Resusitasi Jantung Paru

Emergency cardiac care

Recognition of impending event
Activation of emergency response
system
Basic life support
Defibrillation
Ventilation
Pharmacotherapy

Airway placement (<10 sec)

Breathing (confirm with wave capnography)

Circulation access antiarrythmics

Drugs and differential diagnosis

Epinephrine 1mg every 3 to 5 minutes
Vasopressin 40 units once only
Amiodarone if resistent VT/VF
Search and treat reversible causes

Airway
Evaluate the presence of airway
obstruction:
- mengorok (snoring) sumbatan
pangkal lidah
- seperti suara berkumur (gurgling)
cairan pada saluran napas
- stridor benda padat pada faring

What to do?
Triple air maneuver
In cases possible cervical trauma,
just do head stabilization
Heimlich maneuver

BREATHING
Setelah Airway clear, segera cek bisa
bernapas spontan/tidak
Apneu
Pergerakan dada berkurang
Tidak ada suara napas
Aliran udara berkurang

Dewasa: 2s / breath
Bayi & anak: 1 1.5s

Ada obstruksi jalan

napas
Reposisi kepala &
leher

What To Do Next?
Mouth-to-mouth
Pinch the nose
Observe chest rising

Mouth-to-mask
8-10x/menit

Circulation

Circulation
Chest compression force blood to
flow either by increasing
inthrathoracic pressure (thoracic
pump) or by directly compressing the
heart (cardiac pump)

External Chest Compression

For adult and childrens
Depth is at least 1/3 AP or 2
inches (5cm)
Ratio :
30 : 2 (1 or 2 resuer)

For infants
Depth is at least 1/3 AP or 1
inches (4cm)
Ratio :
30 : 2 (single rescuer)
15 : 2 ( two rescuer )

High Quality CPR

Rate at least 100/min
Compression depth at least 2 inches
(5cm) for adults and children, 1
inches (4cm) for infants
Allow complete chest recoil after
each compression
Minimize interruption in chest
compression
Avoid excessive ventilation

Assessing the Adequacy of Chest

Compression
CO can be estimated by monitoring
end tidal CO2
PETCO2 > 10 mmHg
Coronary perfusion pressure (a.
diastole pressure> 20 mmHg)
SCVO2 >30%

Defibrillation
nonsynchronized random administration
of shock during a cardiac cycle.
Indications
VF/pulseless VT

Cardioversion??
Indications
SVT
VT
Atrial flutter
Atrial fibrillation

ECG Recognition

Invasive Cardiopulmonary
Resuscitation
Thoracotomy dan open chest
cardiac massage
Tidak rutin dilakukan\
Indikasi hanya bila terdapat
cardiac arrest dengan trauma
dada, trauma abdomen, kelaianan
anatomi dada, pulmonary emboli

Intravenous access

Lidocain
Epinefrin
Atroppin
Naloxone
Vasopressin
Dosage: 2-2.5 higher, dilute 10ml

Intraosseous access
Tibia, distal radius and ulna
Distal femur, proximal tibia >> jarum
spinal 18G dengan stylet >> 2-3 cm
45o
Perlu dosis lebih tinggi
Es : emboli lemak pada pasien
pulmonary hipertensi

Terapi Pacemaker
Emergensi
Transcutaneous Cardiac Pacing (TCP)
Metode noninvasif
Aritmia oleh karena disorder konduksi
atau abnormal impulse
Asistol
Bradikardi oleh karena blokade jantung
Takikardia yang berulang

Precordial Thump
Digunakan bila defribilator tidak
tersedia
Dengan syarat:
Menyaksikan terjadinya VT
Memonitor VT yang tidak stabil

Rekomendasi protokol
resusitasi