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Dr. Hardi Cahyanta

Belida 1 September 2012

Kenyataan Hidup …Kenyataan Hidup …

……Suatu saat setiap orang akan mati!Suatu saat setiap orang akan mati!

Kematian dini

Peter Safar, MDPeter Safar, MD

Walaupun ilmu kedokteran telah maju …Walaupun ilmu kedokteran telah maju …

Kematian mendadak tetap meningkatKematian mendadak tetap meningkat

350,000

300,000

250,000

200,000

150,000

100,000

50,000

Kem

a tia

n /ta

hun

(U. S

.)

SuddenCardiacArrest

Lung Breast Traffic AIDS/ Cancer Cancer Accidents HIV

PENYEBAB2 KEMATIAN

Stroke

Penyakit atau kecelakaan

Murder

menimbulkanmenimbulkan

MenghasilkanMenghasilkan

sehinggasehingga

OO2 2

BlockedBlockedCoronaryCoronaryArteryArtery

Damaged Damaged HeartHeartMuscleMuscle

The “S-A” NodeThe “S-A” NodeThe heart’s ownThe heart’s own

““pacemaker”pacemaker”

HeartbeatHeartbeatContinuesContinuesto Beatto Beat

Serangan Jantung

Tanda & Gejala(Patient may have one or more…)

• Nyeri dada/ tak nyaman• Merambat ke lengan, leher, rahang• Banyak keringat• Susah bernafas• Ketakutan, bingung, marah• Membantah gejala

tetap bernafas dan nadinya berdenyut …

Serangan Jantung

VentricularVentricularFibrillationFibrillation

ChaoticChaoticQuiveringQuivering

butbut

NO NO HeartbeatHeartbeatNO NO BreathingBreathing

V-fibV-fib

Kematian Mendadak

Gejala Pasien yang mengalami Ventricular Fibrillation

Tidak SadarTidak Sadar Tidak ada denyut jantungTidak ada denyut jantung Tidak bernafasTidak bernafas Tampak sakit parah dan pucatTampak sakit parah dan pucat

Sehingga …Sehingga …

Hidup dan mati -> masalah WAKTU

Tak ada oksigen ke otak dan tubuhTak ada oksigen ke otak dan tubuh

Sedikitoksigen

0 Minutes0 Minutes0 Minutes0 Minutes

Kematian MendadakKematian Mendadak

NoNo OxygenOxygen

10-12 Minutes10-12 Minutes

Kematian OtakKematian Otak

80-90%80-90%Kematian mendadakKematian mendadak

Disebabkan oleh:Disebabkan oleh:

V-fibV-fib

Satu-satunya koreksi untukSatu-satunya koreksi untuk

V-fibV-fib

De-fibDe-fib

Chain of SurvivalChain of Survival

EarlyEarly Early Early Early Early Early Early Access Access CPR Defibrillation Advanced CPR Defibrillation Advanced Care Care

EarlyEarly DefibrillationDefibrillation

© © American Heart AssociationAmerican Heart Association

Surv

ival

Rat

e (p

erce

nt)

Time to Defibrillation (minutes)

00

2020

4040

6060

8080

100100

55 1010 1515 2020 2525 3030

Untuk setiap menit penundaan defibrillasiUntuk setiap menit penundaan defibrillasiPeluang hidup berkurang 10% Peluang hidup berkurang 10%

• CPR (saja) ……………………… 0-2%

• EMS/ER …………………… 5-15%

• CPR+AED…….. 30-75%

Bagaimana jikaSeseorang tiba-tibaMengalami gejalaSerangan jantung?

Berikan bantuan awal

ASA

1 Adult 1 Adult OrOr

4 Baby4 Baby

Hubungi bantuan medis

Jika anda melihat seseorang tak sadarkan diri …

… … anda tidak tahu apakah ituanda tidak tahu apakah itu

Kematian MendadakKematian MendadakAtau sebuahAtau sebuah

Serangan JantungSerangan Jantung

• Audible Audible

• VisualVisual (Graphical Operator Interface)(Graphical Operator Interface)

ANDA MEMERLUKAN AED

• Kenali bahwa seseorang Kenali bahwa seseorang memerlukan bantuan medismemerlukan bantuan medis

• CCheckheck TThehe AArea rea for personal dangersfor personal dangers

Apakah perlu pertolongan?

• Apakah orangnya tak sadar?Apakah orangnya tak sadar?

Are you Are you okay?okay?

• ““Log-roll” patient onto his backLog-roll” patient onto his back on a firm surfaceon a firm surface

……if not already there,if not already there,

minta bantuanminta bantuan

Ambil nafas dalam2, Ambil nafas dalam2, dan pusatkan dan pusatkan

perhatian kepada perhatian kepada energi emosional energi emosional

andaanda

Tetap tenang

Someone should IMMEDIATELYIMMEDIATELY

Call forCall for EMS/Medical Help

Make the Right Call

• Send someone forSend someone for the AED…the AED…

……or if alone, go yourself!or if alone, go yourself!

