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Resusitasi Jantung Paru

CPR – Guidelines 2010

revisi dari
Guidelines 2000
Guidelines 2005
CANDRA A.W,S.Kep.,Ns M.Mkes
SETYO K, S.Kep.,Ns
 Basic Life Support =BLS
= jalan nafas + nafas buatan + pijat jantung (A-B-C)
 Advanced Life Support = A L S
= Drug (+fluid) + E K G + Defibrilasi

 Cardio Pulmonary Resuscitation = CPR

 Cardio Pulmonary Cerebral Resuscitation
= CPCR = CPR = RJPO
= BLS + ALS

Semua tindakan akut/ segera

untuk menghentikan proses
yang menuju kematian.
KONSENSUS GUIDELINE CPR

Resuscitation Council of
Southern Africa (RCSA)

Inter American Heart Foundation Resuscitation Council of ASIA

(IAHF) (RCA) 3
 Guidelines 2005 ILCOR
Bila anda tidak mampu atau tidak tahu
cara membebaskan jalan nafas, cara memberi nafas buatan
atau
tahu tetapi tidak mau melakukan maka:

lakukan pijat jantung saja

Teruskan pijat jantung
s/d datang bantuan tenaga yang ahli atau alat
untuk membebaskan jalan nafas dan
memberikan nafas buatan ( Ambu Bag)
Chest Compressions Emphasized in
New Heart Association Guidelines on CPR AHA Algorithm
Among the changes, published in Circulation:

1. The order of CPR is now C-A-B (compressions, airway, breathing)

instead of A-B-C for everyone except newborns.
The first cycle should include 30 compressions before rescue breaths.

2. "Look, Listen, and Feel" is no longer recommended.

3. Compressions for adults should be at least (instead of up to) 2 inches

and performed at a rate of at least 100 per minute.
4. Un-trained bystanders should perform compression-only CPR (previous
guidelines did not address untrained bystanders separately).

5. Emergency cardiac treatments no longer recommended include: routine

atropine for pulseless electrical activity/ asystole, cricoid pressure (with
CPR), and airway suctioning for all newborns (exception for those with
obvious obstruction).

6. New sections address post-arrest care, care for children with cardiac
arrest and specific congenital heart defects, and follow-up for children
young adults with sudden, unexplained cardiac death.
Physician's First Watch for October 18, 2010
Adult BLS ERC Algorithm. Simplified Adult BLS
AHA Algorithm
 Guidelines 2005 ILCOR Adult BLS Algorithm.
Korban tidak sadar

A. bebaskan jalan nafas

Call for help

B. jalan nafas bebas

tidak bernafas A.
2 x tiupan awal
awam
raba nadi carotis
C.
tidak teraba nadi
C.
Beri pijatan jantung
dan nafas buatan B.
30 pijat + 2 nafas
EVALUASI TIAP 2 MENIT © 2010 ERC.
 Adult BLS Algorithm.

Untuk mempermudah
disamakan saja 30:2?

© 2010 ERC.
 Mudah diajarkan
 Mudah dimengerti
(tidak membingungkan)
 Mudah dilaksanakan oleh siapa saja
 Tanpa harus berpikir panjang
 Tidak melelahkan
ATTENTION !!!!!
 A. bebaskan jalan nafas Guideline 2010
Call for help
jalan nafas bebas

x
tidak bernafas

raba nadi carotis

2 x tiupan awal
B.
tidak teraba nadi

C. Beri pijatan jantung Raba pijat

Karotis = awam
dan nafas buatan jantung
2005 guideline
B. 30 pijat + 2 nafas (-) 30x
PIJAT JANTUNG
Treatment Recommendation

It is reasonable to compress the sternum

at least 2 inches/ 5 cm for all adult
cardiac arrest victims.

There is insufficient evidence to

recommend a specific upper limit for chest
compression depth.
2010 ILCOR
PIJAT JANTUNG
Treatment Recommendation

It is reasonable for lay rescuers and healthcare

providers to perform chest compressions
for adults at a rate of at least 100
compressions per minute.

There is insufficient evidence to recommend a

specific upper limit for compression rate.

