Basic - General Emergency Life SupportDepart of Anesthesiology and Reanimation

Dr. Soetomo Hospital - Airlangga University

Ventricular Fibrillation and CPR Ventricular Fibrillation and CPR

Aortic pressure (purple)Aortic pressure (purple)

Right atrial pressure (yellow)Right atrial pressure (yellow)

Coronary Perfusion Pressure (Ao diastolic - RA diastolic)Coronary Perfusion Pressure (Ao diastolic - RA diastolic)

Coronary perfusion pressure Coronary perfusion pressure approaches zero within approaches zero within seconds after stopping seconds after stopping

chest compressionschest compressions

42% 58%

Lay persons: 2 rescue breaths interrupted CC for 16 secondsLay persons: 2 rescue breaths interrupted CC for 16 seconds

ACTUALCC/min=ACTUALCC/min=3939±11 ±11 Assar, 2000Assar, 2000

16 secs

Typical lay rescuer 15:2 CPR has circulation Typical lay rescuer 15:2 CPR has circulation less than half the time.less than half the time.

Posisi penolong tegak lurus diatas dada pasien dengan siku lengan lurus menekan tengah-tengahtulang dada ,tekan sedalam 4-5 cm.

Pijat jantung 30 x disusul dg nafas 2 x

100x per menit

Push Hard and Push Fast

Tiupan nafas yang berlebihan berakibat tekanan intra-thoracalmeningkat dan berdampakmenghambat aliran darahyang ditimbulkan akibatpijatan jantung.

Tiupan nafas cukupasal dada mengembang8-10 kali/ menit.

Saat pijat jantung,

Hitung dengan suara keras

Satu,dua,tiga,empat, SATUSatu,dua,tiga,empat, DUASatu,dua,tiga,empat, TIGASatu,dua,tiga.empat, EMPATSatu,dua,tiga,empat, LIMASatu,dua,tiga,empat, ENAM

Total = 30 x pijatan, disela dengan 2 x tiupan nafas

Pijat jantung nafas buatan

30 : 2

A

C

B

Korban tidak sadar

bebaskan jalan nafas

jalan nafas bebastidak bernafas

tidak teraba nadi

Pasang monitor EKG

1.

2.

3.

4.

5.

Call for help

2 x tiupan awalraba nadi carotis

Beri pijatan jantungdan nafas buatan30 pijat + 2 nafas

A.

B.

C.

Awam ( 1,2,4)

raba carotis

tidak adalihat EKG

ada

shockable un-shockable

CPR 30 : 2 2 menit

rosc

pertahankan jl nafas bebastetap beri oksigen

raba arteri radialislihat EKG- ukur tensi nadi

pertahankan infushipotensi : beri inotropik

terapi aritmiakoreksi elektrolit & cairan single shock 360 J

CPR 30:2 (2 menit)

VF / VT

lihat managemen VT / VF

AsistolPEA / EMD

CPR 30 : 2 2 menit

adrenalin

managemen asistol

Observasi di ICUWaspada CA berulang

Adrenaline: 1 mg, iv, repeated every 3-5 minutes

Defibrilation strategy-1

VF / pulseless VT

a single shockBiphasic 150-200 JouleMonophasic 360 Joule

CPR 30 : 2

ROSC

NO

2 MINUTES, 30 : 2

Check ECGCheck pulse

a single shockBiphasic 150-360 JouleMonophasic 360 Joule

AdrenalineCPR 30 : 2

YES

Recovery of Spontaneous Circulation

1).

2).

2 MINUTES, 30 : 2

3).

Defibrilation strategy - 2VF / pulseless VT

ROSC

NO Check ECGCheck pulse

a single shockBiphasic 150-360 JouleMonophasic 360 Joule

AdrenalineCPR 30 : 2

2 MINUTES, 30 : 2

a single shockBiphasic 150-360 JouleMonophasic 360 Joule

CPR 30 : 2

Check ECGCheck pulse

YESNo

YES

2).

3).

2 MINUTES, 30 : 2 Check ECGCheck pulse

Adrenaline: 1 mg, iv, repeated every 3-5

minutes

a single shock1).

ROSC

Defibrilation strategy-3VF / pulseless VT

ROSCa single shockBiphasic 150-360 JouleMonophasic 360 JouleCPR 30 : 2

Check ECGCheck pulse YESNo

3).

Amiodarone 300 mg or Lidocaine 1 mg/kgA single shock Biphasic 150-360 Joule Monophasic 360 JouleCPR 30 : 2

No YESCheck ECGCheck pulse

ROSC4).

2). a single shock

2 MINUTES, 30 : 2

Adrenaline: 1 mg, iv, repeated every 3-5 minutes a single shock

Biphasic 150 – 360 JouleMonophasic 360 JouleCPR 30 : 2 (2minutes)

CPR -1 30 : 2

CALLFORHELP

PASANGMONITOR

VF / VT

a single shocka single shock a single shocka single shock a single shock

2 menit 2 menit

2 menit 2 menit

adrenalinadrenalin

adrenalinCPR-3CPR-2 CPR-5CPR-4

Amiodaron

Adrenaline: 1 mg, iv, repeated every 3-5

minutes

CPR-6

Cardiacarrest

LIDOCAIN. Do not exceed a total dose of 3 mg/kg,during the first hour.

Amiodaron is the first choice300 mg, bolus. Repeated 150 mgfor reccurrent VT/VF. Followed by900 mg infusion over 24 hours

VF/ VT

Intubasi : as soon as possible, without stop CPR Pijat 100x/menitNafas 8x/menit

Evaluasi CPR : tiap 2 menit

DRUGS

• Adrenaline : 1 mg, iv, repeated every 3-5 minutes

• Amiodarone: 300 mg, bolus, if VF/VT persist after 3 shocks. Dose of 150 mg maybe given for

recurrent or refractory VF/VT, followed by an

infusion of 900 mg over 24 hours

• Lidocain : 1 mg/kg, iv, if amiodarone is not available.

Do not exceed a total dose of 3 mg/kg, during the first hour. Do not give lidocaine if amiodarone has

already been given

ILCOR - Guidelines 2005

Asystole (ECG flat)PEA ECG ada gelombang tetapi carotis (-)

|CPR 2 menit

|+Intubasi, iv line,

+adrenalin 1 mg / 3-5 menit|

| |Asystole / PEA ROSC

| |bradycardia normal

atropin 1-1-1 / obat klas IIaCPR 2 menit30 : 2

30 : 2

ASYST 2 menit 2 menit

2 menit 2 menit

• evaluasi• adrenalin

• evaluasi• adrenalin

adrenalin

CPR-3CPR-2 CPR-5CPR-4

Adrenaline: 1 mg, iv, repeated every 3-5

minutes

CPR-6

Cardiacarrest

ASYSTOL/PEA/EMD

Intubasi : as soon as possible, without stop CPR Pijat 100x/menitNafas 8x/menit

Evaluasi CPR : tiap 2 menit

evaluasievaluasi

CPR -1 30 : 2

CALLFORHELP

PASANGMONITOR

?Dr. April Poerwanto Basoeki, SpAnBasic - General Emergency Life Support

Depart of Anesthesiology and ReanimationDr. Soetomo Hospital - Airlangga University