Pediatric Life Support

dr. Defa Rahmatun Nisaa, SpA, MKes.

FK UNSWAGATI CIREBON
Pendahuluan
Resusitasi jantung paru (RJP)
Bantuan hidup dasar (BHD)
Bantuan hidup lanjut (BHL)
BHD : tindakan resusitasi tanpa alat / alat
terbatas (bag-mask ventilation)
BHL : alat & obat resusitasi
Pendahuluan
Resusitasi
Segala bentuk usaha yang dilakukan terhadap
orang yg berada dalam keadaan gawat / kritis
untuk mencegah kematian
Gawat
Keadaan yg berkenaan dengan suatu penyakit /
kondisi sakit lain yg terdapat bahaya kematian
Darurat
Suatu keadaan yg terjadi tiba2 & tidak
diperkirakan sebelumnya (kecelakaan, kebutuhan
yg segera / mendesak)
Pendahuluan
Penyebab henti kardio-respirasi tersering
pada anak sekunder karena:
Trauma
Infeksi
Aspirasi benda asing
SIDS
Syok
Sepsis
Meningitis
Henti jantung primer jarang terjadi : PJB,
miokarditis, disritmia
Pendahuluan
Henti jantung pada anak sekunder
setelah henti napas primer
Usia <1 th angka kematian >75% bila
diluar RS
Pencegahan, pengenalan, intervensi dini
gagal napas & henti sirkulasi
Patofisiologi
Henti jantung
Kolaps sirkulasi
Perfusi organ vital
Anoksia
10-20 detik: kesadaran
60-90 detik: hipotensi
3-5 menit: asistol
RJP akan berhasil dilakukan dalam 4 menit
sejak henti jantung dilanjutkan dengan
bantuan hidup lanjut dalam 8 menit
Kriteria Diagnosis
Gejala umum: kelelahan & berkeringat
banyak
Disfungsi pernapasan: sianosis, PCH, retraksi,
merintih, suara pernapasan , mengi,
takipnea, apnea
Disfungsi serebral: agitasi, gelisah, bingung,
sakit kepala, tidak berrespon terhadap
rangsangan, kejang, koma
Disfungsi kardiovaskular: takikardi, hipertensi,
bradikardi, hipotensi, syok, henti jantung
LAB : AGD (hipoksemia, hiperkapnia)
BHD pada Anak
Dasar
resusitasi pada bayi & anak
mengikuti format:
A membebaskan jalan napas
B bantuan pernapasan
C bantuan sirkulasi
D pemberian obat2an
E defibrilasi
 Step
A Menilai kesadaran, apakah korban sadar atau tidak:
1 Panggil korban dengan suara yang nyaring dan jelas.
2 Berikan rangsang mekanik dengan cara menepuk bahu
korban.

3 Jika korban tidak berespon, artinya yang bersangkutan tidak

sadar.
Segera panggil bantuan untuk mengaktifkan emergency
medical service.

4 Letakkan korban dengan posisi terlentang, menggunakan

alas yang keras dan datar.
B Buka jalan napas:

5 Lakukan manuver head tilt and chin lift.

6. Jika dicurigai trauma leher, lakukan manuver jaw thrust untuk

mempertahankan leher pada posisi netral.

7 Buka mulut korban menggunakan manuver cross finger untuk menilai

adanya sumbatan.

8 Gunakan finger sweep untuk mengeluarkan benda asing di mulut.

9 Jika benda asing tidak tampak, keluarkan benda asing dengan manuver
abdominal thrust. Tindakan dilakukan sebanyak 5 kali.
C Pernapasan
10 Evaluasi korban apakan bernapas atau tidak. Lakukan maksimal 10
detik.

11 Posisikan pipi ke dekat hidung dan mulut korban. Lakukan manuver

look (lihat), listen (dengar), and feel (rasakan):

- Lihat gerakan dinding dada

- Dengar suara napas
- Rasakan aliran udara ke pipi

12 Jika korban tidak bernapas atau napas tidak adekuat (gasping):

- Berikan 5 kali napas buatan awal untuk mendapatkan 2 kali napas

efektif.

