New CPR and Defibrilation-1

8/20/2019 New CPR and Defibrilation-1

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CARDIOPULMONARY RESUSCITATION

AND CARDIAC DEFIBRILLATION

Dr Jatilistiyanto P,SpAn KIC


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• CPR p!rta"a #ali $i%&na#an o' Sa(ar a)al t*n+-an

• ./++ 0 national a1a$!"y o( s1i!n1! a$ *o11on(!r!n1! on CPR

• ./+2 0 Si"posi&" int!rnasional 3 E"!r%!n1yR!s&s1itation $i Oslo

• 4 t*n CPR 5 Car$io6as#&l!r Li(! S&pport

•

A7A stan$ar$ an$ %&i$!lin!s On CPR an$ ERC 0./24, ./8,./8+,.//9:

• Saat ini CPR $ian%%ap s!;a%ai Basi1 Li(! S&pport Far"a#olo%is A$&lt ?P!$iatri1 A$6an1! Car$io6as1&lar Li(! S&pport,9

S!@ara* r!s&sitasi


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S!@ara* r!s&sitasi

'2'.+


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Mat!ri K&rs&s

• T!#ni# $asar Li(! s&pport

• Al%orit"a Li(! s&pport

• Kon$isi #*&s&s


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Principles in Resuscitation withcardiac arrest

.: I""!$iat! recognition of cardiacarrest and activation of t*!!"!r%!n1y r!spons! syst!"

9: Early CPR with an emphasis onchest compressions

: Rapi$ debrillation

4: E!1ti6! advanced life support

: Int!%rat!$ post– cardiac arrestcare


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Changes in 2010 Update

• T*! &lity o( 1*!st 1o"pr!ssion

• Mini"iin% o( $isr&ption in t*!1o"pr!ssion s!&!n1!

• Air)ay "ana%!"!nt

• Us! an$ ti"in% o( $r&%s

•

Post-r!s&s1itation 1ar!

2


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A$&lt BLS

/


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.


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UnresponsiveNo breathing or no

normal breathing


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PPD "ana$o-9.9


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'2'.+ R!s&s1itation 1o&rs!-p!r$i1i-Ma#assar-9.

.


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'2'.+ R!s&s1itation 1o&rs!-p!r$i1i-Ma#assar-9.

.4


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D!;rilator E#st!rnalA&to"atis, D!;rilasi,Car$io6!rsi $an Pacing


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T&@&an p!";!la@aran

.!t!la* p!";!la@aran ini $i*arap#an p!s!rta

.: Ma"p& &nt "!n@alan#an alat D!;rilator E#st!rnal

A&to"atis

9: Ma"p& &nt "!la#an tin$a#an $!;rilasi: Ma"p& &nt "!la#an tin$a#an #ar$io6!rsi

4: Ma"p& &nt "!n%!nali #!a$aan yan%"!n%*ar&s#an

$ila#an tin$a#an pa1in%

:Ma"p& &nt "!n%!nali $an "!n%!ta*&i *al-*alyan% p!rl& $ip!r*ati#an s!;!l&", s!"!ntara $ans!t!la* "!la#an t!rapi !l!#tri#


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P!n$a*&l&an

• D!;rilasi "!r&pa#an s&at& p!n%*antaranaliran listri# "!lal&i "io#ar$i&" &nt"!n$!polarisasi "io#ar$i&" s!*in%%a

$apat "!n%!";ali#an #oor$inat a#ti6itaslistri# @ant&n%:

• T&@&an $!;rilasi a$ala* &nt"!n%!";ali#an rit"! yan% t!rat&r $an

sir#&lasi spontanD!;rilasi

T!r"inasi Fi;rilasi


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P!n%*&;&n% 6ital $ari Chain of

Survival


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D!;rilasi Dini P!ntin%

Unt "!";!ri#an #or;an #!s!"patant!r;ai#

&nt *i$&p, tin$a#an ;!ri#&t

"!r&pa#an"o"!n p!rta"a yan% *ar&s $ila#an

pa$a *!nti @ant&n%

.: Pan%%il ;ant&an9: La#an RJP

: M!n%op!rasi#an $!;rilator


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a#t& $i"&lainya D!;rilasi"!"p!n%ar&*i s&r6i6al


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S*o1#a;l! R*yt*"s


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D!;rilator E#st!rnalA&to"atis


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• DEA a$ala* p!ralatan 1an%%i*, $iat&r#o"p&t!r $!n%an "!n%%&na#ans&ara $an %a";ar &nt "!n&nt&n

p!nolon%:• DEA $i%&na#an &nt "!";!ri#an

$!;rilasi

a)al s!;!l&" t!rs!$ia $!;rilator"an&al:


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4: S!%!ra s!t!la* DEA ti;a nyala#an DEA $an t!"p!l#an pa$ !l!#tro$apa$a $a$a #or;an

Bila p!nolan% l!;i* $ari . oran%, RJP *ar&s$it!r&s#an s!"!ntara pa$ !l!#tro$a $ipasan%pa$a pasi!n

I#&ti p!t&n@ s&ara'6is&al $ari DEA

pasti#an ti$a# a$a yan% "!ny!nt&* #or;an;ila DEA "!n%analisa rit"!:

Lan%#a*-lan%#a* $ala" "!n%%&na#anDEA


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:a Bila in$i#asi s*o1# pasti#an ti$a# a$a yan% "!ny!nt&*

#or;an

t!#an to";ol s*o1# s!%!ra

s!%!ra "&lai #!";ali RJP 9

i#&ti p!t&n@ s&ara'6is&al $ari DEA

:; Bila a$a in$i#asi s*o1#

S!%!ra lan@&t#an RJP 9 I#&ti p!t&n@ s&ara'6is&al DEA

Lan%#a*-lan%#a* Dala" M!n%%&na#anDEA


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+: Lan%#a* s!lan@&tnya i#&ti p!t&n@ DEAsa"pai t!na%a pro(!sional ti;a

