BASIC & ADVANCE CPR

Basic Life Support

• Tindakan pertolongan medis sederhana 
pasien henti jantung sebelum pertolongan
medis lanjutan
• RJP dini dan defibrilasi dini  tanpa bantuan
ventilasi dan obat
• Tujuan  mengembalikan oksigenasi,
ventilasi, dan sirkulasi  henti jantung
teratasi atau pasien dinyatakan meninggal
• Indikasi :
– Henti jantung
– Henti nafas
– Tak sadarkan diri
 Basic Life Support
• Komponen yang harus dikuasai :
– Menilai keadaan pasien
– Teknik penilaian pernafasan dan pemberian
ventilasi buatan yang baik dan benar
– Teknik kompresi dada dan frekuensi yang adekuat
– Penggunaan Automated External Defibrillator
(AED)
– Teknik mengeluarkan obstruksi jalan nafas karena
sumbatan benda asing  oleh penolong pertama
 Basic Life Support
• Harapan dengan dilakukannya BLS :
– Henti jantung dapat dicegah dan transportasi
dapat cepat dilaksanakan
– Fungsi jantung paru dapat diperbaiki dengan AED
dan kompresi
– Otak dapat dijaga dengan baik
 Rantai kelangsungan hidup
berdasarkan rekomendasi American Heart Association

Komponen Rantai Kelangsungan Hidup

Early Access Pengenalan kejadian henti hantung dan aktivasi sistem gawat
darurat segera
Early CPR Resusitasi jantung paru segera
Early Defibrillation Defibrilasi segera
Effective ACLS Perawatan kardiovaskuler lanjutan yang efektif
Integrated post Penanganan pasca henti jantung yang terintegrasi
cardiac arrest care
 Langkah awal Basic Life Support
• Penilaian respon
– Lakukan dengan menepuk atau menggoyangkan
badan penderita
– Bila ada respon  pertahankan posisi atau
usahakan dalam posisi yang mantap  sambil
tetap pantau tanda vital
– Bila no respon, tak bernafas atau gasping 
dianggap mengalami kejadian henti jantung  call
for help
 Unresponsive
No breathing or gasping

Activate emergency
response
Get defibrillator
Start CPR
Push Hard – Push Fast

Check
Basic Life rhythm/shock
Repeat every 2 minutes
Support
technique
 Teknik Basic Life Support
Periksa Tindakan

Periksa denyut a. carotis

•Fungsi : memastikan tidak terabanya nadi saat dilakukan pertolongan
•Pegang leher pasien dan cari trakea dengan 2-3 jari
•Raba kearah lateral dan temukan batas trakea dengan otot samping leher
(tempat a. carotis)
•Maksimal pemeriksaan : 10 detik

