rps - bls (dr. bindo)

7/21/2019 RPS - BLS (Dr. Bindo)

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ADULT CARDIOPULMONARY

RESUSCITATION

INDRIANTO, dr.,SpAn.KICBagian Anestesiologi & Reanimasi

RSUD AL IHSAN BANDUN


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CLINICAL DEATH apatient is !lini!all" dead t#emoment $reat#ing stops andt#e #eart stops $eating.

BIOLOGICAL DEATH i% apatient is not $reat#ing andt#e #eart is not !ir!lating

o'"genated $lood, potentiall"let#al !#anges $egin to ta(epla!e in t#e $rain )it#in 4 to6 minutes. Biologi!al deat#o!!rs )#en t#e patient*s

$rain !ells die. Usually, $rain!ell deat# $egins )it#in 10minutes a%ter t#e #eart stops$eating +t#is !an $e dela"ed$" !old temperatres, see p.

-/. 0o ma" $e a$le to


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Respiratory System Anatomy

Te ma!or str"#t"res o$ te air%ay in#&"'e2 NOSE3 t#e primar" pat#)a" %or air to enter and lea1e

t#e s"stem.

MOUTH3 t#e se!ondar" pat#)a" %or air.

PHARYN( 3 t#e t#roat. T#e !ommon passage)a" %or

air and %ood. LARYN( 3 t#e ne!( str!tre t#at !onne!ts t#e

p#ar"n' and t#e tra!#ea.

TRACHEA3 t#e )indpipe.

BRONCHIALTREE3 $ran!#ing %rom t#e tra!#ea to t#e

mi!ros!opi! air sa!s o% t#e lngs. T#e 4rst $ran!#es aret#e rig#t and le%t main stem +primar"/ )ron#i. T#ese$ran!# into se!ondar" $ron!#i. T#e smaller $ran!#es!oming o5 t#e se!ondar" $ron!#i are !alled t#e)ron#io&es

LUNGS3 t#e spong", elasti! organs !ontaining a&*eo&i,t#e mi!ros!o i! air sa!s )#ere o' en and !ar$on


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Respiratory +"n#tion

automatic function

Involuntary

a"tomati#a&&y a'!"st terate, 'ept, an' rytm o$)reatin-

inter#osta& m"s#&es inspiration

e.piration


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Co&&apse

Remo1e %rom immediatedanger +$rning $ilding,

et!./

C#e!( %orresponsi1eness

Call %or #elp

Air)a"Clear

Open

Assess $reat#ing

Coma position !#e!(plse, B6, re1ie)

$reat#ing

6ro1ide $reat#ing+7AR/ 8 slo)

$reat#s

Assess !ir!lation

Contine 7ARreglarl" assess plse

6ro1ide 7CC at9::;min

Contine at 9


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RESPIRATORY+AILURE

Simpl" stated, respiratory$ai&"re is eit#er t#e !essationo% normal $reat#ing or t#ered!tion o% $reat#ing to t#epoint )#ere o'"gen inta(e is

not s?!ient to spport li%e.@#en $reat#ing stops!ompletel", t#e patient is inrespiratory arrest0

Respirator" arrest !ande1elop dring #eart atta!(,

stro(e, air)a" o$str!tion,dro)ning, ele!tro!tion, drgo1erdose, poisoning, $rainin>r", se1ere !#est in>r",s5o!ation, and prolongedrespirator" %ailre.

To determine t#e Signs o%normal $reat#ing, "o s#old2

LOO1%or t#e e1en +$ilateral/rise and %all o% t#e !#estasso!iated )it# $reat#ing.

LISTEN%or air entering andlea1ing t#e nose or mot#.T#e sonds s#old $e t"pi!al,%ree o% grgling, gasping,!ro)ing, and )#eeing.

+EEL%or air mo1ing ot o% t#enose or mot#.

CHEC1%or t"pi!al s(in!oloration. T#ere s#old $e no$le or gra" !olorations.

