia Hipoksia Hipotermia Hiperkalemia Tamponade jantung Tension pneumothorax Emboli paru luas Infark jantung luas Asidosis Overdose B-block, Ca-block, Digitalis, Trisiklik

Na-bicarb u/ hiperkalemia / asidosis / overdose obat Adrenaline 1-3-5 mg selang 3 menit