Sekelumit: bantuan hidup dasar

Dr. Vera Irawany, SpAn Click to edit Master subtitle style

5/16/12

Henti Jantung Mendadak (Sudden Cardiac Arrest)

Amerika (CDC) kematian CAD/thn 330.000 di luar RS / UGD 250.000 di luar RS Insidens 0,55 kematian/1000 pop/thn Eropa (ESC) 700.000 kematian/tahun 40% Fibrilasi ventrikel

Indonesia (Depkes) Penyebab kematian utama sistem sirkulasi (26,4%)

Courtesy dr George, 2010 5/16/12

Penyakit Penyebab Kematian Umum di Indonesia

26,4%

18,9% 16%

Sistim sirkulasi = henti jantung

5/16/12

Profil

Courtesy of Arif Mansjoer

sejarah
n

resusitasi = "resuscitare" = membangunkan lagi 1950-an : resusitasi nafas buatan (Safar & Elam) 1960-an : resusitasi KJL (Kouwenhoven) 1961 : nafas buatan + KJL (Safar) RJP RJPO

5/16/12

History of Modern CPR

1950 1960
SAFAR Pengendalian jalan napas & Pernapasan buatan

KOUWENHOVEN Kompresi jantung tertutup

197 4 199 3
5/16/12

American Heart Association Cardiopulmonary Resuscitation (CPR)

International Liaison Committee on Resuscitation (ILCOR)

5/16/12

66

Resusitasi modern

5/16/12

5/16/12

Angka keselamatan ?

5/16/12

Tanpa BHD (RJP) kemungkinan korban utk survive berkurang antara 7%-10% /menit

Dengan BHD (RJP) kemungkinan korban utk survive berkurang antara 3%-4% /menit sampai dilakukan defibrilasi

5/16/12

1010

ILCOR = International Liaison Comittee on Resuscitation

1.American Heart Association AHA 2.European Resuscitation Council ERC 3.Heart and Stroke Foundation of Canada HSFC 4.Resuscitation Councils of Southern Africa RCSA 5.Australian Resuscitation Council ARC 6.Resuscitation Councils of Latin America CLAR 7.New Zealand Resuscitation Council NZRC

5/16/12

International Guidelines 2000 Conference on Cardio-pulmonary Resuscitation and Emergency Cardiovascular Care

Circulation 102, 5/16/122000

Resuscitation 46, 2000

5/16/12

...2005.....

5/16/12

BACKGROUND
keluar RS terhadap korban2 henti jantung karena VF di luar RS yg disaksikan sangat rendah yaitu hanya 6% seluruh dunia. Dengan catatan hanya sedikit perbaikan setelah guideline thn 2000 di keluarkan. Data2 ini dibuat hanya bberapa waktu sebelum dimulainya konferensi CPR ILCOR2005. Ada 2 penelitian yg dipublukasi 5/16/12 sebelum konferensi 2005
Data2 tentang angka survival sewaktu

Perubahan utama pada CPR 2005

5/16/12

Check and assess hands-off time = time without chest compression reduce survival

5/16/12

100 per menit Ratio 15:2

Hands-off time = time without chest compression

v

Repeatedly assessing the patient Interruption for ventilation Operator delay for CVP, intubation, changing rescuer Time taker by AED for analysis

A fall in coronary perfusion pressure A deterioration in waveform of VF A decrease of successful outcome after DC shock

5/16/12

Remove check breath and assess circulation RATIO 30:2 (less ventilation)

AED

Why 30:2 or less ventilation?

In VF SCA, ventilation NOT AS important as compressions VQ mismatch (need less Vt) Increases intrathoracic pressure

Decreases venous return

Prevents adequate filling

Gastric insufflation

Hyperventilation is bad.
DECREASES CARDIAC OUTPUT

5/16/12

Aufderheide TP, Sigurdsson G, Pirrallo R, Yannopoulos D, McKnite S, von-Briesen C, et al Hyperventilation-induced hypotension during CPR Circulation. 2004;109:1960-5
Observasi pada penolong terlatih dalam memberikan pernapasan buatan

Percobaan 3 kelompok hewan hiperventilasi

Tekanan intra toraks rata-rata

Tekanan perfusi koroner

Kelompo Kecepatan k ventilasi Kelompok 37 + 4* pasien (napas/m 1 yang (n=7) Kelompok 22enit) + 3* 2 (n=6) ditolon Kelompok 30 + 3.2 Tidak ada korban yang selamat 3 g (n=13)

Penolong profesional pemberian ventilasi berlebih pada tindakan RJP. Hiperventilasi (pada hewan) tekanan intratorakal meningkat, tekanan perfusi koroner menurun, dan angka ketahanan hidup menurun

RANTAI KESELAMATAN
(CHAIN OF SURVIVAL)

Early recognition & EMS activation Early CPR Early defibrilation Early ALS & post resuscitation care
5/16/12
2222

Why AED? Witnessed vs Unwitnessed

v

Witnessed Collapse//Cardiac Arrest

AED first

Unwitnessed arrest

CPR first (2 minutes or 5 cycles), then AED

5/16/12

Etiology of sudden cardiac arrest

v

Etiologi

Cardiac (primary)

Heart attack (MCI) Kelaianan jantung lain

Non-Cardiac (secondary)

Internal

Pneumonia berat, syok, dll

Nolan J. ERC Guidelines for Resuscitation 2005-introduction. Resuscitation. 2005; 67 (suppl Eksternal 1):S3-S6

5/16/12

Trauma, keracunana dll

Etiology of sudden cardiac arrest

v

Etiologi

Nolan J. ERC Guidelines for Resuscitation 2005introduction. Resuscitation. 2005; 67 (suppl 1):S3-S6

5/16/12

100%

Henti Jantung
? % 40%
Saat di EKG: asistol

80%

Henti Penyakit jantung/paru jantung 5/16/12

Henti jantung VT/VF

Saat di EKG: VT/VF

Potensial untuk defibrilasi (AED)

Fase Henti Jantung

(Weisfeldt & Becker)

5/16/12

Electrical phase
AED first
v

VF early defibrillation (class I) Each passing minute decreased survival by 8-10%

Circulation 1997
v

Survival rate approaching 50% Chicago airport study

AED 10/18 VF case survival

NEJM 2002

5/16/12

Chicago Airport
v

AED within 1 minute anywhere in the airport Survival approaching 50% (10/18) for VF

5/16/12

Automated external defibrillator

5/16/12

Bantuan hidup dasar

1.

AKSES DINI (EARLY ACCESS) RJP DINI (EARLY CPR) DEFIBRILASI DINI (EARLY DEFIBRILLATION)

2.

3.

5/16/12

Saat ini yang dipakai..

5/16/12

5/16/12