RESUSITASI JANTUNG

DAN PARU (RJP)

TUJUAN :
UNTUK MENGATASI HENTI NAFAS DAN HENTI JANTUNG
MUNGKIN MASIH DAPAT DITOLONG AGAR TETAP HIDUP
USAHA RJP / CPR

PENYEBAB :

HENTI NAFAS
BIASANYA DISERTAI : - BRADIKARDIA
- ASISTOLE
- FIBRILASI VENTRIKEL

HENTI JANTUNG :
*
*
*
*

HIPOKSEMIA
GANGGUAN ELEKTROLIT
PENYAKIT JANTUNG ( ARITMIA )
PENEKANAN MEKANIK
(TENSION PNEUMOTORAKS, TAMPONADE JANTUNG)

TINDAKAN

1 ORANG PENOLONG
NAFAS BUATAN : PIJAT JANTUNG LUAR
2 :

15

2 ORANG PENOLONG
NAFAS BUATAN : PIJAT JANTUNG LUAR
1 :

A. DEWASA :
I. TINDAKAN OLEH SATU
ORANG :
1.

2.
3.

4.
5.
6.

PADA KORBAN TIDAK SADAR ( PERIKSA

DENGAN GOYANG - GOYANG DAN CUBIT
UNTUK MEMASTIKAN )
LAKUKAN PERTOLONGAN SEGERA MINTA
BANTUAN.
ATUR POSISI KORBAN, TERLENTANGKAN
DENGAN CARA LOGROLL / MENGGELINDING,
HATI-HATI DENGAN ADANYA PATAH
TULANG BELAKANG.
BUKA JALAN NAFAS : HEAD TILT / CHIN
LIFT / JAW THRUST.
LIHAT, DENGAR, RABA NAFAS 3 - 5 DETIK.
BERIKAN NAFAS DUA KALI, PELAN DAN
PENUH PERHATIKAN DADA MENGEMBANG.

7.
8.

RABA DENYUT KAROTIS 5 10 DETIK.

BILA KAROTIS TIDAK TERABA, LAKUKAN PIJAT
JANTUNG DARI LUAR 15 KALI DALAM WAKTU
9 11 DETIK PADA TITIK TUMPU TEKAN JANTUNG,
TEKAN TULANG DADA 5 cm KE DALAM 80 100
KALI PERMENIT.
9. LANJUTKAN PEMBERIAN NAFAS BUATAN TANPA
ALAT / DENGAN ALAT 2 KALI PELAN DAN DALAM.
10. LENGKAPI TIAP SIKLUS DENGAN PERBANDINGAN
DUA NAFAS DIBANDING 15 PIJITAN.
11. LAKUKAN EVALUASI TIAP AKHIR SIKLUS KE
EMPAT ( 5 7 DETIK ) NAFAS, DENYUT,
KESADARAN DAN REAKSI PUPIL.
12. BILA NAFAS DAN DENYUT BELUM TERABA,
LANJUTKAN RESUSITASI JANTUNG PARU
HINGGA KORBAN MEMBAIK ATAU CENDERUNG
MENINGGAL.

Opening airway using head tilt and

chin lift during rescue breathing

Chest must rise

For adults, the correct chest compression

is 1.5 to 2 inches, or 4 to 5 cm

II. TINDAKAN OLEH DUA PENOLONG

:
1.

2.

3.

4.

LANGKAH 1 10 DIATAS TETAP DILAKUKAN

OLEH PENOLONG PERTAMA HINGGA
PENOLONG KEDUA DATANG.
SAAT PENOLONG PERTAMA MEMERIKSA
DENYUT NADI KAROTIS DAN NAFAS,
PENOLONG KEDUA MENGAMBIL POSISI UNTUK
MENGGANTIKAN PIJAT JANTUNG.
BILA DENYUT NADI BELUM TERABA,PENOLONG
SERTA MEMBERIKAN NAFAS BUATAN SATU
KALI SECARA PERLAHAN DAN DALAM,
DISUSUL PENOLONG KEDUA MEMBERIKAN
PIJAT JANTUNG SEBANYAK 5 KALI.
LANJUTKAN SIKLUS PERTOLONGAN DENGAN
PERBANDINGAN : 1 KALI NAFAS BUATAN
( OLEH PENOLONG PERTAMA ) DAN 5 KALI
PIJAT JANTUNG ( OLEH PENOLONG KEDUA ).

B. BAYI :
1. LETAKKAN PADA POSISI NETRAL.
2. TIUPKAN UDARA NAFAS 2 KALI
( TANPA ALAT / DENGAN ALAT ).
3. UNTUK PIJAT JANTUNG,GUNAKAN
PENEKANAN DENGAN 2 JARI
TENGAH DAN JARI MANIS DIATAS
TULANG DADA, 1 JARI DIBAWAH
GARIS IMAJINASI ANTARA PUTING
SUSU.
4. TEKAN TULANG DADA 1 2 cm
DENGAN FREKUENSI MINIMUM 100
KALI PER MENIT.

