Cardiopulmonary resuscitation (CPR) is a combination of rescue breathing and chest compressions delivered to victims thought to be in cardiac arrest.

Cardiac arrest is often caused by ventricular vibrilation(VF)

Immediate recognition of cardiac arrest and activation of the emergency response system.

Early CPR with an emphesis on chest compressions.

Rapid defibrillation Effective advanced life support Integrated post-cardiac arrest care

Bukan lagi ABC, melainkan CAB “A change in the 2010 AHA Guidelines for

CPR and ECC is to recommend the initiation of chest compression before ventilation.”

Satu-satunya pengecualian, bayi baru lahir (neonatus), krn penyebab tersering pd bayi baru lahir yg tidak sadarkan diri dan tidak bernafas, karena masalah jalan nafas ( asfiksia ).

RJP pd bayi, anak, ataupun dewasa biasanya masalah Circulation.

Pada henti jantung Bertindak bukan Menilai. Telepon ambulans segera bila

melihat korban tidak sadar, tidak nafas dg baik (gasping)

BLS (Basic Life Support) ALS (Advanced Life Support)

Pengaktivisian Emergency Response System (ERS)

“Check for response while looking at the patient to determine if breathing is absent or not normal. Suspect cardiac arrest if victim is not breathing or only gasping.”

Posisi penolong tegak lurus diatas dada pasien dengan siku lengan lurus menekan tengah-tengahtulang dada ,tekan sedalam at least 5 cm.

Posisi penolong tegak lurus diatas dada pasien dengan siku lengan lurus menekan tengah-tengahtulang dada ,tekan sedalam at least 5 cm.

Pijat jantung 30 x disusul dg nafas 2 x

At least 100x per menit

Push Hard and Push Fast

Effective chest compressions produce blood flow during CPR (Class I).

“Push hard and push fast”at least 100 compression per minute for

all victims (except newborns) Try to limit interruptions in chest

compression.Every time you stop chest compressions, blood flow stop.

Kompresi dada lebih dalam lagi.“The adult sternum should be

depressed at least 2 inches ( 5 cm).” AHA 2005 ( old)

The adult sternum should be depressed 11/2 to 2 inches ( 4-5 cm)

Kompresi dada lebih cepat lagi.“It is reasonable for lay rescuers and

healthcare providers to perform chest compression at a rate of at least 100x/min.”

AHA 2005 (old) “Compress at a rate about 100x/min.”

Saat pijat jantung,Hitung dengan suara keras

Satu,dua,tiga,empat, SATUSatu,dua,tiga,empat, DUASatu,dua,tiga,empat, TIGASatu,dua,tiga.empat, EMPATSatu,dua,tiga,empat, LIMASatu,dua,tiga,empat, ENAM

Total = 30 x pi jatan, disela dengan 2 x t iupan nafas

Saat pijat jantung,Hitung dengan suara keras

Satu,dua,tiga,empat, SATUSatu,dua,tiga,empat, DUASatu,dua,tiga,empat, TIGASatu,dua,tiga.empat, EMPATSatu,dua,tiga,empat, LIMASatu,dua,tiga,empat, ENAM

Total = 30 x pijatan, disela dengan 2 x t iupan nafas

Pijat jantung nafas buatan

30 : 2

Recommendation: Universal ratio of 30:2 for lone rescuers of

victims from infancy (excluding newly born) through adulthood.

Ratio 15:2 for 2 rescuers CPR in infants & children.

Make rotation every 5 cycles/2 minutes

Hands only CPR. “Hands – Only ( compression – only)

bystander CPR substantially improves survival following adult out-of-hospital cardiac arrests compared with no bystander CPR.”.

Berbuat sesuatu lebih baik daripada tidak berbuat sama sekali.

Jangan berhenti kompresi dada. “The preponderance of efficacy data

suggests that limiting the frequency and duration of interruptions in chest compression may improve clinially meaningful outcomes in cardiac arrest patients.”

Terus dilanjutkan sampai defibrilator otomatik datang.

AIRWAY ( A )

Lakukan jaw-thrust Jangan head-tilt pasien trauma Hati-hati chin lift pasien trauma Pasang oro/naso-pharyngeal tube Pertimbangkan intubasi dini

Each rescue breath should be given over 1 second (class II a)

All rescuers should avoid delivering too many breaths,or breaths that are too large or too forceful

BREATHING 10-12 X / MENIT ( SEKALI NAFAS / 4-5 DETIK)

CARA-CARA MEMBERI NAFAS BANTUCARA-CARA MEMBERI NAFAS BANTU

IIA2. a. MOUTH-TO-MOUTH VENTILATION

IIA2. b. MOUTH-TO-MASK VENTILATION DUA CARA : IIA2.a. 1. TEHNIK SEPHALIK

IIA2.b. 2. TEHNIK LATERAL

II.2.c. MOUTH-TO-NOSE, MOUTH-TO- STOMA VENTILATION

II.2.d. MOUTH-TO-FACE SHIELD

II.2.e. BAG-MASK VENTILATION

II.2.f. INTUBASI

PENGHENTIAN RJP

1. Jika pasien sudah tidak memberikan respon yang stabil2. Pupil dilatasi maksimal3. Tidak ada respon spontan setelah dilakukan RJP setelah 15-30

menit4. Gambaran EKG sudah flat

.

Community Lay Rescuer AED Program 2010 (Slightly Modified).

Cardiopulmonary resuscitation and the use of AEDs by public safety first responders are recommanded to increase survival rates for out-of-hospital sudden cardiac arrest.

In-Hospital Use of AEDs 2010 (Reaffirmed Recommendation); Despite limited evidence, AEDs

may considered for the hospital setting as a way to facilitate early defibrillation (a goal of shock delivery < 3 minute from collaps), especially in areas where staff have no rhythm recognition skills or defibrillator are used infrequently.

Tergantung ECG arrest -VF/VT=shockable=Defibrillation -Asystole/PEA=non-shockable=CPRKalau belum ada ECG -Ya CPR dulu

Recommendation: One shock → optimum shock dose needed → efficiency of first shock monophasic < biphasic Monophasic : 360 J for initial and

subsequent shocks Biphasic : initially 150-200 J or 120

sunaryo

1.SWITCH ON OLES paddles dengan Jelly ECG tipis rata Pasang PADDLES pada posisi apex dan parasternal (boleh ter balik)

2.CHARGE 200 JoulesPerintahkan: Awas semua lepas dari pasien! -nafas buatan berhenti dulu -bawah bebas,samping bebas,atas bebas,saya bebas! 3.SHOCK (tekan dua tombol paddles bersama) Biarkan paddles tetap menempel dada, baca ECG Siap charge

Lagi bila iramamasih shockable

CPR followed by defibrillation within 2 to 3 minutes of collapse has produced survival

rate of up to 50 %.

With each minute of delay,chance of

survival decreases by 7-10 %