TEKNIK RESUSITASI JANTUNG PARU

AMERIKA

Adult BLS Algorithme

Departemen Anestesiologi RSUP Fatmawati

EROPA

Adult BLS Algorithme

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 ???

5

The old (2005) algorithm

Remove open airway and rescue breath time consuming

AED AUTOMATED EXTERNAL DEFIBRILATOR

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

New Sequence for 2010

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

Rationale of changes 2010

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

Basic Life Support

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

BLS Adult Algorithm

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

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

Role of the Lay Person Rescuer

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

CPR Devices and Techniques

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

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.

Advanced Cardiac Life Support

New fifth link in the chain of survival is post 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

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

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
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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

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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

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

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aktifkan sistem pelayanan emergensi

Pastikan keamanan Periksa kesadaran
Panggil bantuan / telpon ambulans Buka jalan nafas & nilai pernafasan

telp. 118 (atau no. lokal

lain) sebutkan: ID penelpon, lokasi, apa Evaluasi setiap 2 menit yg terjadi, jumlah korban, keadaan korban, apa yg sudah dilakukan, informasi Jangan hentikan 30:2 sampai ada indikasi stop BHD penting lain 30

Beri nafas buatan pertama 2x Kompresi jantung + nafas buatan (30 : 2)

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

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MENILAI PERNAFASAN NAFAS AGONAL

Pada > 40% kasus henti jantung, terjadi segera

Nafas pendek, berat, bunyi nafas terdengar keras atau megap-megap

Nafas agonal = tanda henti jantung !!

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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

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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
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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

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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, bergantian

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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

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STOP BHD JIKA .....

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), bukan intoksikasi obat atau hipotermia.

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

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Departemen Anestesiologi RSUP Fatmawati

tanda-tanda kematian yang irreversibel :

Kaku mayat Lebam mayat Dekapitasi Pembusukan

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JIKA KORBAN MULAI BERNAFAS NORMAL LAGI, TEMPATKAN DALAM POSISI RECOVERY

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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,

doubt, do DC shock

when in

Asystole = no wave (flat ECG)

UN-shockable

PEA = EMD = any wave may appear

UN-shockable

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

1. UN-shockable

Cardiac Arrest Pattern ECG

2. shockable

Asystole

Coarse Ventriculer Fibrilation Fine Ventriculer Fibrilation

PEA

VT pulseless

EMD

if VT pulse, its mean no arrest

ROSC

Quick Diagnosis Cardiac Arrest occurence

The principle of CPR

Perubahan guidelines 2010

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

Perhatian!!!