Pauses should be minimized to maximize the

number of compressions delivered per minute.
2010 ILCOR
Tiupan nafas yang berlebihan
berakibat tekanan intra-thoracal
meningkat dan berdampak
menghambat aliran darah
yang ditimbulkan akibat
pijatan jantung.

Tiupan nafas cukup

10 kali/ menit.

Setiap tiupan cukup

1 detik asal dada
mengembang
Pijat jantung :

Langsung
letakkan tangan
di-tengah-tengah dada
Pijat jantung 30 x
disusul dg nafas 2 x
 The hand position
For adults receiving chest compressions, it is
reasonable for rescuers to place their hands on the
lower half of the sternum.
It is reasonable to teach this location in a simplified
way,
such as:
“Place the heel of your hand in the center of the chest
with the other hand on top.”

This instruction should be accompanied by a

demonstration of placing the hands on the lower half of
the sternum.
Use of the inter-nipple line as a landmark for hand
placement is not reliable.

2010 ILCOR
Kapan pijat jantung dilakukan ????
Treatment Recommendation

It is reasonable that lay rescuers and healthcare

professionals use the combination of
unresponsiveness and absent or abnormal
breathing to identify cardiac arrest.

Palpation of the pulse as the sole indicator of

the presence or absence of cardiac arrest is
unreliable.

Agonal gasps are common during cardiac arrest

and should not be considered normal breathing.
2010 ILCOR
 Perabaan nadi carotis
dari tengah ke-lateral

KAPAN DILAKUKAN ?
Guideline 2010

1-2-3-4-5
boleh diulang
1-2-3-4-5

Awam : tidak perlu

meraba carotis
Perubahan Guidelines 2000 menjadi Guidelines 2005
kemudian Oktober 2010 terbit Guidelines 2010
tampaknya menyulitkan kita, namun yang penting
dan perlu diingat bahwa :

1. Pijat dulu 30x. Push fast , push hard sedalam 2 inch

2. “Recoil”, dada mengembang kembali jangan ditahan
3. Usahakan pijat jantung tanpa sela, paling tidak 100x/m
4. Tiap tiupan nafas cukup 1 detik asal dada naik
Ventilasi yang berlebihan adalah berbahaya bahkan
merugikan.
5. Ventilasi secukupnya tanpa harus menghirup udara
sekuat tenaga bagi penolong (unt mouth to mouth)
6. Selama pijat jantung dan nafas buatan, tetap
diupayakan jalan nafas tetap bebas
7. Sedini mungkin ikut sertakan DC shock
Building Blocks of CPR.
The precordial thump
Treatment Recommendation

It should not be used for unwitnessed out-of-hospital

cardiac arrest. The precordial thump may be
considered for patients with monitored, unstable
ventricular tachycardia if a defibrillator is not
immediately available.

There is insufficient evidence to recommend for or

against
the use of the precordial thump for witnessed onset of
asystole.
2010 ILCOR
Chain of Survival
The links in this Chain are:
1. Immediate recognition and activation
of the emergency response system
2. Early CPR with an emphasis on chest compressions
3. Rapid defibrillation,
4. Effective advanced life support and
5. Integrated post-cardiac arrest care.

1 2 3 4 5
 CPR
|
pijat jantung 100 x pm
nafas 10 x pm BLS
sinkronisasi 30:2
(satu atau dua penolong)
|
segera ECG
siap DC-shock
|
| |
VF/VT Asystole / PEA ALS
| (non-VF / VT)
|
DC shock
A SINGLE SHOCK
CPR terus
2 menit
shockable 23
Un-shockable
KAPAN PIJAT JANTUNG DI HENTIKAN….
DARI SISI PENOLONG

PENOLONG KELELAHAN/ CAPEK

PETUGAS YANG LEBIH KOMPETEN DATANG

DARI SISI PASIEN / PENDERITA

PENDERITA DI TEMUKAN TANDA LEBAM MAYAT(RIGOR MORTIS)
RETURN OF SPONTANEUS CIRCULATION (ROSC) Nadi ( + )

DARI SISI LINGKUNGAN

SITUASI YANG TIDAK MEMUNGKINKAN UNTUK CPR
JIKA SUDAH DILAKUKAN SELAMA 30 MENIT TIDAK RESPON