Professional Documents
Culture Documents
CPCR
CPCR
CPCR
of Cardiopulmonary
Resuscitation
Hasanul Arifin, 2003
1
THE CHAIN OF
SURVIVAL
EARLY EARLY
DEFIB. EARLY
EARLY
ACCESS
ADVANCED
CPR CARE
2
Activate the EMS System
• Location of the emergency
• Telephone number from which the call is being made
• What happened: heart attack, auto crash, etc
• Number of persons who need help
• Condition of the victim(s)
• What aid is being given to the victim(s) eg, “CPR is being
performed”
• Any other information requested. To ensure that EMS
personnel have no more questions, the caller should
hang up only when instructed to do so by the EMD
3
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
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5
AUTOMATIC EXTERNAL
DEFIBRILLATION - AED
HEART START
6
7
Check for Sign of Circulation
Provide initial rescue breaths to the unresponsive, non
breathing victim.
Look for signs of circulation,
With your ear near the victim”s mouth, look, listen, and feel for
normal breathing or coughing.
quickly scan the victim for any signs of movement.
If the victim is not breathing normally, coughing or
moving, immediately begin chest compressions.
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100
90
80
Changes of success
70 reduced 7% to 10%
each minute
60
%success
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 minute
Composite data illustrating relationship between probability of survival to
discharge (indicated as success in figure), after VF cardiac arrest and interval 9
between collapse and defibrillation
Hal-hal baru dalam RJPO
• Pijat jantung diprioritaskan tidak ada sela, 100x/m
(dicapai dengan hitungan 1s/d15 dalam 9 detik)
• Bagi awam pijat jantung dimulai tanpa raba carotis
• Satu atau dua penolong 15 pijat, 2 nafas
• Jika trachea sudah diintubasi: pijat(15x) dan
nafas(2x) tidak usah sinkronisasi lagi.
10
Hal-hal baru dalam RJPO
(lanjutan)
• jangan neck lift
irway • jaw-thrust, chin-lift, bila bukan trauma
boleh head-tilt
• pasang oro/naso pharyngeal tube
• pertimbangkan intubasi dini
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• pijat jantung lebih cepat, 100x/menit
irculation • DC shock lebih dini
Carotis(-) CPR
13
CPR
Segera ECG,
Siap DC-Shock
VT/VF A-systole/PEA
(Non-VT/VF)
DC-Shock
CPR terus 3 menit
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Cardiac arrest = carotis(-)
Check ECG
15
VF/VT pulseless
16
Ventricular fibrillation
Ventricular flutter
Langsung DC-shock
200 joules
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Ventricular Tachycardia (VT)
Carotis(+) Carotis(-)
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DC-shock
• oles paddles dengan jelly ECG tipis dan rata
1. switch ON
• pasang paddles pada
posisi APEX dan PARA STERNAL
2. Charge 200 joules (non-synchronized)
• perintahkan : nafas bantu berhenti dahulu
• Katakan dengan suara keras :
Awas!!!, semua lepas dari pasien
Atas bebas, bawah bebas, samping ka/ki bebas
3. SHOCK !!! (tekan kedua paddles bersama)
Biarkan paddles tetap menepel didada, baca ECG.
Siap charge lagi bila irama masih shocksble 19
ECG : VF/VT pulseless
(nadi carotis tdk teraba)
200/300 joules
360 joules
ROSC
MasihVF/VT pulseless Return of Spontaneous
Circulation 20
DC-shock 200-300-360 joules
Masih VF/VT-pulseless
•Intra-venous
•Intra-tracheal/trans-tracheal
(dosis 2-3 x intravena
•Intra-osseus
•TIDAK BOLEH intra-cardial
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A-systole
PEA=EMD
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A-systole (ECG flat)
PEA(gelombang ada tetapi carotis -)
CPR 3 menit
Intubasi, iv line,
adrenalin 1 mg/3-5 menit
1-1-1/1-3-5mg
A-systole/PEA ROSC
4 4
•Tamponade jantung •Massive MI
•Hipoksia
•Tension pneumothorax •Asidosis
•Hipovolemia
•Thromboemboli paru
•Hiperkalemia
•Toxic overdose,
•Hipotermia
B-blocker, Ca-blocker
Digitalis
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GAMBAR
toooloong
GAMBAR
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LOOK, LISTEN & FEEL
Jangan dilakukan
pada kasus trauma
Hasanul Arifin-2003
28
Jaw thrust
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MOUTH TO MOUTH RESPIRATION
30
Mouth
to
ajunct
31
Mouth to ajunct
32
Bag
and
mask
33
FBAO,The foreign body sequence
34
Raba nadi carotis
35
KOMPRESSI JANTUNG LUAR
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KOMPRESSI JANTUNG LUAR
SATU atau DUA PENOLONG
37
CHEST COMPRESSIONS
1 or 2 rescuers
15 compressions
(100x/m)
2 ventilations
38
KOMPRESSI JANTUNG LUAR
39
40
lontoooong
41
1. Menurut guideline 2000 CPCR maka, perbandingan pijat jantung luar
dengan tiupan nafas oleh satu penolong adalah :
a.5:1 b. 15:2 c. 15:1 d. 5:2 e. bssd
2. Menurut guideline 2000 CPCR maka, perbandingan pijat
jantung luar dengan tiupan nafas oleh dua penolong adalah :
a. 5:1 b. 15:2 c. 15:1 d. 5:2 e. bssd
3. Untuk membebaskan jalan nafas pada penderita trauma
dilakukan dengan cara :
a. head tilt & chin lift b. jaw thrust c. neck lift d. extensi kepala
e. benar semua.
4. Yang termasuk dalam “chain of survival” adalah; kecuali,
a. early access b. early CPR c. early defibrillation
d. early infusion/drugs e. early advanced care
5. Yang dimaksud dengan “sign of circulation” adalah :
1. normal breathing 2. gerakan tangan 3gerak kaki
4. batuk
6. DC-shock dilakukan bila gambaran EKG :
1. PEA 2. A-systole 3. EMD 4. VF
7. Pijat jantung luar dilakukan bila gambaran EKG :
1. PEA 2. A-systole 3. EMD 4. VT-pulseless
8. Yang termasuk obat emergency utama dalam CPCR adl; kecuali
a. lidocain b. sulfas atropin c. adrenalin d. vasopressin
e. nat.bicarbonat
9. Pijat jantung luar dilakukan dengan kecepatan :
a. 70 x/m b. 80 x/m c. 90 x/m d. 100x/m e. 120x/m
10. Suntikan adrenalin intra kardial tidak dianjurkan lagi SEBAB,
sukar dan membutuhkan waktu.
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