RESUSITASI JANTUNG PARU SESUAI DENGAN AMERICAN HEART ASSOCIATION GUIDELINES FOR CARDIOPULMONARY RESUSCITATION Dr. Prabowo Wicaksono, SpAn BAGIAN/SMF ANESTESI FAKULTAS KEDOKTERAN UNISSULA/RSISA 2008
RESUSITASI JANTUNG PARU SESUAI DENGAN AMERICAN HEART ASSOCIATION GUIDELINES
FOR CARDIOPULMONARY RESUSCITATION
Dr. Prabowo Wicaksono, SpAnBAGIAN/SMF ANESTESI FAKULTAS KEDOKTERAN UNISSULA/RSISA
2008
ETIOLOGI HENTI JANTUNGPRIMER :
Ventrikel fibrilasi dan asistol akibat:
Iskemia miokard fokal
Infark miokard akut
Blok konduksi jantung
Electric shock
SEKUNDER :
Asfiksia (obstruksi airway/ apneu)
Hemoragik syok
Udem paru akut
Syok septik
Syok kardiogenik
Types of cardiac arrest:
1. SUDDEN CARDIAC ARREST (SCA) Etiology: Ventricular fibrillation (VF)
Pulseless vetricular tachycardia (VT)
2. HYPOXIC ARREST Etiology: drowning, drug overdose, trauma, most infant and children
Resusitasi Jantung Paru OtakResusitasi Jantung Paru Otak (RJPO)(RJPO)
SEMUA TINDAKAN2 AKUTSEMUA TINDAKAN2 AKUTUNTUK MENGHENTIKAN PROSESUNTUK MENGHENTIKAN PROSES
YANG MENUJU KEMATIANYANG MENUJU KEMATIAN
istilah
Resusitasi Kardio Pulmoner ( RKP )
DEFINISIDEFINISI KEADAAN KEADAAN GAWAT DARURATGAWAT DARURAT
KEADAAN YG APABILA TIDAK MENDAPAT PERTOLONGAN CEPAT
KORBAN KEHILANGAN SEBAGIAN ANGGOTA TUBUH ATAU MENINGGAL
Time is critical in starting CPR !!!!
Sirkulasi yang berhenti 3 - 4 menit akan Sirkulasi yang berhenti 3 - 4 menit akan mengakibatkan kerusakan otak yang mengakibatkan kerusakan otak yang
permanen. permanen.
Jika pasien mengalami hipoksemia Jika pasien mengalami hipoksemia sebelumnya, batas waktu itu jadi lebih sebelumnya, batas waktu itu jadi lebih
pendek.pendek.
CPR yang CPR yang dilakukan dengan cara yang benardilakukan dengan cara yang benar menghasilkan cardiacmenghasilkan cardiac output output
30% dari cardiac output normal30% dari cardiac output normal
KAPAN SAJAKAPAN SAJADIMANA SAJADIMANA SAJA
OLEH SIAPA SAJAOLEH SIAPA SAJA
KUNCI : KECEPATAN – KETEPATANKUNCI : KECEPATAN – KETEPATAN
ALIRAN DARAH – TERHENTI 3 – 4 MENIT ALIRAN DARAH – TERHENTI 3 – 4 MENIT ( < 5 MENIT) ( < 5 MENIT)
KERUSAKAN SEL-SEL OTAK KERUSAKAN SEL-SEL OTAK IRREVERSIBELIRREVERSIBEL
kedaruratankedaruratansehari-harisehari-hari
• TENGGELAM
• STROKE
• OBSTRUKSI / BENDA ASING
• INHALASI ASAP
• REAKSI ANAFILAKSIS
• OVERDOSE OBAT
• SENGATAN LISTRIK
• SUFFOKASI
• TRAUMA
• INFARK MYOCARD
• SAMBARAN PETIR
• COMA KARENA BERBAGAI SEBAB
DIAGNOSIS HENTI JANTUNG/ CARDIAC ARRESTGambaran klinis dari berhentinya sirkulasi secara menyeluruh:
•Hilangnya/ penurunan kesadaran
•Death like appereance
•Tidak teraba nadi carotis (adult) / femoralis atau brachialis (infant/pediatrik)
•Dilatasi pupil (bukan tanda utama)
FASE FASE CPR1. BASIC LIFE SUPPORT (BLS): Emergency oxygenation
A. Airway control, protection of C-Spine
B. Breathing support: emergency artificial ventilation and oxygenation of the
lungs
C. Circulation support: recognition of pulselessness, emergency artificial
circulation by cardiac chest compressions, control of hemorrhage and
positioning of shock (horizontal, legs up)
2. ADVANCED LIFE SUPPORT (ALS): is restoration of spontaneous circulation
and stabilization of the cardopulmonary system, by restoring adequate
arteriovenous perfusion pressure and near normal arterial oxygen transport.
