RESUSITASI JANTUNG PARU SESUAI

DENGAN AMERICAN HEART

ASSOCIATION GUIDELINES FOR
CARDIOPULMONARY
RESUSCITATION 2005

Dr. Prabowo Wicaksono, SpAn

BAGIAN/SMF ANESTESI FAKULTAS KEDOKTERAN
UNISSULA/RSISA
2008

ETIOLOGI HENTI JANTUNG

PRIMER :
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

istilah

Resusitasi Kardio Pulmoner

)

( RKP

Resusitasi Jantung Paru Otak (RJPO)

SEMUA TINDAKAN2 AKUT

UNTUK MENGHENTIKAN PROSES
YANG MENUJU KEMATIAN

DEFINISI

KEADAAN
GAWAT 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

mengakibatkan kerusakan otak yang
permanen.
Jika pasien mengalami hipoksemia
sebelumnya, batas waktu itu jadi lebih
pendek.
CPR yang dilakukan dengan cara yang benar
menghasilkan cardiac output
30% dari cardiac output normal

KAPAN SAJA
DIMANA SAJA
OLEH SIAPA SAJA

KUNCI : KECEPATAN KETEPATAN

ALIRAN DARAH TERHENTI 3 4 MENIT
( < 5 MENIT)

KERUSAKAN SEL-SEL OTAK

IRREVERSIBEL

 TENGGELAM
STROKE
OBSTRUKSI / BENDA ASING
INHALASI ASAP

kedaruratan
sehari-hari

REAKSI ANAFILAKSIS
OVERDOSE OBAT
SENGATAN LISTRIK
SUFFOKASI
TRAUMA
INFARK MYOCARD
SAMBARAN PETIR
COMA KARENA BERBAGAI SEBAB

DIAGNOSIS HENTI JANTUNG/ CARDIAC ARREST

Gambaran 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 CPR

1. 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,

1.

TEGUR SAPA
Siapa nama-mu???!!!
Coba buka mata!!!

Tidak ada respon: Aktifkan EMS

(Emergency Medical Services
(Ambulans 118)

2.

A: Airway: Bebaskan Jalan Nafas (Airway): Chin Lift, Head Tilt, Jaw Thrust

Open the airway: CHIN LIFT, HEAD TILT

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.

3.

Cek B: Breathing: Tidak ada nafas: Beri 2 kali nafas bantu

- Buka sedikit mulut pasien.

Ambil napas biasa dan
tempelkan rapatrapat bibir penolong
melingkari mulut pasien.
- Tetap pertahankan head tilt-chin lift
- Tiup selama 1 detik.
Lihat apakah dada terangkat .
- Tetap pertahankan
head tilt-chin lift,
lepas mulut penolong
dari mulut pasien.
- Lihat apakah dada pasien
turun waktu ekshalasi .
- Ambil napas lagi dan ulangi meniup.

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.

4.

C: CIRCULATION: Cek sirkulasi, raba nadi carotis

Tidak ada respon, periksa

tanda-tanda
sirkulasi
dengan
meraba a. carotis (10
detik)

Meraba pulsasi arteri carotis

Nadi carotis tidak teraba = henti jantung (cadiac

arrest) : segera mulai kompresi dada
Tentukan titik tumpu:
pertemuan garis yang
menghubungkan ke dua
papila mamae dengan
sternum (tulang dada)

5.

Pijat Jantung: 30 kompresi (100x/menit) : 2 ventilasi

Tumit tangan satunya

diletakkan
diatas tangan yang
sudah berada tepat dititik pijat jantung.

Jari-jari kedua tangan

dirapatkan
dan diangkat agar
tidak ikut menekan .

Hand positions for external chest compressions

Penolong

mengambil posisi
tegak lurus
di atas dada pasien
dengan
siku lengan lurus
menekan sternum
sedalam 1,5 2 inchi
(4-5 cm).

EKSTERNAL CHEST COMPRESSION

30 compressions are alternated with

2 ventilations.

EMPHASIS ON EFFECTIVE CHEST COMPRESSIONS

To 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 RESCUERS
The 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: Drugs
Epinefrin:
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
g/kg/menit.

E: Electrocardiography
Ventricular Fibrillation
Pulseless Ventricular Tachycardia

Ventricular Fibrillation

Pulseless Ventricular Tachycardia

Non Shockable Rhythm

Asystole
PEA ( Pulseless Electrical Activity ) / EMD ( Electro
Mechanical Dissociation )

Asystole

Pulseless Electrical Activity

F: Fibrillation Treatment
Objective: 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 victims rhythm after giving about 5 cycles
(about 2 minutes) of CPR.
Dosage:
Monophasic defibrillator : 360 J
Biphasic (modern) defibrillator : 150 J and 200 J.

MOBILE DEFIBRILLATOR

AUTOMATED EXTERNAL DEFIBRILLATORS (AED)

Detect shockable waves then automatically gives shock. Can be
operated by trained personel (lay rescuers or healthcare provider)

Press the Green ON

Button

Plug in Connector

Apply Pads to Bare

Chest

Press the Orange SHOCK

You have successfully

used an AED

Thank you......