NOTEt#at t#e rate and dept#

o% $reat#ing s#old $e t"pi!al%or a person at rest

DIAGNOSTICSIGNS


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Unsal $reat#ing sonds. Listen %or2Snoring3pro$a$l" !ased $" t#e tonge o$str!tingt#e p#ar"n'. Gurgling3o%ten de to a %oreign o$>e!tor $lood and ot#er ids in t#e tra!#ea. Crowing3pro$a$l" !ased $" spasms in t#e lar"n'.

Wheezing3t#is ma" not indi!ate an" ma>orpro$lems along t#e air)a". Ho)e1er, )#eeings#old not $e treated lig#tl" sin!e it ma" $e de toserios edema or spasms along t#e air)a".

S(in dis!oloration. T#e patient is $reat#ing, $tt#ere is a noti!ea$le $le or $legra" !olor to t#es(in, lips, tonge, 4ngernail $eds, or ear lo$es. T#isis re!orded as !"anosis, and t#e patient is said to $e

!"anoti!.*

Si-ns o$ Partia& Air%ayO)str"#tion


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PULMONARYRESUSCITATION

Openin- te Air%ay Hea'2Ti&t Mane"*er

Hea'2Ti&t, Cin2Li$tMane"*er

3a%2Tr"st Mane"*er


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SINS O INAD7EUAT7BR7ATHIN

C#est mo1ements are a$sent, minimal, or ne1en.

=o1ements asso!iated )it# $reat#ing are limited to t#e a$domen+a$dominal $reat#ing/.

T#e se o% ne!( ms!les dring respirations.

No air !an $e %elt or #eard at t#e nose or mot#, or e'!#ange ise1alated as $elo) normal.

Breat#ing is nois".

T#e $reat#ing rate is too rapid or too slo)

Breat#ing is 1er" s#allo) or 1er" deep andla$ored.

T#e patient*s s(in is $le or gra". T#is is !alled #yanosis.

Inspirations are prolonged +possi$le pper air)a" o$str!tion/ ore'pirations are prolonged +possi$le lo)er air)a" o$str!tion/.

T#e patient is na$le to spea( or !annot spea( in a normal %as#ion


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RESCUE BREATHINGMo"t2to2Mo"t

4enti&ation6rimaril", t#is pro!edre is sed )#en t#epatient is in respiratory arrest, t#at is, )#en#e is no longer $reat#ing. T#e pro!edre ma"$e sed )#en a patient*s respirator" rate ordept# is not s?!ient to sstain li%eIMPORTANT5 or arti4!ial respirations

pro1ided to t#e adlt patient, "o mst deli1er$reat#s F to t#e patient at one e*ery 6se#on's to gi1e a rate o% 78 )reats permin"te0 To #elp esta$lis# t#is rate, !ont,GOne, one t#osand t)o, one t#osand t#ree,one t#osand %or, one t#osand 41e, onet#osand.

adequately ventilating t#epatient i% "o2 SEEt#e !#est rise and %all. HEARand 77L air lea1ing t#e patient*s lngs. +EELresistan!e to "or 1entilations as t#e

patient*s lngs e'pand.


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NON2IN4ASI4E TECHNI9UES BAG MAS1 4ENTILATION

ORO2 AND NASOPHARYNGEALAIR:AYS

LARYNGEAL MAS1 AIR:AY ;LMA an'Leane2

a/ rade I2 !omplete glottis is 1isi$le

$/ rade II anterior glottis is not 1isi$le!/ rade III2 epiglottis $t not glottis is 1isi$le


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UPPER AIR:AY OBSTRUCTIONClini!al !onditions asso!iated )it#a!te pper air)a" o$str!tion+"n#tiona& #a"ses

Central nervous s"stemdepression

Head in>r", !ere$ro1as!lara!!ident, !ardiorespirator"arrest, siio!(, #"po'ia, drgo1erdose, meta$oli!en!ep#alopat#ies

Peripheral nervous s"stem anneuromus!ular a"normalities

Re!rrent lar"ngeal ner1e pals"+postoperati1e, inammator" or

tmor in4ltration/, o$str!ti1esleep apnoea, lar"ngospasm,m"ast#enia gra1is, illainBarre pol"neritis,#"po!at!aemi! 1o!al !ordspasm

Me#ani#a& #a"sesForeign body aspiration

Laryngeal oedemaAllergi! lar"ngeal oedema,angiotensin !on1erting en"me

in#i$itor asso!iated, #ereditar"angioedema, a!ired CI esterasede4!ien!"