C. ANAK :
1. LETAKKAN PADA POSISI NETRAL.
2. TIUPKAN UDARA NAFAS 2 KALI (
TANPA ALAT / DENGAN ALAT ).
3. PIJAT JANTUNG DENGAN
MENGGUNAKAN SATU TANGAN
DENGAN BERTUMPU PADA
TELAPAK TANGAN DIATAS
TULANG DADA, 2 JARI DIATAS
ULU HATI.
4. TEKAN TULANG DADA 1 2 cm
DENGAN FREKUENSI 80 -100
KALI PERMENIT.

Status terminal
Fibrilasi ventrikel
primer

0 menit

Asistol primer
Anoksia alveolar
Asfiksia
obstruksi/apnea

2-3 menit
5-12 menit

Eksanguinasi

Gagal paru

Syok

Gagal otak

Henti
sirkulasi

Mati
panorganik

MATI KLINIS

5 mt

10 mt

15 mt

20 mt

SIRKULASI PULIH KEMBALI

Napas
spontan

Napas
spontan

Napas
spontan

Apnea
.

Sadar

Sadar/Stupor

Tidak Sadar

Tidak Sadar

Neurologis
normal
.

Neurologis
defisit
.

Status
vegetatif
EEG abn

Mati otak
EEG
isoelektrik

First A - B - C - D
Airway:
Open the airway
Breathing:
Provide positive pressure ventilation
Circulation:
Give chest compressions
Defibrilation:
Shock VF/pulseless VT

Second A - B - C - D
Airway:
Establish advanced airway control
Perform endotracheal intubation
Breathing:
Assess the adequacy of ventilation via endotracheal tube
Provide positive-pressure ventilations
Circulation:
Obtain IV access to administer fluids and medications
Continue CPR
Provide rhythm-appropriate cardiovascular pharmacology
Differential Diagnosis:
Identify the possible reasons for the arrest.
Construct a differential diagnosis to identify reversible
causes that have a specific therapy.

CPR, ONE RESCUER

On the following screen, you will see an action
sequence integrating the basics of CPR.
This sequence will help to structure your decision
making process during an emergency.
It first adresses AIRWAY, then BREATHING, then
CIRCULATION, the famous ABCs of CPR.
The
first sequence is for ONE resquer; the second
sequence is for TWO resquers.
CPR with foreign body obstruction, FBO, will be
treated in the section dealing with foreign body
obstruction.

Are you OK? Gently shake the

victim.
Establish UNRESPONSIVENESS

Establish whether victim is responsive

if no response, CALL 911

If NO RESPONSE, call for HELP.

Instruct bystander to dial 911.

Open airway using head tilt-chin lift or jaw thrust.

LOOK, LISTEN, FEEL for breathing.

In unconscious victim,
the muscles in the tongue
may relax, causing the
tongue to block the
airway

Head tilt and chin

lift may open airway

If NOT breathing, give two slow, full breaths.

The two breaths should take a full five (5) seconds.

Opening airway using head tilt and

chin lift during rescue breathing

Chest must rise

LOOK to verify that the chest RISES.

If chest does NOT rise reposition head.
Is a PULSE present?

Assess whether victim is breathing

by looking for chest movement,
Listening for breath
sounds, and feeling
breath against ear
or cheek

Determine if pulse exists

by checking carotid artery
located between
Adams apple and
neck muscle

If pulse present, give two slow, full breaths.

The two breaths should take a full five (5) seconds.

Opening airway using head tilt and

chin lift during rescue breathing

Chest must rise

If NO PULSE, give 15 rapid, forceful cardiac

compressions. The compressions must take
only 10 - 12 seconds to complete!

Cardiac compression
started by locating
point two fingers
above xyphoid process

For adults, the correct chest compression

is 1.5 to 2 inches, or 4 to 5 cm

Give TWO slow, full breaths, and verify that the

chest rises. Then give 15 more cardiac compressions.
Repeat this cycle two more times for a total of four
(4) cycles.

Opening airway using head tilt and

chin lift during rescue breathing

Chest must rise

For adults, the correct chest compression

is 1.5 to 2 inches, or 4 to 5 cm

Stop and quickly check for breathing and pulse.

IF NO BREATHING AND NO PULSE:

Continue CPR until help arrives.

IF PULSE PRESENT BUT NO BREATHING:

Begin resque breathing at the rate of 15 breaths
per minute. Each breath must take 2 seconds.

IF PULSE PRESENT AND BREATHING:

Congratutation! You saved the patient.

