2010 - AHA ECC Adult Chain of Survival

C–A–B
DIKLAT
 BANTUAN HIDUP DASAR
Otak & jantung tdk dpt oksigen  mati
Golden period : 6 – 8 menit.
 Langkah-langkah RJP
1. Amankan lingkungan  penolong & korban aman,
lingkungan sekitar.
2. Kaji respon klien  pastikan tk kesadaran
(panggil/bangunkan) dengan menepuk pundak dengan
tegas.
3. Call for help  aktifkan bantuan code blue.
4. Posisi terbaring, terlentang, alas yg keras & datar
bebaskan pakaian yg mengikat
5. Kaji nadi karotis (bila -)
6. Compresi dada 30 x  nafas buatan 2x  dalam 5 siklus
(30 x kompresi 2x ventilasi dlm 2 menit dg rate 100 -
120x/mt  kaji nadi karotis). Saat pemberian ventilasi beri
posisi hiperekstensi
7. Bila dada tidak mengembang saat ventilasi  cek
sumbatan jl nafas
Cara penghitungan
1-2-3-4-5-6-7-8-9-1 1-2-3-4-5-6-7-8-9-1
1-2-3-4-5-6-7-8-9-2 1-2-3-4-5-6-7-8-9-2
1-2-3-4-5-6-7-8-9-1 1-2-3-4-5-6-7-8-9-3

1-2-3-4-5-6-7-8-9-1 1-2-3-4-5-6-7-8-9-1
1-2-3-4-5-6-7-8-9-2 1-2-3-4-5-6-7-8-9-2
1-2-3-4-5-6-7-8-9-2 1-2-3-4-5-6-7-8-9-4 dst
 Recovery Position
• Used in unresponsive, uninjured patients,
breathing adequately
• Gravity helps the airway to drain
 Menghentikan RJP
• Teraba arteri karotis, pernafasan spontan
• Petugas kelelahan & tidak ada petugas yg
mengantikan dan RJP sudah dilakukan
selama 30 menit tapi tidak ada tanda-
tanda kehidupan
• Klien dinyatakan meninggal
 Komplikasi RJP
• Fraktur iga  posisi tangan salah
• Perdarahan intraabdominal  posisi
tangan salah
• Distensi lambung  ventilasi berlebihan
 Sumbatan Jalan Nafas
• Benda asing :
makanan, mainan ,
gigi palsu Harus
dikeluarkan
• Korban tidak sadar 
lidah kebelakang
 Removing a Foreign Body

• A conscious, choking patient.

Mengeluarkan sumbatan benda
asing
 Removing a Foreign Body

• A conscious patient who is struggling

to breath.
– Your arms don’t reach
around their abdomen?
• Chest thrusts
 Removing a Foreign Body
• Abdominal thrusts
– Heel of hand between sternum and umbilicus
– Other hand on top
– “Pop” down and
toward the head
 Removing a Foreign Body

• Blind finger sweep

– Attempt to hook finger
behind obstruction and
pull it out!

• In small children look into the airway. If you see the obstruction try to pluck it
out.
– Your finger may push the obstruction back in when performing the blind sweep!
 Choking:
Conscious Infants
• Position with head downward
• 5 back blows
• 5 chest thrusts
• Repeat
 Open the Airway
• Head-tilt/chin lift (no trauma)
– The most common cause of obstruction is
the tongue!
 Open the Airway

• Jaw thrust (trauma)

 Oropharyngeal Airway

• Keeps tongue from blocking the airway

• Cannot be used in patients with gag
reflex
 Oropharyngeal Airway
• Insertion
– Upside down until resistance
– Rotate and advance until flange
is in contact with teeth or gums
 Oropharyngeal Airway
• Other methods of insertion
1. Insert right side up, and use a tongue
depressor.
2. Insert at corner of mouth and rotate 90º
while
advancing.
• Preferred for infants
 Inspect the Airway
• Vomit, blood, teeth, dirt?
• Finger sweep
– Clear large amounts and large particles
– Turn on side for best results
 Oropharyngeal Airway
• Must use correct size
– Measure from corner of
mouth to tip of ear
• Too big could push, tongue
into airway
• Too small, won’t reach back
of throat
• Have a selection of sizes available
 Oropharyngeal Airway

• Wrong!
 Nasopharyngeal Airway

• Keeps the tongue from blocking the

airway
• Better tolerated by patients with gag reflex
• May be used in patients
with locked jaws
 Nasopharyngeal Airway
• Must use correct size
– Measure from tip of nose to tip of ear
• Lubricate with water soluble gel
• Try right nostril first
 Assess for Breathing
• Is the patient breathing?
– Look, listen, & feel for 10 seconds
• If the victim is not
breathing, give two
breaths (1 and ½ - 2 sec.)
– Pinch the nose
– Seal the mouth with yours
• If the first two don’t go in,
re-tilt and give two more
breaths (if breaths still do
not go in, suspect
choking)
 Ventilate the Patient
• Mouth to mask
Bag-Valve-Mask Ventilations
Bila KU penderita tdk baik  OKSIGEN

• Kanul hidung ( 2 – 4 l )  O2: 24-44 %

• Face mask (6-8 l)  O2 : 35 – 60 %
• Non rebreathing mask (8-12l)  O2 : 80 –
90%
• Pernafasan Buatan
– Ventilasi mouth to mouth  O2 16 – 17 %
– Ventilasi mouth to mask udara ekspirasi
– Ambu – bag
Bag-Valve-Mask Ventilations
• Making a good mask to face seal
– Use two hands
• For mouth to mask ventilation
• For two person bag-valve-masking
 Bag-Valve-Mask Ventilations
• Two person BVM (preferred)
– Good seal
• No air leak around mask
– Two hands on bag
• Good volume delivered
• Good control of breath
 Bag-Valve-Mask Ventilations
• One person BVM
– Prone to inadequate tidal volumes
• Air leaks around mask
• Less air delivered by bag
• Fatigue
 Oxygen
• For all patients with
inadequate or absent
breathing
• For all patients with
difficulty breathing
• For all patients in shock
• For all patients with
decreased responsiveness
 Circulation
• Assess circulation
– 10 seconds
– Carotid pulse in adults
and children
– Brachial in infants

Observe:
Breathing, coughing,
movement, normal skin
temp. and color, improved
level of responsiveness,
pulse
Check pulse at carotid
artery NEAREST YOU
 Rescue Breathing
• If victim shows signs of circulation but is
not breathing:
• Give one rescue breath every 5 seconds
• Reassess after 1 minute and every few
minutes thereafter
– Loosen restrictive clothing around the
neck
• No chest compressions when there are
signs of circulation
Hand Placement for CPR
– Place heel of the hand next
to the index finger (on the
sternum)
– Using both hands, give 30
chest compressions
– Count 1 and 2 and 3 and....
– Depth of compressions:
1 .5 to 2 inches
 CPR: Child
• Compress sternum with one hand (1 to 1.5 inches
deep)
• Keep other hand on the tilted head
• 5:1 ratio - (20 cycles)
• Count 1,2,3...
• Recheck circulation and breathing after first minute
and every few minutes thereafter