Haemorrhage and haematoma6ostoperati1e, anti!oaglationt#erap", in#erited or a!ired!oaglation %a!tor de4!ien!" ,

TraumaBurns

In#alational t#ermal in>r",inger.tion o% to'i! !#emi!al and

!asti! agentsNeoplasm6#ar"ngeal, lar"ngeal andtra!#eo$ron!#ial !ar!inoma, 1o!al!ord pol"posis

Congenital

Mas!lar rings, lar"ngeal )e$s,lar"ngo!ele


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IN4ASI4E TECHNI9UES

En'otra#ea& Int")ation Dire#t Laryn-os#opy

Sty&et G"i'e ;Intro'"#erasi Mana!emen 3a&an Napas

T>an mana>emen >alan napas adala# patensi danprote(si dengan memasang 7TT dalam tra(ea denganmengem$ang(an !u# dan di#$ng(an dengan sm$erO8. Tinda(an int$asi sering (ali men"e$a$(an

(ompli(asi dan tergantng dari $er$agai %a(tor. Ada alan napas 2

agal 1entilasi ata o(sigenasi

Ketida(mampan memperta#an(an ata melindngi>alan napas

Tim$ln"a ganggan "ang dise$a$(an ole# pen"a(itpasien

$elivery o% treatment

Keamanan dan perlindngan pasien +patient sa%et"

and prote!tion/


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Mana!emen !a&an napas

Immediate crash intubation

6asien dengan #enti napas "ang mem$t#(an int$asi segera tanpamedi(asi tam$a#an. Kentngan tinda(an ini se!ara te(ni( mda# dan!epat. Kergiann"a dapat mening(at(an te(anan intra(ranial a(i$at stresint$asi, mnta# dan aspirasi.

!apid sequence intubation

&api se'uen!e intu"ation +RSI/ adala# serang(aian lang(a# tinda(an

int$asi tanpa 1entilasi BM=. Se$agian $esar pasien "ang dila((anint$asi darrat tida( dalam (eadaan pasa dan dengan lam$ng terisi,

se#ingga pema(aian BM= mng(in dapat men"e$a$(an distensi a$domendan mening(at(an risi(o aspirasi. Unt( men!ega# (ompli(asi pertama(ali dila((an pem$erian O8 9:: agar O8 terpen#i selama periode

apnea. Selan>tn"a dila((an ind(si dan pem$erian pelmp# otot (er>a!epat agar pasien tida( sadar dan paralisis. Lal pasien diint$asi tanpa$antan 1entilasi BM=. Agar le$i# mda# diingat, lang(a#lang(a# RSI

dising(at dengan 6


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lang(a# 6 &api se'uen!e

intu"ation

Time A!tion

: 9: mintes 6ossi$ilit" o% s!!ess

: 9: mintes 6reparation

: < mintes 6reo'"genation: mintes 6retreatment

Time ero 6aral"sis +)it# ind!tion/

: P 8: :

se!onds

6rote!tion and positioning

: P < se!onds 6la!ement

: P < se!onds 6roo%

: P 9 minte 6ostint$ation management


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9 8

Primary S"r*ey


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REPOSITIONING


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7STABLISH UNR7S6ONSIM7N7SS3Ist#e patient responsi1eQ entl" s#a(e t#e pa

tient*s s#older and s#ot, GAR7 0OUOKA0QG 6atients reiring immediate C6R)ill $e nresponsi1e.

NOT72 I% "o are )or(ing $" "orsel%, !all ot %or #elp i% t#e patient isnresponsi1e.

