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......