AIRWAY VENTILATION DURING TWO

RESCUER CPR
1. Each ventilation requires two (2) seconds
2. Verify that chest rises.
3. Second rescuer is in position for chest
compressions.
4. For adults, the sequence is one (1) ventilation
for every five (5) compressions.

CHEST COMPRESSIONS DURING TWO

RESCUER CPR
1. Five (5) chest compressions in four (4)
seconds.
2. Depress sternum 1 to 2 inches, or 4 to 5
centimeters.
3. Second rescuer is in place for airway
ventilation.

The leader then gives one (1) rescue breath,

and the second rescuer follows with five (5)
cardiac compressions.
This cycle is repeated eight (8) more times for
a total of ten (10) cycles.

Stop and quickly check for breathing and pulse.

IF NO BREATHING AND NO PULSE:
Continue CPR until help arrives.
IF PULSE PRESENT BUT NO BREATHING:
Begin rescue breathing
at the rate of 15 breaths per minute. Each
breath must take 2 seconds.
IF PULSE PRESENT AND BREATHING:
Congratulation! You saved the patient.

In summary, during two rescuer CPR, one

rescuer assumes the leader role and the second
rescuer may do any of the following four tasks:
Go for help....activate EMS.call 911
Monitor victim during CPR
Perform CPR when the leader tires
Perform two (2) rescuer CPR as described
earlier

Mengakhiri resusitasi
1. Sirkulasi dan ventilasi spontan yang efektif telah
timbul
2. RJP diambil alih oleh bertanggung jawab
melanjutkan RJP
3. Tidak sadar, pernapasan spontan (-), dilatasi
pupil 15-30 menit
4. Asistole selama 30 menit setelah RJP dan obat
optimal
5. Stadium terminal suatu penyakit
6. Penolong terlalu lelah

Hal-hal baru dalam RJPO

Airway :
Jangan neck lift

Cukup jaw thrust & chin lift

Pasang oro / nasopharynx tube

Segera intubasi trachea

Breathing :
Nafas jangan 800-1200 ml

Cukup 2 nafas @ 500-600 ml, dada terangkat

Beri sela ekshalasi

Beri oksigen 100% lebih dini

Circulation :

Pijat jantung lebih cepat, 80-100 x / menit

Usahakan DC-Shock lebih dini

Hal-hal baru dalam RJPO

Drugs :

Adrenaline 1-1-1 / 3-5

Atropin 1-1-1 / 3-5

Na-Bicarb hanya 1 meq/kg dan paling akhir

Fibrilation Rx :

DC-Shock sedini mungkin

Drug-Shock-Drug-Shock

200 -- 200-300 -- 360 Joule

# Early access

# Early defibrilation

# Early CPR

# Early ALS

nadi carotis (+) > 60 mmHg

nadi radialis (+) > 80 mmHg

VF / VT
nadi carotis tak teraba
A-B-C
sampai defibrilator terpasang
200 J -- 200-300 J -- 360 J

VF / VT

PEA

A-B-C
intubasi, IV line
Adrenaline 1-1-1 mg tiap 3-5
DC shock 360 J dalam 30-60
Obat klas IIa
DC shock 360 J dalam 30-60
POLA : obat-DC-obat-DC

ASYSTOLE

ROSC

Jaga jalan nafas

Bantu nafas
Obat u/ tek darah,
nadi, irama
Lidocain 1,0 - 1,5 mg/kg
tiap 3-5 sp 3 mg/kg
MgSO4 1-2 gm u/torsades
Procainamide 30mg/min
Na-bicarb 1 meq/kg

Early defibrilation
DC-Shock

Non-Synch

Synchronized

Khusus VF/VT

SVT / PVC

tidak ada QRS yang baik

ada QRS yang baik

DC-Shock Discharge

DC-Shock Discharge

Tidak menunggu gelombang R

Menunggu gelombang R
dikenali

PULSELESS ELECTRICAL ACTIVITY

ada kompleks ECG tetapi
nadi carotis tak teraba
Electromechanical Dissociation
Idioventricular rhythm / escape
Brady-asystolic rhythm
A-B-C
intubasi, IV line
Adrenaline 1-1-1 mg tiap 3-5
Jika bradikardia
Atropin 1-1-1 mg tiap 3-5
sampai 3 mg
Obat klas IIa

SINGKIRKAN :
Hipovolemia
Hipoksia
Hipotermia
Hiperkalemia
Tamponade jantung
Tension pneumothorax
Emboli paru luas
Infark jantung luas
Asidosis
Overdose B-block,
Ca-block, Digitalis,
Trisiklik

Na-bicarb u/ hiperkalemia / asidosis / overdose obat

Adrenaline 1-3-5 mg selang 3 menit