D: Drugs and fluids via intravenous infusion
E: Electrocardiography
F: Fibrillation treatment
3. PROLONGED LIFE SUPPORT (PLS) is post-resuscitative brain oriented intensive
therapy.
G: Gauging: Determining and treating the cause of arrest and deciding whether to
continue resuscitation.
H: Human mentation: to be restored hopefully by new cerebral resuscitation
measures.
I: Intensive Care: Long ter resuscitation, for multipel organ failure in the post
resuscitation period
Phase 3 should be continued untl the patient regain consciusness and extracerebral organ function have been stabilized, or brain death have been certified, or the underlying disease makes further resuscitation efforts senseless
1.BASIC LIFE SUPPORT
A : Airway: Clear the airway, protection of C-spine
B: Breathing: Ventilation and oxygenation
C: Circulation: Recogniton of cardiac arrest, Chest
compression, Hemorrhage control
TEGUR SAPATEGUR SAPA““Siapa namaSiapa nama-mu-mu????!!!??!!!””
““Coba buka mataCoba buka mata!!!!!!””1.
Tidak ada respon: Aktifkan EMS (Emergency Medical Services
(Ambulans 118)
A: Airway: Bebaskan Jalan Nafas (Airway): Chin Lift, Head Tilt, Jaw Thrust
Open the airway: CHIN LIFT, HEAD TILT
2.
Head-tilt/chin-lift maneuver. Perpendicular line reflects proper neck extension, i.e., a line along the edge of the jaw bone should be perpendicular to the surface on which the victim is lying.
A: AIRWAY CONTROL PROTECTION OF C-SPINE
•AHA GUIDELINES FOR CPR 2005: Chin lift dan Jaw thrust
•Suspek cedera C-spine: Jaw Thrust
•Bila dengan Jaw thrust airway tidak clear: Head tilt dan chin lift .
•Airway tetap merupakan prioritas, meskipun terdapat kemungkinan cedera
C-spine.
- - Buka sedikit mulut pasien.Buka sedikit mulut pasien. Ambil napas Ambil napas biasabiasa dan dan tempelkan rapat-tempelkan rapat- rapat bibir penolong rapat bibir penolong melingkari mulut pasienmelingkari mulut pasien..
- Tetap pertahankan “head tilt-chin lift”- Tetap pertahankan “head tilt-chin lift” - T- Tiup selama iup selama 11 detik.detik. Lihat apakah dada terangkat . Lihat apakah dada terangkat .
- Tetap pertahankan- Tetap pertahankan ‘‘head tilt-chin lifthead tilt-chin lift’’,, lepas mulut penolonglepas mulut penolong dari mulut pasiendari mulut pasien..
-- LLihat apakah dada pasien ihat apakah dada pasien turun waktu turun waktu ekshalasi .ekshalasi .
- - Ambil napas lagi dan ulangi meniup. Ambil napas lagi dan ulangi meniup.
Cek B: Breathing: Tidak ada nafas: Beri 2 kali nafas bantu3.
Nafas bantu dengan menggunakan alat : AMBU Bag dan Barrier Devices
Mouth-to-nose breathing.
B: BREATHING SUPPORT: EMERGENCY ARTIFICIAL VENTILATION AND OXYGENATION OF THE LUNGS
Udara ekshalasi: 16-18% O2 : cukup untuk resusitasi.
Bila tersedia, berikan O2 100%.
AHA GUIDELINES FOR CPR 2005: RECOMMENDATIONS for 1-SECOND BREATHS DURING ALL CPR
•Each rescue breath should be given over 1 seconds.
•Each rescue breath should make the chest rise (rescuers should be able to see the chest rise).
•All rescuers should give the recommended number of rescue breath.
•All rescuers should avoid delivering too many breaths or breath that are too large or to forcefull.
•During CPR, blood flow to the lungs is much less than normal, so the victim need less ventilation than normal.
•Rescue breaths can safely be given in 1 second. During CPR, it is important to limit the time used to deliver rescue breaths to reduce interruptions in chest compressions.
•Rescue breaths given during CPR increase pressure in the chest which reduces the amount of blood that refills the heart and in turn reduces the blood flow generated by the next group of chest compressions.• •Hyperventilation may also cause gastric inflation and its complications.
Tidak ada respon, pTidak ada respon, periksa eriksa tanda-tandatanda-tanda sirkulasi sirkulasi
dengandengan meraba a. carotis meraba a. carotis (10 (10
detik) detik)
C: CIRCULATION: Cek sirkulasi, raba nadi carotis4.
