bhd ii pelatihan icu dr vera
TRANSCRIPT
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TEKNIK RESUSITASI JANTUNG PARU
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Adult BLS Adult BLS AlgorithmeAlgorithme
AMERIKA
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Adult BLS Adult BLS AlgorithmeAlgorithme
EROPA
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International Liaison Committee on Resuscitation
ILCOR
Konsensus 2005
Universal Cardiac Arrest Algorithm
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Do we still need to check pulse ???Do we still need to check pulse ???
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AEDAEDAUTOMATED EXTERNAL DEFIBRILATORAUTOMATED EXTERNAL DEFIBRILATOR
✖✖
Remove open airway and
rescue breath time
consuming
The old (2005) algorithm
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Universal Algorithm CPR 2010
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BLS HEALTHCARE PROVIDER ALGORITHM
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Rescuer Proficiency
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Chain of Survival
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EarlyEarlyAccessAccess
EarlyEarlyCPRCPR
EarlyEarlyDefibrillationDefibrillation
EarlyEarlyAdvancedAdvanced
CareCare
20002000
20052005
20102010
Call for help Chest Compression
Defibrillation Advanced Life Support
Post-Cardiac arrest Care
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New Sequence for 2010
“Chest compressions, Airway, Breathing” (CAB) is the new order of operations from American Heart Association.
This applies for adults, pediatrics and infants, excluding newborns. Newborn arrest are most likely respiratory and should use the ABC sequence.
Adult Chain of Survival.
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Rationale of changes 2010
A large number of witnessed cardiac arrest are patients going into a ventricular fibrillation, or pulseless ventricular tachycardia. Early chest compressions and defibrillation are key components to the patient’s survival.
The CAB method allows the responder to save time, and provide blood flow to the heart muscle quickly.
A lay person is more likely to give CPR if chest compressions are the priority.
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Basic Life Support
Hands-Only (Compressions only) CPR for the untrained lay person. Can be guided by dispatcher on the phone.
Start chest compression before opening the airway. CAB.
Allowing the chest to recoil between compressions with a depth of 2 inches. Rate of 100/min.
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BLS Adult Algorithm
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Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Any unnecessary interruptions in chest compressions,
decreases the effectiveness of the CPR. CPR should be continued until return of spontaneous circulation (ROSC) or termination of resuscitative efforts.
Healthcare providers should take no longer than a 10 second pulse check to determine if pulses are present.
Chest compression and rescue breathing at a rate of 30:2.
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Role of the Lay Person Rescuer
Initial recognition of the victim is imperative to quick treatment. A patient having a cardiac arrest may have gasping respirations or even have seizure like activity. The rescuer should learn through training these are atypical presentations of a cardiac arrest and alert responders to these findings.
Lay persons should call EMS when finding unconscious victim and should not attempt to check for a pulse. The lay person should assume that the victim is in a cardiac arrest; 1. suddenly collapses, 2. person is unresponsive, and 3. not breathing normally or not at all.
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CPR Devices and Techniques
No device other than the defibrillator has proven to have long-term survival from in the field cardiac arrest.
Electrical Therapies-Pacing in bradycardia, cardioversion and defibrillation for symptomatic tachycardia are all proven methods to help the chain of survival. No precordial thump.
CPR prior to defibrillation improves outcomes in cardiac arrest.
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Capnography Capnography is recommended for
intubated patients.
This tool is used as an additional indicator of proper tube placement, monitoring CPR quality and detecting ROSC.
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Advanced Cardiac Life Support
New fifth link in the chain of survival is post cardiac care.
Hypothermia treatment studies are showing improvement with neurological, hemodynamic and metabolic function in the ROSC patients.
Transportation to most appropriate hospital with comprehensive post-cardiac arrest treatment.
Post cardiac care should include prevention, treatment of possible multiple organ dysfunction.
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ACLS Algorithm
Start CPR –give 02 -Attach monitor/
defibrillator.
Call for help!
Post-Cardiac Care
ROSC
•Drug Therapy•Advanced Airway•Treat Reversible Causes
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LANGKAH-LANGKAH BANTUAN HIDUP DASAR
LANGKAH-LANGKAH BANTUAN HIDUP DASAR
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
Pastikan keamanan
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JANGAN MENJADI KORBANBERIKUTNYA !
Lingkungan
Penolong
Korban
Orang2 disekitar
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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PASTIKAN KORBAN TIDAK SADAR
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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Guncangkan bahu dengan lembut
Tanya: ”apakah anda baik-baik saja?”
Jika ada respons:• Jangan ubah posisi korban.
