CODE BLUE

up date on CPR
Guidelines 2015
Imam Suyuthi, dr, Sp. An
Peraturan Perumahsakitan
Akeditasi RS, JCI

Semua petugas (medis, non medis) Rumah Sakit,

wajib mengerti dan mampu melakukan pertolongan
awal bila ada seseorang mendadak tidak sadar

BASIC LIFE SUPPORT

Bantuan hidup dasar
Code Blue
Merriam-Webster's Medical Dictionary

1. A declaration of or a state of medical emergency and call

for medical personnel and equipment to attempt and
resuscitate a patient especially when in cardiac arrest or
respiratory distress.
Merriam-Webster's Medical Dictionary, © 2002 Merriam-Webster, Inc.

Pernyataan kondisi gawat darurat medis dan panggilan minta

bantuan medis dan peralatan untuk membantu korban henti
jantung atau gawat nafas
2. A medical emergency in which paramedics
are dispatched to aid a person undergoing cardiac
arrest.
Kegawatdaruratan medis dimana paramedis dituntut
untuk menolong korban yang mengalami henti jantung
Dictionary.com Unabridged (v 1.1) Based on the Random House Unabridged Dictionary,© Random House, Inc.2006.

3. A medical emergency in which a team of medical

personnel work to revive an individual in cardiac
arrest.
Kegawatdaruratan medis dimana tim medis
dituntut menyelamatkan pasien henti jantung
The American Heritage® Dictionary of the English Language, Fourth
Edition
 Jantung mendadak berhenti
dapat terjadi:

Kapan saja
Dimana saja
Mengenai siapa saja

Siapapun dapat menolong

Life support for everyone ....
Life support by everyone ....
1999 di Amerika: kematian 460.000 dari total 728.743 C.Arrestsetahun
36% terjadi didalam Rumah Sakit (in-hospital CA),
64% terjadi di luar Rumah Sakit (out-of-hospital CA)
(Geocadin et 2008)
Cardiac Arrest = jantung berhenti

Out-of-hospital Cardiac Arrest = kejadian diluar RS

In-hospital Cardiac Arrest = kejadian didalam RS

in-patient CARDIAC ARREST :

kejadian DIDALAM, di- ruang tindakan atau di- bangsal
MEDIK
out-patient CARDIAC ARREST : NON MEDIK
kejadian DILUAR ruang tindakan atau diluar bangsal

BLS - BASIC LIFE SUPPORT 6

Contoh
Code Blue CSystem
Tim / personil NON MEDIS
= Petugas Tata Usaha/ admin
= Petugas Security
= Petugas cleaning service
Tim Code Blue Lokal
= Petugas Kes. terlatih
Tim Advanced Code Blue
= Petugas terlatih (perawat
bersertifikat emergency)
= Ada DokterAhli
= ada defibr , alat
emergency lengkap
Alur
Kejadian
CardiacArrest
Korban roboh tidak sadar
Siapapun yang paling dekat dengan korban melakukan
pertolongan, melakukan BLS dan Call for help
Teriakkan Code Blue…..!!!!!!!
Petugas kesehatan tempat kejadian melanjutkan bantuan,
Melanjutkan BLS.
Call for help - teriakkan Code Blue
Tim Code Blue terdekat datang
melanjutkan bantuan. BLS - ALS
Jantung berdenyut Jantung TIDAK berdenyut
ROSC Tidak ROSC
transportasi
ke - ICU IKK
7
Langkah bila terjadi
“CODE BLUE” Area-I Poli/ R. KONSULTASI ANESTESI
1. Penolong pertama datang GPDT LT - 1 Tilp. 3118
teriakkan “CODE BLUE !!”
2. Lakukan BLS s/d
Area-II IRD – RUANG RESUSITASI
Tim Bantuan datang
RES Tilp. 1234 CENTER
RUANG RECOVERY GBPT- L3 CODE BLUE
Area-III
RR Tilp. 1831 & 1832
Minta bantuan GBPT
Area-IV ICU GBPT – L2 / IRIR
Tilp. 1823 & 1876
AREA MANA
YANG TERDEKAT?
Area-V BEDAH –A
Tilp. 1307

Area-VI POLI KARDIOLOGI

IRJ Tilp. .1453 SUB-CENTER
UPI - IRNAANAK
CODE BLUE
Area-VII
Tilp. 1683

GRAHA AMERTA Lt-3

Area-VIII
Tilp. 501245 & 5012903
Langkah bila terjadi
“CODE BLUE” Call Center menginformasikan
1. Penolong pertama datang kesemua ruangan
teriakkan “CODE BLUE !!”
2. Lakukan BLS s/d
Tim Bantuan datang
Orang terdekat korban menolong
korban dan meneriakkan code blue,
atau menghubungi Call center
Minta bantuan
Ruangan D
Ruangan B

TKP
Code Blue
Ruangan E
Ruangan C

Ruangan F
 Consensus Guidelines

The major contributor for ILCOR

Resuscitation Council of
Southern Africa (RCSA)

Inter American Heart Foundation

Resuscitation Council of ASIA
(IAHF) (RCA)
NEW Guidelines 2015
CARDIO PULMONARY RESUSCITATION

Since 2000, researchers from the ILCOR member councils have evaluated
resuscitation science in 5-yearly cycles.
The most recent International Consensus Conference was held in Dallas in
February 2015 and the published conclusions and recommendations from
this process form the basis of these ERC Guidelines 2015.
New Guidelines 2015 ~ Guidelines 2010
Key Points

Adult basic life support (BLS):

