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1. DAPAT MENDIAGNOSA HENTI JANTUNG
ALS / BHL
Kelanjutan dari BLS
Dilakukan di Rumah Sakit ; bersamaan
dengan BLS
Pengobatan Medik Defenitif
Mengembalikan Sirkulasi Spontan (ROSC)
Monitoring Ketat
istilah
Basic Life Support = B L S
= jalan nafas + nafas buatan + pijat jantung (A-B-C)
Advanced Life Support
=ALS
= Drug (+fluid) + E K G + Defibrilasi
Cardio Pulmonary Resuscitation = CPR
Cardio Pulmonary Cerebral Resuscitation
= CPCR = CPR = RJPO
= BLS + ALS
Semua tindakan akut/ segera untuk
menghentikan proses yang menuju kematian.
Kunci keberhasilan
CPR
Early Access to BLS
to get help
Early Defibrillation
to restart the heart
Early ALS
to stabilize
E uropean
R esuscitation
C ouncil
Main
Main
Main
Main
changes
changes
changes
changes
in
in
in
in
E uropean
R esuscitation
C ouncil
Main changes in adult basic life support
normally
to ventilations is 30 : 2
THE CHAIN OF
SURVIVAL
EARLY
EARLY
ACCESS
EARLY
DEFIB.
ADVANCED
CARE
CPR
To get help
To buy time
EARLY
To restart heart
To stabilize
Principle of Early
Defibrillation
(AED, Automated External
Defibrillation)
The most frequent initial rhythm in witnessed
sudden cardiac arrest is VF
The most effective treatment for VF is electrical
defibrillation
The probability of successful defirillation diminishes
rapidly over time.
VF tends convert to asystole within a few minutes
AUTOMATIC EXTERNAL
DEFIBRILLATION - AED
Emergency defibrillator
Bandara Schipol di - Belanda
ILCOR
reathing
irculation
rugs
e- FIBRILLATION
head tilt
chin lift
neck lift
neck lift
Dont do
Be careful
JAW THRUST
dianjurkan
titik tumpu
pijat jantung
Tempatkan
tumit tangan satunya
di atas sternum tepat
di samping telunjuk
tersebut.
Guidelines 2005 :
spend more time to using
the rib margin method
Jari-jari kedua tangan dirapatkan dan diangkat pada waktu dilakukan tiupan nafas,
agar tidak menekan dada.
4-5 cm
bernafas
tidak bernafas
tidak ada
CPR 30 : 2
2 menit ( 5 siklus )
pasang monitor
shockable
un-shockable
ada
Nafas
buatan
teruskan
bernafas
tidak bernafas
ada
tidak ada
Posisi shock
Pasang infus
Extra cairan
tidak ada
CPR 30 : 2
2 menit ( 5 siklus )
pasang monitor
shockable
un-shockable
ada
Nafas
buatan,
teruskan
CPR 30 : 2
2 menit ( 5 siklus )
raba carotis
ada
tidak ada
lihat EKG
rosc
shockable
un-shockable
VF / VT
Asistol
PEA / EMD
CPR 30 : 2
2 menit
( 5 siklus )
adrenalin
lihat managemen
VT / VF
managemen asistol
E uropean
R esuscitation
C ouncil
E uropean
R esuscitation
C ouncil
E uropean
R esuscitation
C ouncil
Fine VF :
If there is a doubt about whether
the rhythm is asystole or fine-VF
do NOT attempt defibrilation,
continuous chest compression and
ventilation
E uropean
R esuscitation
C ouncil
VF / pulseless VT
1).
Defibrilation strategy
a single shock
Biphasic 150-200 Joule
Monoph
360 Joule
CPR 30 : 2
2 MINUTES, 5 cycles at 30 : 2
NO
2).
a single shock
Biphasic 150-360 Joule
Monoph 360 Joule
Adrenaline
CPR 30 : 2
Check pulse
YES
ROSC
Recovery of
Spontaneous
Circulation
E uropean
R esuscitation
C ouncil
Defibrilation strategy
Check pulse
NO
2).
2 MINUTES, 5 cycles at 30 : 2
3).
Check pulse
a single shock
YES
ROSC
a single shock
Adrenaline
CPR
30 : 2
No
VF / pulseless VT
30 : 2
YES
ROSC
2 MINUTES, 5 cycles at 30 : 2
Check pulse
E uropean
R esuscitation
C ouncil
Defibrilation strategy
No
3).
Check pulse
a single shock
30 : 2
2 MINUTES, 5 cycles at 30 : 2
No
4).
Check pulse
Lidocaine 1 mg/kg or
Amiodarone 300 mg
A single shock
Biphasic 150-360 Joule
Monophasic 360 Joule
CPR
30 : 2
YES
ROSC
CPR
VF / pulseless VT
YES
ROSC
E uropean
R esuscitation
C ouncil
Adrenaline
Amiodarone
Lidocain
:
:
resume
VF / pulseless VT
E
R
C
a single shock
Biphasic 150-200 Joule
Monoph 360 Joule
CPR
30 : 2
2 MINUTES, 5 cycles at 30 : 2
NO
a single shock
Biphasic 150-360 Joule
Monophasic 360 Joule
Adrenaline 1 mg iv
CPR
30 : 2
2 MINUTES, 5 cycles at 30 : 2
Lidocaine 1 mg/kg or
Amiodarone 300 mg
single shock
Biphasic 150-360 Joule
Monophasic 360 Joule
CPR
30 : 2
Check pulse
NO
Check pulse
R
O
S
C
a single shock
Biphasic 150-360 Joule
Monoph 360 Joule
CPR
30 : 2
2 MINUTES, 5 cycles at 30 : 2
NO
Check pulse
Normal Electrocardiogram
SA node
(pacemaker)
AV node
(relayer)
DC shock
1. Switch ON
Oles paddles dengan jelly
ECG tipis rata
DC shock
(Non-synchronized)
Perintahkan :
Awas semua lepas dari pasien!
nafas buatan berhenti dulu
bawah bebas,
samping bebas,
atas bebas,
saya bebas!
sternum
3. Shock!!
apex
pulseless VT / VF
drug
dc
cpr
VT / Ventricular Tachycardia
|
|
carotis (+)
carotis (-)
Lidocain
1 mg/kg iv cepat
atau
Amiodaron
a single shock
360 Joules
5 SIKLUS
Managemen VT/ VF
UN-shockable
CPR + adrenalin
- ROSC < 10%
( Recovery of
Circulation )
Spontaneous
|
|
Asystole / PEA
CPR 2 menit
30 : 2
|
ROSC
|
bradycardia
|
atropin 1-1-1 sp 3 mg / obat klas IIa
|
normal
PEA = EMD
ada gelombang mirip ECG normal
TETAPI nadi carotis tidak teraba
terapi sama seperti Asystole ( CPR + Adrenalin )
P-ulseless
E-lectrical
A-ctivity
E-lectro
M-echanical
D-issociation
Intra-osseus
TIDAK intra-cardial
menghentikan pijat jantung
sukar pastikan intra-ventrikuler
kena miokard : nekrosis
kena a. coronaria : infark
VF
VT
Pulse/no ?
VT
Pulse/no ?
Asystole
PEA
PEA
4
Hipoksia
Hipovolemia
Hiperkalemia
Hipotermia
4
Tamponade jantung
Massive MI
Tension pneumothorax
Asidosis
Thromboemboli paru
Toxic overdose,
B-blocker, Ca-blocker
Digitalis
TERIMA KASIH