CARDIOPULMONARY RESCUCITATION (CPR)

CARDIOPULMONARY RESCUCITATION (CPR) Yanuar K1What is CPR ?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)

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Kunci keberhasilan CPREarly Access to BLSto get helpEarly (correct) CPRto buy timeEarly Defibrillationto restart the heartEarly ALSto stabilize

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4Kasus 1Wanita 18 tahun, saat sedang berjalan jalan di mall, tiba tiba jatuh, sikap anda ??5Guidelines 2000 ILCOR ConsensusAIRWAY ( A )Lakukan jaw-thrustJangan neck-lift semua pasienJangan head-tilt pasien traumaHati-hati chin lift pasien traumaPasang oro/naso-pharyngeal tubePertimbangkan intubasi dini6Pada pasien trauma

head tiltneck liftDont do !!!Be carefulneck liftchin lift7

JAW THRUST dianjurkan8AIRWAY DEFINITIFOROPHARYNGEAL TUBE

NASOPHARYNGEAL TUBE

9AIRWAY DEFINITIF (advanced)ENDOTRACHEAL TUBE

LARYNGEAL MASK AIRWAY

10Guidelines 2000 ILCOR ConsensusBREATHING ( B )Usahakan 2 nafas yang berhasil dada terangkat , 500-600 ml (maksimal 1000 ml)Beri sela ekshalasiBeri oksigen 100 % lebih dini

11Breathing 2005 (new)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 forcefulWhen giving rescue breaths, give sufficient volume to cause visible chest rise 8 10 x / min12Mouth to mouth

13Bag Mask Ventilation

14Circulation2005 (NEW)Effective chest compressions produce blood flow during CPR (Class I).Push hard and push fast100 compression per minute for all victims (except newborns)Try to limit interruptions in chest compression. Every time you stop chest compressions, blood flow stop !!!15Compression-to-ventilation ratio for all lone rescuers2005 (New )The AHA recommends a compression-to-ventilation ratio of 30:2 for all lone (single) rescuers to use for all victims from infants (excluding newborns) through adults. 16

Ventricular Fibrillation and CPR Aortic pressure (purple)Right atrial pressure (yellow)Coronary Perfusion Pressure (Ao diastolic - RA diastolic)Coronary perfusion pressure approaches zero within seconds after stopping chest compressions17

42%58%Lay persons: 2 rescue breaths interrupted CC for 16 secondsACTUALCC/min=3911 Assar, 200016 secsTypical lay rescuer 15:2 CPR has circulation less than half the time.18Posisi penolong tegak lurus diatas dada pasien dengan siku lengan lurus menekan tengah-tengah tulang dada, tekan sedalam 4-5 cm.

Pijat jantung 30 x disusul dg nafas 2 x100x per menitPush Hard and Push Fast19

Synchronizing : 30 compressions - 2 breathsOne or two rescuers 30 : 220Guidelines 2000 ILCOR ConsensusDRUGS ( D )

Adrenalin 1-1-1 tiap 3-5 menit

Atropin 1-1-1 tiap 3-5 menit

Jangan menyuntik intra-cardial

Berikan intra-vena, intra-tracheal, intra osseus

Na-bikarb hanya 1 mEq/kg dan paling akhir 21CARA PEMBERIANADRENALIN,ATROPIN,LIDOCAIN,VASOPRESININTRA - VENOUS

INTRA - TRACHEAL/TRANS-TRACHEAL DOSIS 2-3 X INTRAVENA (2 amp adrenalin dalam 10 cc aquabidest)

INTRA OSSEOUS

TIDAK INTRA - CARDIAC Menghentikan pijat jantung Sukar pastikan intra-ventrikuler .Kena miokard nekrosis .Kena a koronaria infark 22OBAT KLAS IIaLIDOCAIN 1-1.5 mg/kg tiap 3-5 menit maksimal 3 mg/kgMgSO4 1-2 g untuk torsades des pointesPROCAINAMIDE 30mg/menitNa-bicarb 1 mEq/kg 23Guidelines 2000 ILCOR ConsensusDe-FIBRILLATION -DC shock sedini mungkin (sebelum 5-10 menit) -200/200-300/360 Joules (satu rangkaian cepat)Th 2005 one shock dosis tinggiBifasik 200 JoulesMonofasik 360 joulesOne shock24KEBERHASILANCPR 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 % 25CPR first or Defib first?Tergantung ECG VF/VT = shockable = Defibrillation Asystole/PEA = non-shockable = CPRKalau belum ada ECG Ya CPR dulu 26