1. By standers should initiate compression-only CPR.

2. Compression rate should be 100–120 per minute (updated from
“at least” 100 per minute).
3. Compression depth should be 2–2.4 inches (upper limit added).
4. Compression time should be maximized.
5. Social media may be used to summon rescuers to perform CPR.
Chest Compression-Only CPR
The AHA recommends that anyone who sees an adult suddenly collapse
should call 911 and push hard and fast on the center of the chest,
a technique known as Hands-Only CPR. 2015 AHA

Treatment Recommendation

• Chest compressions alone are recommended for untrained

laypersons
• Professional rescuers should provide chest compressions
with ventilations for cardiac arrest victims

• Performing chest compressions alone is reasonable for

trained laypersons if they are incapable of delivering
airway and breathing maneuvers 2010 ILCOR
 ERC – AHA - ILCOR
ERC Guidelines 2015
HEAD TILT – CHIN LIFT
AHA Guidelines 2015
Since 2010 The 2010 Guidelines
were most notable for the
re-orientation of the universal
sequence from
A-B-C (Airway, Breathing,
Compressions) to C-A-B
(Compressions,Airway,
Breathing) to minimize time
to initiation of chest compressions.
"Look, Listen, and Feel" is no
longer recommended
ERC 2015 = ILCOR 2015
"Look, Listen, and Feel"
is recommended
ERC Guidelines 2015

HEAD TILT – CHIN LIFT

LOOK – LISTEN – FEEL

ILCOR 2010
3 – 5 seconds
 Kapan pijat jantung harus segera dilakukan??

Bila mendadak tidak sadar dan tidak bernafas

atau
Mendadak tidak sadar, nafas ter-sengal2 (gasping)

Treatment Recommendation

It is reasonable that lay rescuers and healthcare professionals use the combination
of unresponsiveness and absent or abnormal breathing to identify cardiac arrest.
Palpation of the pulse as the sole indicator of the presence or absence of cardiac
arrest is unreliable.
Agonal gasps are common during cardiac arrest and should not be considered
normal breathing.
2010 ILCOR
April_Surabaya
 Sel otak : normal reversible injury irreversible injury

4-6
menit

19
 Push hard and fast — but not too hard or too fast!

Pijat dibagian tengah dada

(setengah bagian bawah tulang dada)
Dengan berat badan penolong,
agar tulang dada tertekan 5-6 cm

BLS - awam 100-120x per menit

Mendadak tidak sadar ...??
Tidak bernapas ...??

Pijat jantung saja ....

sampai bantuan datang atau 5-6 cm
korban sudah mulai
bergerak2 sebagai tanda
adanya kehidupan
 Korban mendadak roboh
Code Blue
Kepala di-tengadahkan
Bila ternyata tidak sadar & tidak bernafas

segera lakukan pijat jatung dan

berteriak minta tolong ....Code Blue

Pijat jantung dan teruskan .......

sampai bantuan tim medis datang

Pijat ditulang dada bagian bawah

Kecepatan pijatan 100-120 x/ menit

Perhatikan
posisi tangan penolong
(tumit tangan)
 Korban mendadak tidak sadar
Berteriak-lah
minta bantuan
Kepala ditengadahkan
Check Nafas

Bila anda tidak mau atau

tidak mampumemberikan korban tidak bernafas
tiupan nafas atau nafas tersengal-sengal
Lakukan pijat jantung saja
sd bantuan medis datang
Pijat jantung 30 X
disusul dengan
2 x tiupan nafas
 Korban mendadak tidak sadar

Kepala ditengadahkan
Check Nafas

korban tidak bernafas

atau nafas tersengal-sengal

Pijat jantung 30 X

tidak teraba Raba nadi karotis teraba

Pijat jantung 30 X Stop Pijatan

2 x tiupan nafas
 Cardiac Arrest, jantung berhenti berfungsi sbg pompa
• Penelitian: 70% ECG arrest awalnya adalah VT/VF,
ketika akhirnya ATP di miokard habis
 ECG menjadi asystole
• Jika ECGnya VT/VF, 50-70% bisa ROSC jika ditolong
dalam waktu < 5 menit, dgn melibatkan defibrilator
biphasic
• Jika ECG-nya asystole hanya 7-10% yang bisa ROSC
AED
berperan

Ventrikel Fibrilasi kasar Ventrikel Fibrilasi halus Asystole

Key Points

New Guidelines 2015

Advanced Cardiovascular Life Support (ACLS):
Advanced Life Support (ALS):

1. Vasopressin is out; stick with epinephrine.

2. Extracorporeal CPR is an alternative to CPR in patients for whom
the suspected etiology is reversible.
3. Maximize oxygenation during CPR, but titrate down after return of
spontaneous circulation (ROSC).
4. After 20 minutes of CPR, a low end-tidal CO2 level may be used to
help determine whether to terminate resuscitation in intubated patients.
5. Ultrasound may be used to confirm endotracheal tube placement.
Capnography Waveforms
Key Points

New Guidelines 2015

Post Cardiac Arrest Care

After ROSC:
In comatose patients, target temperature to 32–36°C for
at least 24 hours, and prevent fever.

Sel cortex otak, normotermia Sel cortex otak, teknik hipotermi

Banyak sel apoptosis (mati) Banyak sel normal (hidup)
GOALS of CPR

The goals of resuscitation are not only to

preserve cardiac and neurologic function but
also to improve quality of life for survivors

Return of cardiac function does not automatically

restore normal cerebral circulation. Depending on
the duration of the ischemic period, cerebral vessel
dysfunction develops which likely contribute to
neuronal damage. Reperfusion Injury
2010
 Kapan giliran anda berkesempatan “menghidupkan”
seseorang kembali ...............???
• Berlatihlah
agar
senantiasa siap
• Kesempatan “indah”
itu bisa tiba-tiba
muncul
dimuka Anda

Tidak ada waktu untuk berfikir dua kali,

kerjakan .....atau kesempatan itu hilang
ED_2013