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This document outlines the phases and procedures for cardiopulmonary resuscitation (CPR). It discusses the three phases of CPR identified in 1961 which focus on emergency oxygenation, restoration of spontaneous circulation, and post-resuscitative care. The key steps of CPR include airway management, breathing support through manual ventilation or bag valve mask, and circulation support through chest compressions. Drugs like epinephrine may help restore spontaneous circulation. Proper techniques are described for clearing the airway, positioning the patient, providing manual ventilation, administering chest compressions, and establishing intravenous access for drugs.
This document outlines the phases and procedures for cardiopulmonary resuscitation (CPR). It discusses the three phases of CPR identified in 1961 which focus on emergency oxygenation, restoration of spontaneous circulation, and post-resuscitative care. The key steps of CPR include airway management, breathing support through manual ventilation or bag valve mask, and circulation support through chest compressions. Drugs like epinephrine may help restore spontaneous circulation. Proper techniques are described for clearing the airway, positioning the patient, providing manual ventilation, administering chest compressions, and establishing intravenous access for drugs.
This document outlines the phases and procedures for cardiopulmonary resuscitation (CPR). It discusses the three phases of CPR identified in 1961 which focus on emergency oxygenation, restoration of spontaneous circulation, and post-resuscitative care. The key steps of CPR include airway management, breathing support through manual ventilation or bag valve mask, and circulation support through chest compressions. Drugs like epinephrine may help restore spontaneous circulation. Proper techniques are described for clearing the airway, positioning the patient, providing manual ventilation, administering chest compressions, and establishing intravenous access for drugs.
SMF Anestesiologi dan Unit Perawatan Intensif RSUD Arifin Ahmad / FK Universitas Riau Objective: Identification phases of resuscitation Algorythm of CPR initiation Airway management Breathing support Circulation Support Drug s and fluids
Introduction 1961 : Safar devided CPR into 3 phases Phase I : Basic Life Support, goals of this phase action ( ABC) Emergency Oxygenation Phase II : Advanced Life Support, goals of this phase action (DEF) Restoration of spontaneous circulation and stabilization of the cardiopulmonary system Phase III : Prolonged Life Support, goals ( GHI) Post resuscitative brain oriented and intensive care
Awake? / No Breath ? / No
Airway management Breath ?/No
Breathing Support 2x Carotid Pulse / No
Circulation support Airway management: The most common site of airway obstruction in comatouse patients : relaxed tongue , when patients head is in flexed or mid position Foreign matter : vomitus, blood stimulation in stuporous or lightly comatose patients Laryngospasm is usually caused by upper airway could be complete or partial obstruction, in complete obstrc (if not corrected) leads to apnea and cardiac arrest within 5 10 minute , in partial obstrc must be corrected promptly can result in brain damage or even cardiac arrest Recognition of Airway obtruction ; Can not hear and feel of air flow at the mouth and nose for complete airway obstruction When patients still breathing inspiratory retraction of intercostal and supraclavicular Partial airway obstruction : snoring, crowing, gurgling, wheezing Hypercarbia : somnolence Hypoxemia : sympathetic stimulation Manual clearing of the airway: The crossed finger maneuver Finger behind teeth manuever Tongue jaw lift manuever
Clearing the airway by suction
Technique for foreign body clearing If the victim is conscious , encourage to expel by coughing and spitting it out Apply abdominal thrust s or back blows
If the victim is unconscious Apply back blows or abdominal thrust in horizontal position
Positioning to open the airway Head tilt Neck lift Chin lift Jaw thrust Open the airway using equipment Oropharyngeal airway Nasopharyngeal airway Endotracheal intubation Cricothyroidotomy and Tracheostomy H Chin Lift Neck Lift
Breathing support - Without equipment Mouth to mouth and Mouth to nose - Mouth to ventilation - Bag Valve Mask with oxygen Giving positive pressure during inspiration and spontaneous expiration
Mouth to mouth or mouth to nose ventilation Exhalation consist of 16 - 18 % of oxygen
Recognition of cardiac arrest unconsciousness, apnea or gasping, death like appearance(cyanosis, or pallor), absence of pulse in large arteries ( carotid or femoral )
Circulation Support Cardiac arrest : Primary : Ventricular fibrillation, asystole caused by myocardial infarction Secondary : exsanguination, asphyxia The most common caused of cardiac arrest : Ventricular fibrillation Closed chest cardiac compressions External cardiac compression (C) in combination with airway control ( A ) , breathing support (B) Made it possible to promptly initiate attempts at reversal of clinical death The aims of cardiac compression : Initiate artificial circulation
1 operator dan 2 operator pada pasien yang belum terintubasi Pada pasien yang telah terintubasi : kompresi 80-100/mnt ventilasi 12-15/mnt Monitoring the effectiveness of CPR Cheking whether the spontaneously pulse has returned at first after 1 minute CPR, and every 2 5 minute there after Intermittently palpating the carotid pulse Emergency management of hemorrhage Control of external hemorrhage without surgical measures, by elevation and compression Positioning of conscious patients in horizontal with leg elevated ABC resuscitation initiation in unconscious patients
Drugs and Fluids Routes for drugs and fluid : Peripheral intravenous route for the administration of drugs and fluids should be establish as quicly as possible after the initiation of CPR without interrupting CPR Drugs Epinephrine ( Adrenaline ) may help restore spontaneous circulation in cardiac arrest of 1 2 minute duration Alpha and beta receptor activity Alpha receptor activity is the most important in cardiac arrest Vasoconstriction, diastolic pressure raises, improve myocardial and cerebral blood flow LMA