• Cari hal yang tidak beres.
• Ulangi pemeriksaan berkala.
PERIKSA KESADARAN
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jika korban tidak respon
Panggil BANTUAN
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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aktifkan sistem pelayanan emergensi
✓ telp. 118 (atau no. lokal lain)✓ sebutkan: ‣ ID penelpon, lokasi, apa yg
terjadi, jumlah korban, keadaan korban, apa yg sudah dilakukan, informasi penting lain
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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BUKA JALAN NAFAS
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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Pada > 40% kasus henti jantung, terjadi segera
Nafas pendek, berat, bunyi nafas terdengar keras atau megap-megap
Nafas agonal = tanda henti jantung !!
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MENILAI PERNAFASAN
NAFAS AGONAL
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2X NAFAS BUATAN
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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NAFAS BUATAN
Pencet hidung korban
Penolong tarik nafas normal
Bibir penolong menutupi mulut korban dgn erat
Tiupkan udara nafas sampai dada korban bergerak terangkat
1 tiupan = 1 detik
Biarkan dada korban mengempis spontan
Ulangi34
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i30x KOMPRESI JANTUNG
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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• Letakkan pangkal telapak tangan di pertengahan bawah tulang dada
• Letakkan tangan yang lain diatas punggung tangan yang satunya
• Jari-jari boleh dikepal atau dibuka
• Kompresi dada– Laju kompresi 100x per menit– Kedalaman 4-5 cm– Kompresi konstan diselingi relaksasi• Jika mungkin, bergantian
kompresi setiap 2 menit
KOMPRESI DADA
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LANJUTKAN BHD
30 2
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Periksa apakah ada tanda-tanda
sirkulasi:
Bergerak
Bernafas
Batuk
dll
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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Kembalinya sirkulasi dan ventilasi spontan
Pasien dialihrawatkan kpd yg lebih berwenang
Penolong lelah atau keselamatannya terancam
Adanya perintah DNAR Jika 30’ setelah ACLS
yang adekuat tidak didapatkan tanda-tanda kembalinya sirkulasi spontan (asistole yang menetap), bukan intoksikasi obat atau hipotermia.
STOP BHD JIKA .....
Pastikan keamanan
Periksa kesadaran
Panggil bantuan / telpon ambulans
Buka jalan nafas & nilai pernafasan
Beri nafas buatan pertama 2x
Kompresi jantung + nafas buatan (30 : 2)
Evaluasi setiap 2 menit
Jangan hentikan 30:2 sampai ada indikasi stop BHD
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JIKA KORBAN MULAI BERNAFAS NORMAL LAGI, TEMPATKAN DALAM POSISI “RECOVERY”
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Algoritma nakes 2010
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VF / VT pulseless = characteristic wavesVF / VT pulseless = characteristic waves shockableshockable, do DC-shock immediately, do DC-shock immediately in VT with pulse (+) in VT with pulse (+) DC-shock is not required, DC-shock is not required, when when
in doubt, do DC shockin doubt, do DC shock
Asystole = no wave (flat ECG) Asystole = no wave (flat ECG) UN-shockableUN-shockable
PEA = EMD = any wave may appearPEA = EMD = any wave may appear
UN-shockableUN-shockable
2 important ECG pattern during cardiac arrest (no carotid pulse)
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CPR|
chest compression 100 x /minutebreaths 8-10 x /minute
synchronize 30:2
(either one or two rescuers)|
early DC shock(check rhythm)| |
VF/VT Asystole / PEA | (non-VF/VT)
DC shock | continue CPR
2 minutes
intubated/LMA
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Cardiac Arrest Pattern ECG
VT pulseless
if VT pulse, it’s mean no arrest
Coarse Ventriculer Fibrilation
2. shockable
Fine Ventriculer Fibrilation
Asystole
PEA
EMD
1. UN-shockable
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The principleThe principle of of CPRCPR
Quick DiagnosisCardiac Arrest
occurence
ROSC
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Perubahan “guidelines 2010” Defibrilasi merupakan bantuan hidup dasar
Urutan A-B-C-D, menjadi C-A-B-D kecuali pada kasus henti jantung yang disebabkan karena hipoksia
Tidak ada periksa pernapasan secara khusus
Cek irama jantung, harus bisa ditentukan <10 detik
Kompresi jantung dilakukan dengan cepat (kec 100x/menit) dan keras/dalam dengan fase relaksasi
Defibrilasi dilakukan hanya 1 kali, diikuti langsung KJL
Evaluasi setiap 2 menit
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Perhatian!!!
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