Meraba pulsasi arteri carotis
Tentukan titik tumpu:Tentukan titik tumpu: pertemuan garis yangpertemuan garis yang menghubungkan ke duamenghubungkan ke dua papila mamae denganpapila mamae dengan sternum (tulang dada)sternum (tulang dada)
Nadi carotis tidak teraba = henti jantung (cadiac arrest) : segera mulai kompresi dada
Tumit tangan satunya Tumit tangan satunya diletakkan diletakkan diatas tangan yang diatas tangan yang sudah berada tepat di-sudah berada tepat di-titik pijat jantung. titik pijat jantung. Jari-jari kedua tangan Jari-jari kedua tangan dirapatkan dirapatkan dan diangkat agar dan diangkat agar tidak ikut menekantidak ikut menekan . .
Pijat Jantung: 30 kompresi (100x/menit) : 2 ventilasi5.
Hand positions for external chest compressions
Penolong Penolong mengambil posisi mengambil posisi
tegak lurus tegak lurus di atas dada pasien di atas dada pasien dengan dengan siku lengan lurus siku lengan lurus menekan sternum menekan sternum sedalam sedalam 1,5 – 2 inchi1,5 – 2 inchi ((4-5 cm4-5 cm))..
EKSTERNAL CHEST COMPRESSION
30 compressions are alternated with 2 ventilations.
EMPHASIS ON EFFECTIVE CHEST COMPRESSIONSTo give chest compression, all rescuers should “push hard and push fast”. Compress the chest at rate of about 100 compressions per minute for all victims .Allow the chest to recoil (return to normal position) completely after each compression .Try to limit interruptions in chest compressions. Every time you stop chest compressions, blood flow stops.
ONE UNIVERSAL COMPRESSION-to-VENTILATION RATIO FOR ALL LONE RESCUERSThe AHA recommends a compression-to-ventilation ratio of 30:2 for all lone (single) rescuers to use for all victims from infants through adults. This recommendation applies to all lay rescuers and to all heatlhcare providers who perform 1 rescuers CPR.
ADULT CPR
CHILD CPR
INFANT CPR
2.ADVANCED LIFE SUPPORT
D: DrugsEpinefrin: 1 mg IV/IO (intra trakeal) tiap 3-5 menit (Adult)0,1 mg/kgBB IV (Pediatrik)
Atropine : 1 mg IV tiap 3-5 menit (Adult)0,2 mg/kgBB IV (Pediatrik)
Amiodarone : 300 mg IV/IO, can be followed by one dose of 150 mg (Adult)5 mg/kg BB IV/IO, repeat up to 15 mg/kg. Maximun dose 300 mg m(Pediatrik)
Lidokain:1-1,5 mg/kg IV. If VF or VT pulseless persist, additonal dose 0.5-0.75 mg/kg IV tiap 5-10 menit, dosis maksimum 3 mg/kg (Adult)1 mg/kg bolus (IV/IO) Pediatrik. Dosis maksimum 100 mg. Infusion 20- 50 µg/kg/menit.
Ventricular FibrillationVentricular Fibrillation Pulseless Ventricular TachycardiaPulseless Ventricular Tachycardia
E: Electrocardiography
Ventricular FibrillationVentricular Fibrillation
Pulseless Ventricular TachycardiaPulseless Ventricular Tachycardia
Non Shockable Rhythm AsystoleAsystole PEA ( Pulseless Electrical Activity ) / EMD PEA ( Pulseless Electrical Activity ) / EMD ( Electro Mechanical Dissociation )( Electro Mechanical Dissociation )
AsystoleAsystole
Pulseless Electrical ActivityPulseless Electrical Activity
F: Fibrillation TreatmentObjective: to “reset” electrical conduction in the heart.Indication : Shockable rhytme: - Ventricular Fibrillation (VF)
- Pulseless Ventricular Tachycardia (pulseless VT)
ATTEMPTED DEFIBRILLATION: 1 SHOCK, THEN IMMEDIATE CPR
When attempting defibrillations, all rescuers should deliver 1 shock followed by immediate CPR, beginning with chest compressions. All rescuers should check the victim’s rhythm after giving about 5 cycles (about 2 minutes) of CPR.
Dosage: Monophasic defibrillator : 360 JBiphasic (modern) defibrillator : 150 J and 200 J.
MOBILE DEFIBRILLATOR
Press the Green “ON” Press the Green “ON” ButtonButton
AUTOMATED EXTERNAL DEFIBRILLATORS (AED)Detect shockable waves then automatically gives shock. Can be operated by trained personel (lay rescuers or healthcare provider)
Plug in ConnectorPlug in Connector
Apply Pads to Bare Apply Pads to Bare ChestChest
Press the Orange “SHOCK” Press the Orange “SHOCK” ButtonButton
You have successfullyYou have successfullyused an AEDused an AED
Thank you......