R76OSITION TH7 6ATI7NT +see C#apter /, i% ne!essar".

7STABLISH AN O67N AIR@A03T#is s#old $e done $" t#e #eadtilt, !#inli%t, or >a)t#rst mane1ers. Usall" at t#is time, "o !an easil" !#e!( tosee i% t#e patient is a ne!( $reat#er.

CH7CK OR BR7ATHIN3Use t#e LOOK, LIST7N, and 77L met#od, ta(ing to < se!onds to determine i% t#e patient is $reat#ing. A patient )#o is

$reat#ing does not need immediate C6R. I% t#e patient is in respirator"arrest, "o s#old . . .

D7LIM7R T@O BR7ATHS3Use res!e $reat#ing te!#nies. Allo) %ordeation $et)een $reat#s. I% "o note an pper air)a" o$str!tion, $egint#e te!#nies sed to !lear t#e air)a". I% t#e patient*s air)a" is !learand #e is still in respirator" arrest a%ter "o #a1e pro1ided t)o

$reat#s . . .

Te Te#ni="es o$ CPR

Te CPR


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Te CPRCompression Site


23/38

Compression an' 4enti&ations

COMPRESSIONS a rate o% -: to9:: per minte, pro1iding 9

e1er" 9 to 9.< se!onds.

ONE RESCUER CPR


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ONE RESCUER CPR


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26/38

E?e#ti*e CPR

6pils !onstri!t.

S(in !olor impro1es.

Heart$eat retrnsspontaneosl".

Spontaneos, gaspingrespirations.

Arms and legs mo1e.

Attempts are made tos)allo).

Cons!iosnessretrns.

Spontaneos !ir!lationo!!rs .. t#en pro1idearti4!ial respiration asneeded.

Spontaneos !ir!lation

and $reat#ing o!!r. Anot#er trained res!er!an ta(e o1er %or "o.

0o trn !are o% t#e

patient o1er to ap#"si!ian or a medi!al%a!ilit".

0o are too e'#astedand !annot !ontine.

On#e yo" a*e Starte' CPR,yo"y m"st #ontin"e to

pro*i'e CPR "nti&5


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Comp&i#ation o$ CPR


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T:O RESCUER CPR

C S


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CPR SUMMARY

e# n ="es


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7sta$lis# nresponsi1eness.

Corre!tl" position t#e patient. Open t#e air)a" +#eadtilt,

!#inli%t, or >a)t#rst/.

7sta$lis# respirator" arrest +to < se!onds/.

6ro1ide arti4!ial 1entilationsand !lear t#e air)a", i%ne!essar".

7sta$lis# t#e la!( o% plse in 35

Ue output (ml,) >30 20-30 5-15 #e'l'ble

.et!l evous

s+stem,met!l st!tus

/l'tl+

!ous

ldl+

!ous

ous

oused

.oused

let!'

lud epl!emet +st!llod +st!llod.+st!llod !d

blood

.+st!llod !d

blood

Ameri#an Co&&e-e o$ S"r-eons A'*an#e' Tra"maLi$e S"pport ;ATLS< #&assi@#ation o$ )&oo' &oss)ase' on initia& patient presentation

A i C && $ S A' ' T


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Ameri#an Co&&e-e o$ S"r-eons A'*an#e' Tra"maU$e S"pport ;ATLS< responses to initia& /"i'res"s#itation

Rapidresponse Transient response

Minimal or

noresponse

6t!l s'setu toom!l

!set mpovemet euee odee!sed blood pessue !d

e!sed e!t

em!!bom!l

8stm!ted blood

loss

m!l

(10%-20%) ode!te !d o'o' (20%-40%)

/evee

(>40%)

teed o moe+st!llod

9o: &' &'

#eed o blood 9o: ode!te to ' ;mmed!te

Blood

pep!!to

+pe !d

ossm!t +pe-spe

8me'e+

blood ele!se

#eed oope!tve

tevetoPossbl+ 9


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TERIMA1ASIH

rps - bls (dr. bindo)

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