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8/17/2019 BasicSkill CPR Guideline2000
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Perkembangan baru
Resusitasi Jantung Paru
Advanced Life Support
Guidelines 2000
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Sinonim
• Resusitasi Jantung Paru Resusitasi
!ardio Pulmonar" Resuscitation !PR
!P!R Pi#at Jantung $ %afas &uatan
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'
(apan Resusitasi Jantung Paru
diperlukan )
• Jika pasien !ardiac Arrest
• Apa tanda !ardiac Arrest )
* nadi carotis +,-A( +.RA&A
• !ardiac Arrest %adi !arotis tidak teraba
• !ardiac Arrest ≠ .!G flat ≠ suara #antung /
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&asic 3 Advanced Life Support
• Air4a" * #a4 t5rust6 c5in lift
* trac5eal intubation
• &reat5ing * rescue breat5ing
7to76 Ambu6 82
• !irculation * cardiac compression
• -rugs 9 -efibrillation
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(orban tidak sadar
• A
• &
• !
• -rugs 9 -efibrillation
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;
Pasien tidak sadar
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Guidelines 2000 ,L!8R !onsensus
• A,R>A?
* Lakukan jaw-thrust
* Jangan necklift semua pasien * Jangan 5eadtilt pasien trauma
* @ati5ati c5in lift pasien trauma
* pasang oro9 nasop5ar"ngeal tube
* pertimbangkan intubasi dini
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Guidelines 2000 ,L!8R !onsensus
• &R.A+@,%G
* usa5akan 2 nafas "ang ber5asil dada terangkatB :00;00 ml /maksimal 1000 ml
* beri sela eks5alasi
* beri oksigen 100C lebi5 dini
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Guidelines 2000 ,L!8R !onsensus
• !,R!ELA+,8% pijat jantung
– Bagi awam, pijat jantung dimulai tanpa raba
carotis
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11100x per menit
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Guidelines 2000 ,L!8R !onsensus
• !,R!ELA+,8% – Pijat diprioritaskan agar tidak sela, 100 / menit
• -ua atau satu penolong tidak dibedakan lagi – 15 pijat - 2 naas
• Jika trac5ea suda5 intubasi – pijat 100 / menit ! naas 12 / menit
– tak usa" sinkronisasi
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1'
AFas !PR
-iagnosis cepat
adan"a
!ardiac Arrest
R8S! * #antung berden"ut lagi
nadi perifer teraba lagi
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Guidelines 2000 ,L!8R !onsensus
• -e,&R,LLA+,8%
– #$ s"ock sedini mungkin
%sebelum 5-10 menit& – 200 / 200-'00 / '(0 )oules
%satu rangkaian cepat&
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1:
)ika deib diberikan sebelum 5 menit,
* 50+ kemungkinan jantung berdenut kembali
Public ccess #eibrillation
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1;
$P.
<
pi#at #antung 100 H pm
nafas 12 H pm
sinkronisasi 1:I2/satu atau dua penolong
<
segera $siap #$-s"ock
3/4
#$ s"ock'x berturutan
sstole / P%non-3 / 4&
$P. terus' menit
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• 9 + pulseless ada gelombang k5as6 tetapi nadicarotis tidak ada – s"ockable, "arus segera #$-s"ock
* /ada + "ang nadi carotis /$ → tak perlu -!s5ock
• As"stole tak ada gelombang /.!G flat6 nadicarotis tidak ada
– 6-s"ockable• P.A .7- ada gelombang mirip .!G normal tetapi
nadi carotis tidak ada – 6-s"ockable
.!G dalam cardiac arrest ada ' pola
/pada semuan"a6 nadi carotis tidak ada
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!PR follo4ed b" defibrillation
4it5in 2 to ' minutes of collapse
5as produced survival rate of up to :0CK
>it5 eac5 minute of dela"6 c5ance of survival
decreases b" =10C
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1D
Guidelines 2000 ,L!8R !onsensus
• -REGS – adrenalin 1-1-1 tiap '-5 menit
– atropin 1-1-1 tiap '-5 menit – )angan menuntik intra-cardial7
– Berikan 8ntra-9ena, intra-trac"eal, intra-osseus
– 6a-bikarb "ana 1 m:/kg dan paling ak"ir
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Adrenalin6 Atropin6 Lidocain6 asopresin
• ,ntravenous
• ,ntratrac5eal 9 transtrac5eal
* dosis 2' H intravena
• ,ntraosseus
• +,-A( intracardial * meng5entikan pi#at #antung
* sukar pastikan intraventrikuler
• kena miokard nekrosis
• kena aK coronaria infark
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@ipoksia@ipovolemia
@iperkalemia
@ipotermia
+amponade #antung
+ension pneumot5oraH
+5romboemboli paru
+oHic overdose&blocker6 !ablocker -igitalis6 +ric"clic A-
7assive 7,
Asidosis
@
+
7A
&ila !ardiac Arrest membandel
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&ila ber5asil R8S!
• Lan#utkan oksigenasi6 kalau perlu nafas buatan
• @ipotensi diatasi dengan inotropik dan obat vaso
aktif /adrenalin6 dopamin6 dobutamin6 ep5edrin• +etap di infus untuk #alan obat cepat
• +erapi aritmia
• (oreksi elektrolit6 cairan dsb• A4asi di ,!E
• a4asI cardiac arrest sering terulang lagi