resusitasi bayi

8/18/2019 resusitasi bayi

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Resuscitation in PediatricDr. Afriyan Wahyudhi, SpA, MKes


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A Airway

B Breathing

C CirculationD Disability

E Exposure

Penilaian Klasik


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Look, Listen, Feel


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kepala besar, leher pendek -> fleksi leher gigi / rahang -> rapuh

lidah besar -> obstruksi jalan nafas trakhea pendek dan kecil -> over ekstensi -> kompresi

trakhea berbeda sesuai dengan usia maka berbeda problem

o < 6 bulan : nasal breather o 3-8 thn : hipertrofi adeno tonsilar

Pada Anak

Airway


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Suara Penyebab

Stridor Obstruksi jalan nafas atas

Mengi Obstruksi jalan nafas bawahmerintih Oksigenasi tidak adekuat

Ronkhi basah Cairan, lendir, darah pada jalan nafas

Suara nafas –Usaha nafas

Obtruksi jalan nafas totalGangguan transmisi suara

Interpretasi Suara Nafas Abnormal


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laju/ frekuensi pernafasanretraksistridor inspirasi / ekspirasigruntingpenggunaan otot bantu nafasnafas cuping hidung

Gangguan pernafasan berat

Depresi SSPPenyakit neuromuskular

tidak bisa dinilai

pada

BREATHING

Usaha Nafas/Kinerja Pernafasan


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dipengaruhi : demam, nyeri, emosi/ takut

frek > 60 : potensial gagal nafas

retraksi , kesadaran

Frekuensi Nafas


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frekuensi jantung/kompensasiHipoksia takikardiHipoksia berat dan lama bradikardi

warna kulithipoksia vasokonstriksi pucat

kesadaran

hipoksia/ hiperkapnia agitasi dan /atau mengantuk

Efek Gangguan Breathing pada Organ Lain


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frekuensi denyut Takikardi : tanda hipoksia, perfusi buruk

demam, sakit, takut

bradikardi: hipoksia, iskemia

isi dan tekanan(volume nadi)

Kuat, filiformis

capillary refil normal < 2 detik

tekanan darah

produksi urin

hipotensi

1 – 2 cc/ kgbb/jam

Circulation

Status Cardio Vaskular


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DISABILITYStatus Neurologik


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Untuk evaluasi fungsi fisiologis dan identifikasikelainan anatomis

Monitor suhu

Pertahankan lingkungan sekitar yang hangat

Hangatkan cairan infus

Exposure


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CPR


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Basic Life Support

• The big change: no longer ABC

• Now it’s C-A-B

• Why?• Don’t delay compressions for

positioning airway, obtaining a seal

for mouth-to-mouth, etc


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The change from ABC to CAB applies to infantsand children as well as adults

• High quality compressions are essential togenerate blood flow to vital organs

• Beginning CPR with 30 compressions rather

than 2 ventilations leads to shorter delays tofirst compression

• All rescuers should be able to deliver

compressions almost immediately. Positioningthe head and attaining a seal for ventilation

takes time and delays the initiation of CPR


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The change from ABC to CAB applies to infantsand children as well as adults

• Hypoxic arrest is more common than VF ininfants and children and ventilations are

extremely important in pediatric resuscitation

• Starting with compressions only delaysventilations by approximately 18 seconds for

alone rescuer and even shorter for two

rescuers

• CAB simplifies training with the hope that more

victims will receive bystander CPR


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The Guideline..........

• Chest compressions should be immediately started by

one rescuer, while a second rescuer prepares to startventilations with a bag and mask. Ventilation is

extremely important in pediatrics because of the large

percentage of asphyxial arrests in which best results are

obtained by a combination of chest compressions andventilations. Unfortunately ventilations are sometimes

delayed because equipment (bag, mask, oxygen,

airway) must be mobilized. Chest compressions require

only the hands of a willing rescuer. Therefore, start CPR

with chest compressions immediately, while a second

rescuer prepares to provide ventilations (Class I, LOE

C).


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Rules

In less than 10 sec, start compression if :

Unresponsive

Not breathing normally or only gasping

No sign of life


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How to do chest compression ?

Two finger chest compression in infant (1 rescuer)


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2 thumb-encircling hands chest compression


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Compression ratio

• Single rescuer = 30 comp : 2 breaths

• 2 or more rescuer = 15 comp : 2 breaths


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CPR


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The EC clamp technique of bag mask ventilations


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• The effectiveness, dependent on high-qualityCPR, which requires an adequate compression

rate (at least 100 compressions/ min), an

adequate compression depth (at least one third

of the AP diameter of the chest or approximately11 ⁄2 inches [4 cm] in infants and approximately 2

inches [5 cm] in children), allowing complete

recoil of the chest after each

compression,minimizing interruptions incompressions, and avoiding excessiveventilation

The Guideline..........


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It’ l b t ibilit th i d f


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• It’s only about responsibility, the wisdom of adoctor, and pride.

A great Doctor will be.....


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