Basic Life

Support
Emilzon Taslim, dr., SpAn., MKes
Bagian Anestesiologi dan Reanimasi
Fakultas Kedokteran Universitas Andalas/
RS. Dr. M. Djamil Padang

Triage dan evakuasi

Siapa didahulukan dan siapa dikirim ke mana

4 korban

Ratusan korban

Natural disaster

Complex disaster
Kerusuhan

Complex
disaster

Man-made disaster

Kecelakaan kereta api

Mass-casualties
disaster

small scale

Silent epidemic

Introduction
The leading causes of preventable or reversible
sudden death resulting from heart attacks,
accidents, and other medical emergency

hypoxia or anoxia from:

airway obstr.
hypoventilation
apnea blood loss
pulselessness
brain injury

Irreversible brain damage may occur

when very low oxygen transport or no
oxygen transport lasts longer than a
few minutes.

Cardiopulmonary cerebral
Resuscitation
Phase I : Basic Life Support (BLS)
Emergency oxygenation. (A,B,C)
Phase II: Advanced Life Support (ALS)
Restoration of spontaneous circulation.

(D,E,F)
Phase III: Prolonged Life Support (PLS)
Cerebral resuscitation and post resuscitation intensive therapy. (G,H,I)

CPCR
CPCR // RJPO
RJPO (Peter
(Peter
Safar)
Safar)

1. Basic life support emergency oxygenation

A
: Airway
B
: Breathe
C
: Circulate
2. Advanced life support Restoration of spontan
circulation
D
: Drugs and Fluids
E
: EKG
F
: Fibrillations treatment
3. Prolonged life support post resuscitation bra
oriented therapy
G
: Gauging
H
: Human mentation
I
: Intensive care

Basic Life Support

Airway control
Breathing support
Circulation support
With or without equipment

irway control

PRIORITAS
PRIORITAS UTAMA
UTAMA
Airway
Bebas dan terjaga
Breathing / ventilation
Adekuat
Supplemen oxygen
Adekuat

Airway control

Partial
Cause of airway obstruction: Complete
Base tongue and epiglottis fall to the
posterior pharyngeal wall.
the most common.
Foreign matter (vomitus, blood).
Laryngospasm.
in lightly comatous pasient.

 Complete: if one can not hear or feel air

flow at the mouth or nose.
- Spontaneous breathing
retraction (+) but chest expansion (-).
- Apnea
when PPV to inflate the lung difficult.
Partial: is recognized by noisy air flow

Patient Assessment
Level of consciousness
Spontaneous efforts vs.
apnea
Airway and cervical spine
injury
Chest expansion
Signs of airway obstruction
Breath sounds
Protective airway reflexes

Look, listen, and feel

SUMBATAN
SUMBATAN JALAN
JALAN
NAFAS
NAFAS
Look / Lihat
Perubahan Status Mental
Agitasi / gelisah
Hipoksemia
Obtundasi / teler
Hiperkarbia
Gerak Nafas
Normal
See saw / rocking
Retraksi
Deformitas
Debris
Darah / sekret
Muntahan
Gigi
Sianosis

SUMBATAN
SUMBATAN JALAN
JALAN
NAFAS
NAFAS
Listen / Dengar
Bicara normal Tak ada sumbatan
Ada suara tambahan
Snoring Lidah
Gurgling Cairan
Stridor / crowing Penyempitan
Suara parau (hoarseness / dysphonia)
Feel / Raba
Hawa nafas
Krepitasi / fraktur (maxillofacial / laryngeal)
Deviasi trakhea
Hematoma
Getaran di leher

MACAM
MACAM
SUMBATAN
SUMBATAN
LOOK
SUMBATAN
BEBAS

LISTEN

FEEL

GERAK
SUARA
HAWA
NAFAS TAMBAHANEKSHALASI
NORMAL

PARSIAL RINGAN NORMAL

PARSIAL BERAT SEE SAW

SEE SAW

TOTAL

PENGELOLAAN
PENGELOLAAN PERLU
PERLU ::
CEPAT,
CEPAT, TEPAT,
TEPAT, CERMAT
CERMAT
Sumbatan Total :
FRC (Functional Residual Capacity)

: 2500 ml

Kadar O2 15% x 2500 ml

: 375 ml

Kebutuhan O2 permenit

: 250 ml

Bila ada sumbatan total O2 dalam paru habis dalam

: 375 / 250 : 1,5 menit

PENYEBAB
PENYEBAB
SUMBATAN
SUMBATAN
Lidah
Epiglotis
Benda asing / muntahan / darah / sekret
Trauma jalan nafas

PEMBEBASAN
PEMBEBASAN JALAN
JALAN
NAFAS
NAFAS
PENYEBAB LIDAH
Manual :
- Non trauma :
Head tilt
Neck lift
Chin lift
Jaw thrust
- Trauma :
Chin lift
Jaw thrust
Dengan in-line manual immobilization atau
pasang cervical collar
Bantuan Alat
- Oropharyngeal airway
- Nasopharyngeal airway

Airway control (cont)

Without equipment:
Chin lift, jaw thrust, head tilt.
Lung inflation attempts
Manual clearing of mouth and throat.