Kompresi dada
Circulation •Fungsi : menciptakan aliran darah melalui tekanan intratorakal dan
penekanan langsung pada dinding jantung
•Pasien dibaringkan di tempat yang datar dan keras
•Lokasi : di bagiah bawah sternum, 2 jari diatas prosesus xiphoideus
•Cara : telapak tangan saling berkaitan, dalam keadaan bertelut
•Frekuensi : minimal 100x/menit tanpa interupsi dilanjutkan kompresi
dengan ventilasi (30 : 2)
•Kedalaman : ±5cm (dewasa) atau 4cm (bayi)
•Evaluasi : periksa denyut a. carotis setelah 5x siklus kompresi
 Teknik Basic Life Support
Periksa Tindakan
*Airway and Breathing (ventilasi)*
Buka jalan nafas dengan metode :
Airway •Head tilt chin lift  untuk pasien non trauma cervical dan leher
•Jaw thrust  untuk pasien dengan trauma cervical dan leher
Breathing Memberikan nafas bantuan (2x dalam 1 detik setiap tiupan) setelah 1x siklus
kompresi (30x kompresi)
Berikan sesuai kapasitas volume tidal  lihat pengangkatan dinding dada
Metode :
-Mulut ke mulut
-Mulut ke hidung
-Mulut ke sungkup
-Dengan kantung pernafasan
Evaluasi : raba a. carotis  bila teraba : jaga airway tetap terbuka dan posisikan
dalam recovery position
Defibrillation Bisa menggunakan defibrillator manual atau AED
•Untuk dewasa dengan VF/TV : th/ kejut listrik (monofasik : 360J atau bifasik :
200J)
•Untuk anak  th/ kejut listrik : dosis 2-4 J/kg, dosis ulangan 4-10 J/kg
•Untuk neonatus : manual defibrillator
•Tidak diindikasikan pada pasien asistole atau PEA
 Komplikasi Basic Life Support
• Aspirasi regurgitasi
• Fraktur costae-sternum
• Pneumothorax, hematothorax, contusio paru
• Laserasi hati atau limpa
BASIC LIFE
SUPPORT
• When someone is found unresponsive, the following
should be performed rapidly and in sequence:
1. Assess responsiveness. If unresponsive, then
2. Obtain assistance and activate the local emergency
medical service system
3. Call for a defibrillator (if available).
4. Position the patient and open the airway (maintain
cervical spine immobilization if trauma is potentially
involved).
5. Assess breathing. If no breathing is noted, then
6. Give two slow breaths.
7. Assess circulation. If no pulse noted, then
8. Begin closed-chest compressions and continue
ventilations. Use the defibrillator if available and
indicated.
1. Assess Circulation and Initiate Compressions
– The carotid artery is generally the most reliable and
accessible location to palpate a pulse
– Simultaneous palpation of both carotid arteries
should not be performed because in low-pressure
states this could obstruct cerebral blood flow and may
interfere with the ability to detect a pulse
– The femoral artery may be used as an alternative site
to palpate a pulse
– If no pulse is felt after 5 to 10 s, chest compressions
should begin.
• Chest Compression
– The victim is placed supine on a firm surface with the
rescuer at the side
– The care provider places the heel of one hand midline
on the lower half of the sternum, approximately 2 in.
(5 cm) cephalad of the xiphoid process
– The heel of the hand should be parallel with the long
axis of the patient's body
– The second hand is then placed on top of the first
hand so the hands are parallel with each other
– The fingers of the two hands may be interlaced if
desired, but they should not be touching the chest
– The arms should be straight and the elbows preferably
locked
– The sternum should be depressed 1 ½ to 2 in. (3.8 to
5.1 cm) in an adult at a rate of approximately 100
compressions per min
2. Open the airway
– Requires positioning the
individual supine on a flat,
firm surface with arms
along the sides of the
body, followed by opening
the person's airway
– After positioning the
patient, the mouth and
oropharynx should be
inspected for secretions or
foreign objects
– 2 basic maneuvers: head
tilt–chin lift and jaw thrust
3. Assess Breathing and Initiate Ventilation
– Should look for chest expansions and listen and
feel for airflow
– Two slow breaths over 2 s each should be given
– At this point, if a foreign body obstruction is
noted, as indicated by a lack of chest rise or
airflow on ventilation, the obstruction requires
removal
– Use a ratio of 15 chest compressions to 2
ventilations (15:2)
ADULT ADVANCED LIFE SUPPORT
 Advanced Cardiac Life Support
Periksa Tindakan
Airway Lakukan intubasi dan pemasangan ETT, LMA atau Combitube
Pemasangan sebaiknya dilakukan dalam 30 detik, kalau tak
berhasil  ventilasi dengan kantung nafas-sunngkup muka
Breathing Setelah pemasangan ETT, kembangkan balon
Pastikan ETT masuk ke thorax
Periksa 5 point : paru basis anterior kanan kiri, di apex pada
mid axillaris kanan-kiri, dan perut
Circulation Nilai keadaan sirkulasi (irama jantung, frekuensi nadi,
tekanan darah)
Pasang jalur IV di V. ante cubital, berikan bolus 20-30cc
cairan sebagai pendorong
Differential diagnose Cari tahu penyebab dan berikan tata laksana
 Penting diperhatikan !
• Hipovolemia • Toxin
• Hipoksia • Tamponade cardiac
• Hidrogen acidosis • Tension pneumothorax
• Hipo/hiperkalemi • Thrombosis
• Hipoglikemi coroner/pulmonary
• Hipotermia • Trauma
 AEDs (Automatic External
Defibrillators)
• Shock advisory defibrillators
– analyze the patient's rhythm by computer
algorithm
– determines if the rhythm meets defibrillation
criteria
– informs the operator that a shock is advised
• Designed only to shock ventricular fibrillation
and very fast ventricular or supraventricular
tachycardias (usually over 180 beats/min).
 INTUBATION
• CRITERIA:
1. Failure to maintain or protect the airway
2. Failure of ventilation or oxygenation
3. Anticipated clinical course (antidepressant overdose,
coma,seizure, etc)
• Identification of the difficult airway
Difficult Direct Laryngoscopy (LEMON)
Look externally for signs of difficult intubation
Evaluate the “3-3-2 rule”
Mallampati
Obstruction/Obsesity
Neck mobility
“3-3-2 rule”
Mallampati Scale
• Measurement of Intubation Difficulty
Laryngoscopy grading:
– Grade I: the entire glottic aperture is seen 
100% success
– Grade II: only a portion of the glottis is seen
(arytenoid cartilages alone (2b) 67% failure or
plus part of the vocal cord(2a) 4% failure)
– Grade III: only the epiglottis  extreme intubation
difficulty
– Grade IV: not even the epiglottis is visible 
impossible intubation
• Confirmation of ETT Placement
1. Colorimetric ETCO2 (End-Tidal carbon dioxide)
2. Aspiration technique
3. Chest radiography
• Methods of Intubation
1. Rapid Sequence Intubation (RSI)
7 “Ps” of RSI
– Preparation
– Preoxygenation
– Pretreatment
– Paralysis with induction
– Positioning
– Placement of tube
– Postintubation management
2. Blind Nasotracheal Blindness
3. Awake Oral Intubation
4. Oral Intubation without Pharmacologic
Agents
5. Laryngeal Mask Airway (LMA)
6. Esophagotracheal Combitube
7. Surgical Airway Management 
Cricothyrotomy
 PHARMACOLOGIC AGENTS
1. Neuromuscular Blocking Agents
• Succinylcholine
– Rapidly active, typically producing intubating
conditions within 60 s of rapid IV bolus injection
– Duration of action: 6-10 min
– Full recovery: 15 min
– ES: cardiovascular (bradycardia, VF, asystole),
fasciculation, hyperkalemia, increased TIO,
masseter spasm, malignant hyperthermia
2. Competitive Agents 3. Induction Agents
• Aminosteroid agents • Etomidate
– Pancuronium • Barbiturate
– Vecuronium • Benzodiazepine
– Rocuronium  best
agent for use when
• Ketamine
succinylcholine is
contraindicated
Goal-directed
postresuscitation
algorithm