(Tim PPGD)
(RSUP Dr Sardjito Yogyakarta)
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Special Aspect of Emergency
Medicine
Emergency patients show a wide range of
symptom challenge the EMT to obtain a
tentative diagnosis quickly and start a specific
treatment with no further harm. With limited
in diagnosis tool, time, and human resource.
Classic approach look, listen and feel, is
still the most important aspect of patients
examinations
Peter N, 2010
Resusitasi jantung-paru
Kematian klinis
Kematian biologis
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Cardiac Arrest
Jantung kehilangan fungsi secara mendadak
dan sangat tiba-tiba
Penyebab tersering Ventrikel Fibrilasi
75 % terjadi di luar rumah sakit
CPR dan DC 3-5 menit setelah henti jantung
meningkatkan harapan hidup 49-75%
Setiap menit tanpa CPR menurunkan angka
harapan hidup 7-10%
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Penyebab:
Penyakit Jantung: Metabolisme:
IMA (terbanyak) Hiperkalsemia
Miokarditis hiper/ hipokalemi
Kardiomiopati Hipotermi
Trauma/ tamponade Sengatan listrik
Gagal Jantung Refleks vagal
Gangguan respirasi:
Hipoksia
Hiperkapnea
Electrocardiographic evolution of a
cardiac arrest
Callans DJ
NEJM
2004;351;632-4
Diagnosis of cardiac arrest by bystanders
in BLS
Unconsciousness Patient who does not reply
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Prompt defibrillator shock is
recommended
B : Breathing
C : Circulation
Early defibrilation:
Cepat identifikasi adanya VT/ VF cepat lakukan defibrilasi.
Early ACLS:
Cepat mendapat pertolongan alat bantu pernapasan dan terapi medikamentosa
untuk mengontrol sirkulasi dan perawatan post resusitasi
LANGKAH RJP
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1. Memastikan kesadaran penderita
2. Panggil bantuan
1. 2.
Apa kau baik-
Baik saja!!
Tolong!!
Bantu saya..
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•Mouth to Mouth
•Mouth to Mask
•Bag Valve Mask
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Teknik
Berikan dalam waktu > 1 detik
Berikan volume 500-600 ( 6-7ml/Kg)
Berikan hingga dada mengembang
Hindari hiperventilasi
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C. Cek nadi (circulation)
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Mencari titik kompresi
Naik 2 jari
Letakkan pangkal
telapak tangan
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Posisikan tangan
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Kedalaman kompresi:
½-1/3 ketebalan dinding dada
Neonatus
Anak
Bayi
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Teknik kompresi
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Perbandingan kompresi : ventilasi
Perbandingan
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Rescue breathing: pemberian ventilasi tanpa
kompresi
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POSISI RECOVERY
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Menghentikan RJP :
•RJP BERHASIL
•RJP GAGAL
•PENOLONG KELELAHAN?
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During CPR
1. Push hard and fast (100x/menit)
2. Ensure full chest recoil
3. Minimize interuption in chest compressions
4. One cycle of CPR: 30 Compressions then 2 Breath. 5
cycles=2 mnt
5. Avoid hiperventilation
6. After advanced airway placed give continues chest
compression wihout pauses for breath.
7. Rotate compressors every 2 minutes with rhytme checks
8. Search for and treat possible contributing factors.
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Penurunan
Tidak ada gerakan/respon
kesadaran
Defibrilator tersedia
Berikan 1 shock
Lanjutkan RJP 5 siklus Lanjutkan RJP
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COMPARISON OF OUTCOME IN PATIENTS
GIVEN EITHER A REPEATED STANDARD
DOSE OR A HIGH DOSE OF ADRENALINE
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