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ACB30

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32Korban tidak sadarbebaskan jalan nafasjalan nafas bebastidak bernafastidak teraba nadiPasang monitor EKG1.2.3.4.5.Call for help2 x tiupan awalraba nadi carotisBeri pijatan jantungdan nafas buatan30 pijat + 2 nafasA.B.C.Awam ( 1,2,4)33raba carotistidak adalihat EKGadashockableun-shockableCPR 30 : 2 2 menitroscpertahankan jl nafas bebastetap beri oksigenraba arteri radialislihat EKG- ukur tensi nadipertahankan infushipotensi : beri inotropikterapi aritmiakoreksi elektrolit & cairansingle shock 360 J CPR 30:2 (2 menit)VF / VTlihat management VT / VFAsistolPEA / EMDCPR 30 : 2 2 menit adrenalinmanagement asistoleObservasi di ICUWaspada CA berulangAdrenaline: 1 mg, iv, repeated every 3-5 minutes

34Defibrilation strategy-1VF / pulseless VTa single shockBiphasic 150-200 JouleMonophasic 360 JouleCPR30 : 2ROSCNO2 MINUTES, 30 : 2Check ECGCheck pulsea single shockBiphasic 150-360 JouleMonophasic 360 JouleAdrenalineCPR30 : 2YESRecovery of Spontaneous Circulation1).2).2 MINUTES, 30 : 23).35Defibrilation strategy - 2VF / pulseless VTROSCNOCheck ECGCheck pulsea single shockBiphasic 150-360 JouleMonophasic 360 JouleAdrenalineCPR30 : 22 MINUTES, 30 : 2a single shockBiphasic 150-360 JouleMonophasic 360 JouleCPR30 : 2Check ECGCheck pulseYESNoYES2).3).2 MINUTES, 30 : 2Check ECGCheck pulseAdrenaline: 1 mg, iv, repeated every 3-5 minutes

a single shock1).ROSC36Defibrilation strategy-3VF / pulseless VTROSCa single shockBiphasic 150-360 JouleMonophasic 360 JouleCPR30 : 2Check ECGCheck pulseYESNo3).Amiodarone 300 mg or Lidocaine 1 mg/kgA single shock Biphasic 150-360 Joule Monophasic 360 JouleCPR30 : 2NoYESCheck ECGCheck pulseROSC4).2). a single shock2 MINUTES, 30 : 2Adrenaline: 1 mg, iv, repeated every 3-5 minutesa single shockBiphasic 150 360 JouleMonophasic 360 JouleCPR 30 : 2 (2minutes)37CPR -1 30 : 2

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PASANGMONITOR

VF / VTa single shocka single shocka single shocka single shocka single shock2 menit2 menit2 menit2 menitadrenalinadrenalinadrenalinCPR-3CPR-2CPR-5CPR-4AmiodaronAdrenaline: 1 mg, iv, repeated every 3-5 minutes

CPR-6Cardiacarrest

LIDOCAIN. Do not exceed a total dose of 3 mg/kg,during the first hour.Amiodaron is the first choice300 mg, bolus. Repeated 150 mgfor reccurrent VT/VF. Followed by900 mg infusion over 24 hoursVF/ VTIntubasi : as soon as possible, without stop CPRPijat 100x/menitNafas 8x/menitEvaluasi CPR : tiap 2 menit38DRUGS

Adrenaline: 1 mg, iv, repeated every 3-5 minutes

Amiodarone: 300 mg, bolus, if VF/VT persist after 3 shocks. Dose of 150 mg maybe given for recurrent or refractory VF/VT, followed by an infusion of 900 mg over 24 hours

Lidocain: 1 mg/kg, iv, if amiodarone is not available. Do not exceed a total dose of 3 mg/kg, during the first hour.Do not give lidocaine if amiodarone has already been givenILCOR - Guidelines 200539Asystole (ECG flat) / PEA|CPR 2 menit|+Intubasi, iv line, +adrenalin 1 mg / 3-5 menit|||Asystole / PEA ROSC | |bradycardianormal

atropin 1-1-1 / obat klas IIaCPR 2 menit30 : 230 : 240ASYST2 menit2 menit2 menit2 menit evaluasi adrenalin evaluasi adrenalinadrenalinCPR-3CPR-2CPR-5CPR-4Adrenaline: 1 mg, iv, repeated every 3-5 minutes

CPR-6Cardiacarrest

ASYSTOL/PEA/EMDIntubasi : as soon as possible, without stop CPRPijat 100x/menitNafas 8x/menitEvaluasi CPR : tiap 2 menitevaluasievaluasiCPR -1 30 : 2

CALLFORHELP

PASANGMONITOR

41CARDIAC ARREST MEMBANDEL4 H

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HIPOKSIAHIPOVOLEMIAHIPERKALEMIAHIPOTERMIATAMPONADE JANTUNGTENSION PNEUMOTHORAXTHROMBOEMBOLI PARUTOXIC OVERDOSE B-BLOCK,Ca-BLOCK DIGITALIS,TRICYCLIC ADMASSIVE MIASIDOCIS42?43Terima Kasih44