Resuscitation in Pediatric

Dr. Afriyan Wahyudhi, SpA, MKes

Penilaian Klasik
A

Airway

Breathing

Circulation

Disability

Exposure

Look, Listen, Feel

Airway
Pada Anak

kepala besar, leher pendek -> fleksi leher

gigi / rahang -> rapuh
lidah besar -> obstruksi jalan nafas
trakhea pendek dan kecil -> over ekstensi -> kompresi
trakhea
berbeda sesuai dengan usia maka berbeda problem
o < 6 bulan
: nasal breather
o 3-8 thn
: hipertrofi adeno tonsilar

Interpretasi Suara Nafas Abnormal

Suara

Penyebab

Stridor

Obstruksi jalan nafas atas

Mengi

Obstruksi jalan nafas bawah

merintih

Oksigenasi tidak adekuat

Ronkhi basah

Cairan, lendir, darah pada jalan nafas

Suara nafas
Usaha nafas

Obtruksi jalan nafas total

Gangguan transmisi suara

BREATHING
Usaha Nafas/Kinerja Pernafasan
laju/ frekuensi pernafasan
retraksi
stridor inspirasi / ekspirasi
grunting
penggunaan otot bantu nafas
nafas cuping hidung
tidak bisa dinilai
pada

Gangguan pernafasan berat

Depresi SSP
Penyakit neuromuskular

Frekuensi Nafas

dipengaruhi : demam, nyeri, emosi/ takut

frek > 60

: potensial gagal nafas

retraksi , kesadaran

Efek Gangguan Breathing pada Organ Lain

frekuensi jantung/kompensasi
Hipoksia takikardi
Hipoksia berat dan lama bradikardi
warna kulit
hipoksia vasokonstriksi pucat

kesadaran
hipoksia/ hiperkapnia agitasi dan /atau mengantuk

Circulation
Status Cardio Vaskular
frekuensi denyut Takikardi : tanda hipoksia, perfusi buruk
demam, sakit, takut
bradikardi: hipoksia, iskemia
isi dan tekanan
(volume nadi)

Kuat, filiformis

capillary refil

normal < 2 detik

tekanan darah
produksi urin

hipotensi
1 2 cc/ kgbb/jam

DISABILITY
Status Neurologik

Exposure
Untuk evaluasi fungsi fisiologis dan identifikasi
kelainan anatomis
Monitor suhu
Pertahankan lingkungan sekitar yang hangat
Hangatkan cairan infus

CPR

Basic Life Support

The big change: no longer ABC

Now its C-A-B
Why?
Dont delay compressions for
positioning airway, obtaining a seal
for mouth-to-mouth, etc

The change from ABC to CAB applies to infants

and children as well as adults
High quality compressions are essential to
generate blood flow to vital organs
Beginning CPR with 30 compressions rather
than 2 ventilations leads to shorter delays to
first compression
All rescuers should be able to deliver
compressions almost immediately. Positioning
the head and attaining a seal for ventilation
takes time and delays the initiation of CPR

The change from ABC to CAB applies to infants

and children as well as adults
Hypoxic arrest is more common than VF in
infants and children and ventilations are
extremely important in pediatric resuscitation
Starting with compressions only delays
ventilations by approximately 18 seconds for
alone rescuer and even shorter for two
rescuers

CAB simplifies training with the hope that more

victims will receive bystander CPR

The Guideline..........
Chest compressions should be immediately started by
one rescuer, while a second rescuer prepares to start
ventilations with a bag and mask. Ventilation is
extremely important in pediatrics because of the large
percentage of asphyxial arrests in which best results are
obtained by a combination of chest compressions and
ventilations. Unfortunately ventilations are sometimes
delayed because equipment (bag, mask, oxygen,
airway) must be mobilized. Chest compressions require
only the hands of a willing rescuer. Therefore, start CPR
with chest compressions immediately, while a second
rescuer prepares to provide ventilations (Class I, LOE
C).

Rules
In less than 10 sec, start compression if :
Unresponsive
Not breathing normally or only gasping
No sign of life

How to do chest compression ?

Two finger chest compression in infant (1 rescuer)

2 thumb-encircling hands chest compression

Compression ratio
Single rescuer
= 30 comp : 2 breaths
2 or more rescuer = 15 comp : 2 breaths

CPR

The EC clamp technique of bag mask ventilations

The Guideline..........

The effectiveness, dependent on high-quality

CPR, which requires an adequate compression
rate (at least 100 compressions/ min), an
adequate compression depth (at least one third
of the AP diameter of the chest or approximately
112 inches [4 cm] in infants and approximately 2
inches [5 cm] in children), allowing complete
recoil of the chest after each
compression,minimizing interruptions in
compressions, and avoiding excessiveventilation

 Its only about responsibility, the wisdom of a

doctor, and pride.
A great Doctor will be.....

Terimakasih