- Lakukan dengan menggunakan alat BVM (Bag valve mask

ventilation)
D Sirkulasi
13 Evaluasi sirkulasi dengan meraba nadi di arteri karotis atau femoral.

Lakukan maksimal 10 detik.

14 Jika nadi tidak teraba atau < 60 kali per menit dan perfusi jelek (pucat,
sianosis), mulai lakukan resusitasi jantung paru. Identifikasi lokasi
kompresi dada yang tepat. Sebutkan syarat kompresi dada yang baik
(push fast, push hard, release completely, and minimize interruption).

Anak berusia lebih dari 1 tahun

15 Kompresi dada dilakukan di setengah bagian bawah dari sternum tetapi
tidak boleh menekan prosessus xiphoideus
16 Letakkan pangkal 1 telapak tangan ditempat untuk melakukan kompresi
dada
17 Rasio kompresi dada : ventilasi adalah 30 : 2 (1 penolong).
18 Kedalaman kompresi dada 1/3 diameter anteroposterior dinding
dada.
E Evaluasi
19 Setalah 2 menit atau 5 siklus resusitasi jantung paru, evaluasi kondisi
korban.
- Nadi
- Napas
- Warna kulit
- Kesadaran
- Pupil
20 Jawab dengan tepat:

Jika setelah 2 menit/5 siklus resusitasi jantung paru, nadi tidak teraba
atau < 60 kali/menit, apa yang akan dilakukan? (Jawab: resusitasi
jantung paru dilanjutkan). Jika setelah di evaluasi ternyata nadi 60
kali/menit, tetapi korban tidak bernapas, apa yang akan dilakukan?
(Jawab: berikan napas buatan lanjutan 12-20 kali/menit; 1 kali
napas/3-5 detik)
Trauma
Head, Spinal cord, Thoracic, Abdominal,
Spleen, Liver, Renal,Pancreatic, Intestinal
Pre-hospital trauma care:
Rapid assessment
Support of the ABCs
Immobilization
Transportation
Hospital Trauma team
Trauma
Hospital
Primary survey ABCDEs
A & B + control of the cervical spine, anatomic
injuries, full stomach (risk of aspiration)
C observation, palpation, restored (2 iv lines),
bleeding control
D neurologic status (pupil, CGS)
E full assessment of the patient (prevent
hypothermia)
Trauma
Secondary survey
More detail head to toe exam
More complete history

Tertiary survey
Repeat primary & secondary survey
Lab & Radiologic test in 24 hours
Trauma
The principles of BLS resuscitation for the injured child are the
same as those for the ill child, but some aspects require emphasis

The following are important aspects of resuscitation of pediatric

victims of trauma:
Anticipate airway obstruction by dental fragments, blood, or
other debris. Use a suction device if necessary.
Stop all external bleeding with direct pressure.
When the mechanism of injury is compatible with spinal injury,
minimize motion of the cervical spine and movement of the head
and neck.
Professional rescuers should open and maintain the airway with
a jaw thrust and try not to tilt the head. If a jaw thrust does not
open the airway,use a head tilt chin lift, because a patent
airway is necessary. If there are 2 rescuers, 1 can manually restrict
cervical spine motion while the other rescuer opens the airway.
Trauma

To limit spine motion, secure at least the thighs, pelvis, and

shoulders to the immobilization board. Because of the
disproportionately large size of the head in infants and
young children, optimal positioning may require recessing
the occiput or elevating the torso to avoid undesirable
backboard-induced cervical flexion
If possible, transport children with potential for serious
trauma to a trauma center with pediatric expertise
Do not routinely hyperventilate even in case of head
injury. Intentional brief hyperventilation may be used as a
temporizing rescue therapy if there are signs of impending
brain herniation (eg, sudden rise in measured intracranial
pressure, dilation of one or both pupils with decreased
response to light, bradycardia, and hypertension)
Trauma
Suspect thoracic injury in all thoraco-abdominal trauma,
even in the absence of external injuries. Tension
pneumothorax, hemothorax, or pulmonary contusion may
impair oxygenation and ventilation
If the patient has maxillofacial trauma or if you suspect a
basilar skull fracture, insert an orogastric rather than a
nasogastric tube
In the very select circumstances of children with cardiac
arrest from penetrating trauma with short transport times,
consider performing resuscitative thoracotomy
Consider intra-abdominal hemorrhage, tension
pneumothorax, pericardial tamponade, and spinal cord
injury in infants and children, and intracranial hemorrhage
in infants, as causes of shock.
Trauma
Some aspects of trauma resuscitation require emphasis
because improperly performed resuscitation is a major
cause of preventable pediatric deaths.