Pada pasien trauma

head tilt

chin lift

neck lift
neck lift

Dont do

Be careful

JAW THRUST
dianjurkan

Opening the Airway the Triple

Airway Maneuver
Slightly extend neck
(when cervical spine
injury not suspected)
Elevate mandible
Open mouth
Consider adjunctive
devices

Airway control (cont)

With equipment:

Pharyngeal suctioning.
Oro/Nasopharyngeal intubation.
Laryngeal Mask Airway (LMA).
Endotracheal/bronchial intubation.
Cricothyrotomy laringeal jet insufflation.
Tracheostomy.

Pharyngeal intubation

Endotracheal intubation - technique

Tracheostomy tube

Translaryngeal O2 jet
insufflation

Oro-pharyngeal tube

Perhatikan ukuran

OROFARINGEAL
TUBE

Naso-pharyngeal
Nasopharyngeal
tube

Tidak merangsang muntah

Ukuran u/ dewasa 7 mm atau
jari kelingking kanan

tube

NASOFARINGEAL
TUBE

PEMBEBASAN
PEMBEBASAN JALAN
JALAN
NAFAS
NAFAS
PENYEBAB BENDA ASING
Manual
Penghisap
Definitive airway
Pada chocking :
Back blows
Abdominal thrust (Heimlich manuver)
Thoracal thrust
Cricothyroidotomy

CHOKING
Back blows
Lima kali hentakan
pada punggung,
diantara dua scapula

CHOKING
Heimlich
Abdominal trust

Korban : sadar

Heimlich Abdominal trust

Korban : Tidak sadar

Membrana cricothyroid
Pada keadaan gawat darurat
- Tempat injeksi transtracheal
obat emergency
- Tempat untuk
needle dan surgical
cricothyroidotomi
Bagaimana caranya ??
Obat apa saja boleh masuk ??

DEFINITIVE
DEFINITIVE
AIRWAY
AIRWAY
Indications
1. Apnea
2. Risk of aspiration
3. Insecure airway
4. Poor oxygenation
5. Impending airway compromise
7. Closed head injury

TUJUAN
TUJUAN INTUBASI
INTUBASI
ENDOTRAKHEAL
ENDOTRAKHEAL
1. Sebagai jalan nafas
2. Untuk oksigenasi
3. Untuk pemberian ventilasi
4. Mencegah aspirasi
5. Jalan pemberian obat (intra trakheal)
6. Bronchial toilet

MACAM
MACAM INTUBASI
INTUBASI
ENDOTRAKHEAL
ENDOTRAKHEAL
Orotrakehal
Nasotrakheal

Lewat mulut
Lewat hidung

ENDOTRACHEAL
ENDOTRACHEAL
INTUBATION
INTUBATION

The trachea should be intubated by prope

trained personnel

PERALATAN
PERALATAN INTUBASI
INTUBASI
ENDOTRAKHEHAL
ENDOTRAKHEHAL
Laryngoscope dengan blade yang sesuai
Tube dengan ukuran yang sesuai
Jelly
Anestetik lokal / spray
Forceps magill
Bite block / oropharyngeal airway
Adhesive tape / tali
Suction metal yang kauer
Connectors
Synringe (20 cc)
Stylet
Stetoscope
End tidal CO2 monitor

INTUBASI

INTUBASI
INTUBASI
ENDOTRAKHEAL
ENDOTRAKHEAL
Oksigenasi + ventilasi (5 menit)
Alat dan obat siap
Harus berhasil kurang 30 detik
Bila > 30 detik belum berhasil oksigenasi + ventilasi ulang
Penolong tak kuat tahan nafas
Saturasi O2 menurun
Monitoring :
Saturasi O2 (Pulse oxymeter)
End-tidal CO2 (Capnografi)

reathing support

GANGGUAN
GANGGUAN
VENTILASI
VENTILASI

Penyebab
Tindakan anestesi
Penyakit
Kecelakaan trauma

Lokasi
Sentral
Pusat nafas
Perifer
Jalan nafas
Paru
Rongga pleura

Dinding dada
Otot nafas
Syaraf & jantung

GANGGUAN
GANGGUAN VENTILASI
VENTILASI
(penderita
(penderita masih
masih bernafas)
bernafas)
Look / Lihat
Sianosis
Status mental
Asimetri dada

Takhipnea
Distensi vena leher
Paralisis otot nafas

Listen / dengar
Keluhan: Tak bisa nafas!
Stridor, wheeze
atau hilang suara nafas

gangguan
gangguan ventilasi
ventilasi
(penderita
(penderita masih
masih bernafas)
bernafas)

Feel / raba
Hawa ekspirasi
Emfisema subkutan
Krepitasi / tenderness / nyeri
Deviasi trakhea

