Sejarah RJP Pelatihan ICU RSF
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Transcript of Sejarah RJP Pelatihan ICU RSF
SEKELUMIT: BANTUAN HIDUP
DASAR
Dr. Vera Irawany, SpAn
HENTI JANTUNG MENDADAK(SUDDEN CARDIAC ARREST)
Amerika (CDC)kematian CAD/thn• 330.000 di luar RS / UGD• 250.000 di luar RSInsidens 0,55 kematian/1000 pop/thn
Eropa (ESC)700.000 kematian/tahun40% Fibrilasi ventrikel
Indonesia (Depkes)Penyebab kematian utama sistem sirkulasi (26,4%)
Courtesy dr George, 2010
Profil Kesehatan Indonesia 2001 Depkes RI 2002
PENYAKIT PENYEBAB KEMATIAN UMUM DI
INDONESIA
16%
18,9%
26,4%
Sistim sirkulasi = henti jantung
Courtesy of Arif Mansjoer
SEJARAH
resusitasi = "resuscitare" = membangunkan lagi
1950-an : resusitasi nafas buatan (Safar & Elam)
1960-an : resusitasi KJL (Kouwenhoven)
1961 : nafas buatan + KJL (Safar)
RJP RJPO
1950
-1960
SAFAR Pengendalian jalan napas
& Pernapasan buatan
KOUWENHOVENKompresi jantung tertutup
1974
American Heart Association Cardiopulmonary Resuscitation (CPR)
1993
International Liaison Committee on Resuscitation
(ILCOR)
History of Modern CPR
6
RESUSITASI MODERN
guidelines
research
research
ANGKA KESELAMATAN ?
10
Tanpa BHD (RJP) kemungkinan korban utk “survive”
berkurang antara 7%-10% /menit
Dengan BHD (RJP) kemungkinan korban utk “survive” berkurang antara 3%-4% /menit sampai
dilakukan defibrilasi
ILCOR = International Liaison Comittee on Resuscitation
1. American Heart Association AHA
2. European Resuscitation Council ERC
3. Heart and Stroke Foundation of Canada HSFC
4. Resuscitation Councils of Southern Africa RCSA
5. Australian Resuscitation Council ARC
6. Resuscitation Councils of Latin America CLAR
7. New Zealand Resuscitation Council NZRC
Circulation 102, 2000 Resuscitation 46, 2000
International Guidelines 2000 Conference on Cardio-pulmonary
Resuscitation and Emergency Cardiovascular Care
BACKGROUNDData2 tentang angka survival
sewaktu keluar RS terhadap korban2 henti jantung karena VF di luar RS yg disaksikan sangat rendah yaitu hanya 6% seluruh dunia. Dengan catatan hanya sedikit perbaikan setelah guideline thn 2000 di keluarkan. Data2 ini dibuat hanya bberapa waktu sebelum dimulainya konferensi CPR ILCOR2005.
Ada 2 penelitian yg dipublukasi sebelum konferensi 2005 menunjukkan buruknya kualitas CPR yg dilakukan baik itu di luar RS atau di dalam RS.
PERUBAHAN UTAMA PADA CPR 2005
✖
✖
Check and assess - “hands-off time” = time without chest
compression reduce survival
100 per menit
Ratio 15:2
“HANDS-OFF” TIME = TIME WITHOUT CHEST COMPRESSION
Repeatedly assessing the patient
Interruption for ventilation
Operator delay for CVP, intubation, changing rescuer
Time taker by AED for analysis• A fall in coronary perfusion pressure• A deterioration in waveform of VF• A decrease of successful outcome after DC shock
Remove check breath and
assess circulationRATIO 30:2
(less ventilation)
AED
In VF SCA, ventilation NOT AS important as compressionsVQ mismatch (need less Vt)Increases intrathoracic pressure
• Decreases venous return• Prevents adequate filling
• DECREASES CARDIAC OUTPUTGastric insufflation
Why 30:2 or less ventilation?
Hyperventilation is bad….
Percobaan 3 kelompok hewan hiperventilasi
Tekanan intra toraks rata-rata
Tekanan perfusi koroner
Aufderheide TP, Sigurdsson G, Pirrallo R, Yannopoulos D, McKnite S, von-Briesen C, et al Hyperventilation-induced hypotension during CPRCirculation. 2004;109:1960-5
Observasi pada penolong terlatih dalam memberikan pernapasan buatan
30 + 3.2Kelompok 3 (n=13)
22 + 3*Kelompok 2 (n=6)
37 + 4*Kelompok 1 (n=7)
Kecepatan ventilasi (napas/menit)
Kelompok pasien yang ditolong
Tidak ada korban yang selamat
Penolong profesional pemberian ventilasi berlebih pada tindakan RJP. Hiperventilasi (pada hewan) tekanan intratorakal meningkat, tekanan perfusi koroner menurun, dan angka ketahanan hidup menurun
22
Early recognition & EMS activation Early CPR
Early defibrilationEarly ALS & post resuscitation
care
RANTAI KESELAMATAN (CHAIN OF SURVIVAL)
WHY AED?WITNESSED VS UNWITNESSED
Witnessed Collapse//Cardiac Arrest • AED first
Unwitnessed arrest• CPR first (2 minutes or 5 cycles), then AED
ETIOLOGY OF SUDDEN CARDIAC ARREST
Nolan J. ERC Guidelines for Resuscitation 2005-introduction. Resuscitation. 2005; 67 (suppl 1):S3-S6
Etiologi• Cardiac (primary)
• Heart attack (MCI)• Kelaianan jantung lain
• Non-Cardiac (secondary)• Internal
• Pneumonia berat, syok, dll• Eksternal
• Trauma, keracunana dll
ETIOLOGY OF SUDDEN CARDIAC ARREST
Nolan J. ERC Guidelines for Resuscitation 2005-introduction. Resuscitation. 2005; 67 (suppl 1):S3-S6
Etiologi
HENTI JANTUNG
100%
Henti jantung/par
u
80%
Penyakit jantung
? %
Henti jantungVT/VF
40%
Saat di EKG:VT/VF
Saat di EKG: asistol
Potensial untuk defibrilasi (AED)
0-4 menit
• Electrical phase
• Th/ Defib
4-10 menit
• Circulatory phase
• Th/ kompresi-ventilasi
• Tujuan: memberi perfusi pada otak dan jantung
> 10 menit
• Th/ hipotermia (32-340C)
• Menurunkan kebutuhan oksigen otak
Fase Henti Jantung(Weisfeldt & Becker)
ELECTRICAL PHASEA E D F I RS T
VF early defibrillation (class I)
Each passing minute decreased survival by 8-10%
Survival rate approaching 50%
Chicago airport study• AED 10/18 VF case survival
Circulation 1997
NEJM 2002
CHICAGO AIRPORTAED within 1 minute anywhere in the airport
Survival approaching 50% (10/18) for VF
AUTOMATED EXTERNAL DEFIBRILLATOR
BANTUAN HIDUP DASAR
1. AKSES DINI (EARLY ACCESS)
2. RJP DINI (EARLY CPR)
3. DEFIBRILASI DINI (EARLY
DEFIBRILLATION)
SAAT INI YANG DIPAKAI..
Guidelines AHA 2010