Common errors in pediatric trauma resuscitation include

Failure to open and maintain the airway
Failure to provide appropriate fluid resuscitation
Failure to recognize and treat internal bleeding
Shock
Shock results from inadequate blood flow and oxygen delivery
to meet tissue metabolic demands.
The most common type of shock in children is hypovolemic,
including shock due to hemorrhage.
Distributive, cardiogenic, and obstructive shock occur less
frequently.
Shock progresses over a continuum of severity, from a
compensated to a decompensated state.
Compensatory mechanisms include tachycardia and
increased systemic vascular resistance (vasoconstriction) in an
effort to maintain cardiac output and perfusion pressure
respectively.
Decompensation occurs when compensatory mechanisms fail
and results in hypotensive shock.
Shock
Typical signs of compensated shock include:
Tachycardia
Cool and pale distal extremities
Prolonged (2 seconds) capillary refill (despite warm ambient
temperature)
Weak peripheral pulses compared with central pulses
Normal systolic blood pressure
Shock
As compensatory mechanisms fail, signs of inadequate end-
organ perfusion develop.
In addition to the above, these signs include:
Depressed mental status
Decreased urine output
Metabolic acidosis
Tachypnea
Weak central pulses
Deterioration in color (eg, mottling)
Shock
Decompensated shock is characterized by signs and symptoms
consistent with inadequate delivery of oxygen to tissues (pallor,
peripheral cyanosis, tachypnea, mottling of the skin, decreased
urine output, metabolic acidosis, depressed mental status), weak
or absent peripheral pulses, weak central pulses, and
hypotension.
Shock
Learn to integrate the signs of shock because no single sign
confirms the diagnosis. For example:
Capillary refill time alone is not a good indicator of circulatory
volume, but a capillary refill time 2 seconds is a useful indicator of
moderate dehydration when combined with decreased urine
output, absent tears, dry mucous membranes, and a generally ill
appearance. Capillary refill time is influenced by ambient
temperature, site, and age and its interpretation can be
influenced by lighting.
Tachycardia is a common sign of shock, but it can also result
from other causes, such as pain, anxiety, and fever.
Shock
Pulses are weak in hypovolemic and cardiogenic shock,
but may be bounding in anaphylactic, neurogenic, and
septic shock.
Blood pressure may be normal in a child with
compensated shock but may decline rapidly when the
child decompensates.
Like the other signs, hypotension must be interpreted
within the context of the entire clinical picture.
Hypotension is defined as a systolic blood pressure:
<60 mm Hg in term neonates (0 to 28 days)
<70 mm Hg in infants (1 month to 12 months)
<70 mm Hg + (2 x age in years) in children 1 to 10 years
<90 mm Hg in children 10 years of age
Tatalaksana
Hypovolemic ShockA, B, C
Use an isotonic crystalloid solution (eg, lactated Ringers solution or
normal saline)as the initial fluid for the treatment of shock. There is no
added benefit in using colloid (eg, albumin) during the early phase of
resuscitation.
Treat signs of shock with a bolus of 20 mL/kg of isotonic crystalloid
even if blood pressure is normal. Crystalloids may have an associated
survival benefit over colloid for children with shock secondary to
general trauma, traumatic brain injury, and burns. There is no
evidence to support the use of a specific isotonic crystalloid. Give
additional boluses (20 mL/kg) if systemic perfusion fails to improve.
There are insufficient data to make a recommendation for or against
use of hypertonic saline for shock associated with head injuries or
hypovolemia
There is insufficient evidence in infants and children to make a
recommendation about the best timing or extent of volume
resuscitation for children with hemorrhagic shock following trauma.
Bacaan lebih
lanjut
1. Pediatric Basic Life Support: 2010
American Heart Association Guidelines
for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care
2. Pediatric Advanced Life Support : 2010
American Heart Association Guidelines
for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care
Terima Kasih