Adjuncts
Pulse oximeter
CO2 detector
Gas darah
X-ray dada

DASAR
DASAR PEMBERIAN
PEMBERIAN
VENTILASI
VENTILASI
Intermittent positive pressure ventilation (IPPV)
Penderita tak bernafas
Nafas buatan (controlled ventilation)
Penderita masih bernafas / tak adekuat
Nafas bantuan (assisted ventilation)
Diberikan pada akhir ekspirasi
Tekanan oropharing > 25 cm H2O udara masuk
esophagus distensi lambung

.dasar
.dasar pemberian
pemberian
ventilasi
ventilasi
Sellicks maneuver
Menekan cricoid kebelakang sehingga esophagus
terjepit diantara cricoid dan corpus vertebra leher
Agar :
Udara tak masuk lambung
Isi lambung tak mengalir ke oropharing
Tak boleh pada cedera tulang leher
Nafas buatan :
Tidak volume 10-15ml/kg
Frequensi 12-15 / m

CARA
CARA PEMBERIAN
PEMBERIAN
VENTILASI
VENTILASI
Tanpa Alat
Mouth
to
Mouth
to
Mouth
to

mouth
nose
mouth and nose

Dengan Alat
Safar airway
Esophageal obturator airway
Face mask / pocket mask
Laryngeal mask
Bag-valve-mask
Bag-valve-tube
Ventilator

Breathing support
Goals: Emergency artificial ventilation and oxygenation.
Without equipment:
Mouth to mouth/nose ventilation.

With equipment: (with or without oxygen)

Mouth to adjunct.
Manual bag-mask (tube) ventilation.
Mechanical ventilation.

Breathing support (cont)

Position your cheek close to victims' nose and
mouth, look toward victims' chest.
Look, listen, and feel for breathing (5-10 seconds).
If not breathing, pinch victim's nose closed and give
2 full breaths into victim's mouth.
If breaths won't go in, reposition head and try again
to give breaths.

Nafas
buatan

Nafas
berhenti

Nafas ada

Manual Assisted Ventilation

Open the airway
Apply face mask and
obtain seal
Deliver optimal
minute ventilation
from resuscitation bag
Consider cricoid
pressure

Single-Handed Method
of Face Mask Application
Base of mask placed over
chin and mouth opened
Apex of mask over nose
Mandible elevated, neck
extended (if no cervical
spine injury), and
downward pressure by
mask hand

Two-Handed Method of
Face Mask Application
Helpful when mask
seal difficult
Fingers placed along
mandible on each
side
Assistant provides
ventilation

Inadequate Mask-to-Face Seal

Identify leak
Reposition face mask
Improve seal along cheek(s)
Change mask inflation or size
Slightly increase downward pressure
over face
Use two-handed technique

irculation support

C
C
(Circulation)
(Circulation)
Assessment of organ perfusion
- Level of conciousness
- Skin color and temperature
- Pulse rate and character
- Urinary output

SHOCK
SHOCK

An abnormality of the circulatory system

that result in inadequate organ perfusion

and tissue oxygenation

GANGGUAN
GANGGUAN SIRKULASI
SIRKULASI
Syok
Disritmia
Henti jantung
dll

SHOCK
SHOCK RECOGNITION
RECOGNITION AND
AND
MANAGEMENT
MANAGEMENT

Recognize signs of inadequate perfusion

and oxygenation
Identify probable cause
Restore perfusion
Re-evaluate patient response
Immediate involvement by specialists

CLINICAL
CLINICAL SIGNS
SIGNS
1. Tachycardia
2. Vasoconstriction
3. cardiac output
4. Narrow pulse pressure
5. MAP
6. blood flow
Remember :
Compensatory mechanisms

Circulation support
Control of external hemorrhage.

Position for shock.

Pulse checking.
Manual chest compressions.

BLEEDING
Apply direct pressure to
the wound (at this time a
direct pressure bandage
may be used)
Elevate (do not further
harm)
Pressure Point additional
pressure may be applied to
a pressure point to help
reduce bleeding.

CARE FOR SHOCK

Keep the victim laying down
(if possible).
Elevate legs 10-12 inches
unless you suspect a spinal
injury or broken bones.
Cover the victim to maintain
body temperature.
Provide the victim with
plenty of fresh air.
If victim begins to vomit place them on their left side.

Circulation (cont)
Check for carotid pulse by feeling for 5-10
seconds at side of victims' neck.
If there is a pulse but victim is not
breathing, give Rescue breathing at rate of
1 breath every 5 seconds Or 12 breaths
per minute.

Circulation (cont)
If there is no pulse, begin chest compressions as follows:
Place heel of one hand on lower part of
victim's sternum. With your other hand
directly on top of first hand, Depress
sternum 1.5 to 2 inches.
Perform 15 compressions to every 2
breaths.

Conclusion

CARDIOPULMONARY RESUSCITATION

CPR ABCs
AIRWAY - Open the
airway with the tiltchin method.

Breath - give two

breaths.

Check circulation.
If there is no pulse or
breathing..(next slide)

CPR Continued
Perform chest compressions.
15 compressions and two breaths.

Count = 1&2&3&4&5&15

RESCUE BREATHING
1 breath every 5 seconds - 12 per
minute.

Compressions : ventilations = 15:2