#or;an "&lai ;an%&n ;!r%!ra#, ;a "ata$an ;!rnapas nor"al

p!nolan% l!la*:

Lan%#a*-lan%#a* $ala" "!n%%&na#anDEA


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Lan%#a*-lan%#a* s!;!l&"$!;rilasi

•

Mini"al#an @!$a* pr!-s*o1#• M!n%%&na#an O9 s!1ara a"an s!la"a $!;rilasi

• T!*ni# #onta# !l!#tro$a $!n%an $a$a #or;an1&p ;&l& $a$a

t!#anan p!$al pa$a $a$a #or;an

8 #% &nt $!)asa

#% pa$a ana# .-8 ta*&n

posisi !l!#tro$a

arit"ia 6!ntri#&lar $an *!nti @ant&n%


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Lan%#a*-lan%#a* s!;!l&"$!;rilasi

• T!*ni# #onta# !l!#tro$a $!n%an $a$a#or;an< lan@&t::= (as! r!spirasi


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D!;rilasi


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Lan%#a*-lan%#a* "!la#an$!;rilasi

.: T!"p!l#an !l!#tro$a pa$a $a$a pasi!n

9: Nyala#a $!;rilator $an pili* l!a$

: Analisa r!t"!, apa#a* s*o1#a;l!G

4: B!ri#an coupling agent atau pa$s pa$a $a$apasi!n

: Pili* l!6!l !n!r%i

+: T!"p!l#an p!$al #! $a$a pasi!n

2: C*ar%! p!$al56 Pastian 7Clear8

96 Perisa embali monitor

.:Dis1*ar%! s*o1# $an #!";ali#an p!$al #! "!sin:


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On! S*o1# 6s T*r!!-Sta1#!$S*o1#

• &i$!lin!s 9 t!la*"!r!#o"!n$asi#an single shock $i;an$in% ti%a-l!;i* s*o1# ;!r&r&tan:

• Proto#ol $!n%an single shock"!";!ri#an an%#a s&r6i6al yan%l!;i* ;ai#:

• Strat!%i sin%l! s*o1# $apat$i%&na#an pa$a $!;rilator"ono(asi# $an ;i(asi#:


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D!;rilasi Mono(asi# 6s Bi(asi#

• !lo";an% ;i(asi# l!;i* !(!#ti( pa$a t!r"inasiarit"ia 6!ntri#&lar $!n%an tin%#at !n!r%i r!n$a*:

• !lo";an% ;i(asi# "!"p!rli*at#an !#asi yan%l!;i* ;!sar pa$a s*o1# p!rta"a &nt T'F

$!n%an $&rasi la"a:

• !lo";an% ;i(asi# s&p!rior t!r*a$ap %!lo";an%"ono(asi# &nt #ar$io6!rsi !l!#ti( pa$a #as&sAF:

• Saat ini $!;rilator "ono(asi# pro$sinya "&lai"!n&r&n, $an "&lai $i%anti#an $!n%an$!;rilator ;i(asi#


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Tin%#at En!r%i•

S*o1# p!rta"a – !lo";an% "ona(asi#

r!#o"!n$asi %&i$!lin!s 9 + J ti$a# a$a p&;li#asit!r;ar&:

– !lo";an% ;i(asi#

$ir!#o"!n$asi#an ti$a# #&ran% $ari .-9 J

• S*o1# #!$&a $an s!lan@&tnya – D!;rilator "ona(asi#

+ J

– D!;rilator ;i(asi#ti$a# a$a ;ti yan% "!n$&n% proto#ol $!n%an!n!r%i t!tap ata& $itin%#at#an:


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D!;rilasi pa$a Ana#

• 7!nti @ant&n%, F r!lati( @aran% pa$aana# 2-. pa$a p!$iatri# $anr!"a@a:

• D!;rilasi 1!pat $apat "!"p!r;ai#il&aran

• Tin%#at !n!r%i yan%

$ir!#o"!n$asi#an &nt "an&al$!; 9-4 J'K% &nt s*o1# p!rta"a$an s!lan@&tnya


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Synchronized Cardioversion

• Synchronized Cardioversion a$ala* s*o1# yan%$i*antar#an $!n%an )a#t& yan% t!rsin#ronisasi$!n%an #o"pl!#s RS:

• Sin#ronisasi ini a#an "!n1!%a* p!n%*antaran s*o1#

s!la"a si#l&s @ant&n% yan% r!(ra#t!r $i"ana s*o1#$apat "!ni";&l#an F:

• Synchronized Cardioversion $ir!#o"!n$asi#an&nt t!rapi ST


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Kar$io6!rsi Atrial Fi;rilasi

• Posisi !l!#tro$! ant!rolat!ral $anant!ropost!rior:

• !lo";an% ;i(asi# l!;i* !(!#ti( $ari

"ono(asi# $an r!si#o la ;a#ar pa$a #&litl!;i* #!1il:

• !lo";an% "ono(asi# $ia)ali $!n%an9 J, $apat $itin%#at#an ;!rta*ap *in%%a

+ J

• !lo";an% ;i(asi# .9-. J, $apat$itin%#at#an ;ila p!rl&

K $i i A i l Fl $


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Mono(asi# . J, ;i(asi# 2-.9 J


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Pa1in%

• P!rti";an%#an pa1in% pa$a pasi!n$!n%an ;ra$i#ar$ia si"to"ati# y%r!(ra#t!r t!r*a$ap o;at anti

#olin!r%i#


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T!ri"a Kasi*


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New CPR and Defibrilation-1