BHD II Pelatihan ICU Dr Vera

TEKNIK RESUSITASI JANTUNG PARU

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Adult BLS Adult BLS AlgorithmeAlgorithme

AMERIKA

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Adult BLS Adult BLS AlgorithmeAlgorithme

EROPA

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International Liaison Committee on Resuscitation

ILCOR

Konsensus 2005

Universal Cardiac Arrest Algorithm

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Do we still need to check pulse ???Do we still need to check pulse ???

AEDAEDAUTOMATED EXTERNAL DEFIBRILATORAUTOMATED EXTERNAL DEFIBRILATOR

✖✖

Remove open airway and

rescue breath time

consuming

The old (2005) algorithm

Universal Algorithm CPR 2010

BLS HEALTHCARE PROVIDER ALGORITHM

Rescuer Proficiency

Chain of Survival

EarlyEarlyAccessAccess

EarlyEarlyCPRCPR

EarlyEarlyDefibrillationDefibrillation

EarlyEarlyAdvancedAdvanced

CareCare

20002000

20052005

20102010

Call for help Chest Compression

Defibrillation Advanced Life Support

Post-Cardiac 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 patient’s 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

Start CPR –give 02 -Attach monitor/

defibrillator.

Call for help!

Post-Cardiac Care

ROSC

•Drug Therapy•Advanced Airway•Treat Reversible Causes

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LANGKAH-LANGKAH BANTUAN HIDUP DASAR

LANGKAH-LANGKAH BANTUAN HIDUP DASAR

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

Pastikan keamanan

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JANGAN MENJADI KORBANBERIKUTNYA !

Lingkungan

Penolong

Korban

Orang2 disekitar

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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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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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.

PERIKSA KESADARAN

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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

✓ telp. 118 (atau no. lokal lain)✓ sebutkan: ‣ ID penelpon, lokasi, apa yg

terjadi, jumlah korban, keadaan korban, apa yg sudah dilakukan, informasi penting lain

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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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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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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MENILAI PERNAFASAN

NAFAS AGONAL

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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

Ulangi34

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i30x KOMPRESI JANTUNG

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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• 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

kompresi setiap 2 menit

KOMPRESI DADA

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LANJUTKAN BHD

30 2

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Periksa apakah ada tanda-tanda

sirkulasi:

Bergerak

Bernafas

Batuk

dll

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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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.

STOP BHD JIKA .....

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

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Algoritma nakes 2010

VF / VT pulseless = characteristic wavesVF / VT pulseless = characteristic waves shockableshockable, do DC-shock immediately, do DC-shock immediately in VT with pulse (+) in VT with pulse (+) DC-shock is not required, DC-shock is not required, when when

in doubt, do DC shockin doubt, do DC shock

Asystole = no wave (flat ECG) Asystole = no wave (flat ECG) UN-shockableUN-shockable

PEA = EMD = any wave may appearPEA = EMD = any wave may appear

UN-shockableUN-shockable

2 important ECG pattern during cardiac arrest (no carotid pulse)

CPR|

chest compression 100 x /minutebreaths 8-10 x /minute

synchronize 30:2

(either one or two rescuers)|

early DC shock(check rhythm)| |

VF/VT Asystole / PEA | (non-VF/VT)

DC shock | continue CPR

2 minutes

intubated/LMA

Cardiac Arrest Pattern ECG

VT pulseless

if VT pulse, it’s mean no arrest

Coarse Ventriculer Fibrilation

2. shockable

Fine Ventriculer Fibrilation

Asystole

PEA

EMD

1. UN-shockable

The principleThe principle of of CPRCPR

Quick DiagnosisCardiac Arrest

occurence

ROSC

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

Evaluasi setiap 2 menit

Perhatian!!!