ilcor adult bls_cd
DESCRIPTION
ILCOR dewasaTRANSCRIPT
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