Compressions

3030

Sementara ada yg mengambilkan AED, Sementara ada yg mengambilkan AED, bila tidak ada nafas dan denyut nadi …bila tidak ada nafas dan denyut nadi …

22 Breaths

Mulailah CPRMulailah CPR

JIKA AED SUDAH ADAJIKA AED SUDAH ADA

Push thePush the““ ON” ON”

ButtonButton

Tetap tenangTetap tenang Are you Are you

okay?okay?

Periksa daya tanggap pasienPeriksa daya tanggap pasien

• Pastikan lagi Pastikan lagi bahwa bahwa

pasiennya tak pasiennya tak sadarsadar

• Be sure someone Be sure someone has called forhas called for

EMS/Medical HelpEMS/Medical Help

Apakah bantuan sudah Apakah bantuan sudah menuju lokasi?menuju lokasi?

• Head Tilt/Chin LiftHead Tilt/Chin Lift• Empty the mouth? Empty the mouth?

Buka Jalan Nafas

• LookLook• ListenListen• FeelFeel

Check Breathing

• Give 2 Slow Give 2 Slow BreathsBreaths (Take a Fresh Breath In (Take a Fresh Breath In Between)Between)

...if none is found ...if none is found

Provide BreathingProvide Breathing

• Check for Neck PulseCheck for Neck Pulse (If skilled to do so) (If skilled to do so)

• Normal Skin Color ??? Normal Skin Color ??? • Coughing Coughing or or

Obvious BreathingObvious Breathing

Examine for

Signs of Circulation

• Don’t Touch Patient During AnalysisDon’t Touch Patient During Analysis

• Stay Clear of Patient During ShocksStay Clear of Patient During Shocks Verbal Command to ClearVerbal Command to Clear Visually Confirm All Are ClearVisually Confirm All Are Clear

AEDAED ONLYONLY Advises TreatmentAdvises Treatment

Deliver one shock If there is aDeliver one shock If there is a

Shockable RhythmShockable Rhythm Push Shock Button No Shock Needed

OpenOpen

Airway

Check forCheck for

Breathing

Signs of Circulation

Whether shocks are delivered or not advised…Whether shocks are delivered or not advised…

If No Signs of Circulation …If No Signs of Circulation …

• Kneel next to patientKneel next to patient• Locate hand positionLocate hand position(on compression depth sensor) (on compression depth sensor)

• Position your body Position your body • Give CPR at rate of 30:2Give CPR at rate of 30:2

22 3030

Resume CPR 2 Mins

You will hear: You will hear: “Good compressions” “Good compressions” or or “Push harder”“Push harder” A Adaptive metronome will help pace you daptive metronome will help pace you

• Maintain AirwayMaintain Airway CChin Lift hin Lift Empty Mouth? Empty Mouth? “ “RecoveryRecovery Position” ?Position” ? Place PASS ??Place PASS ??

• Assist BreathingAssist Breathing• Give Emotional SupportGive Emotional Support

If CPR or Shocks aren’t needed…If CPR or Shocks aren’t needed…

When Breathing & PulseWhen Breathing & PulseDo Not ReturnDo Not Return

• Continue CPRContinue CPR• Follow Voice PromptsFollow Voice Prompts

Rhythm Re-analysisRhythm Re-analysis Repeat Shock(s)Repeat Shock(s)

When Breathing When Breathing && Pulse Return Pulse Return

• AirwayAirway• BreathingBreathing• Circulation Circulation

Be as Be as Efficient & EffectiveEfficient & Effective as Possible as Possible

Support LifeSupport Life

……Until EMS ArrivesUntil EMS Arrives

• Verbal ReportVerbal Report Initial ConditionInitial Condition Care Delivered Care Delivered (including # of shocks) (including # of shocks) Estimated “Down Time”Estimated “Down Time” Any Changes in Patient’s ConditionAny Changes in Patient’s Condition Any available Medical HistoryAny available Medical History

Transfer of Care

• Cooperate Cooperate and and AssistAssist (as necessary & requested) (as necessary & requested)

Additional FactorsAdditional FactorsWhen using an AEDWhen using an AED

Sensitivity to FamilySensitivity to Family Crowd ControlCrowd Control Periods of “Inactivity”Periods of “Inactivity” Talk to the PatientTalk to the Patient

When Not to Use an AEDWhen Not to Use an AED Patient is less than 8 yrs of agePatient is less than 8 yrs of age Patient is under 80 poundsPatient is under 80 pounds Explosive environmentExplosive environment Patient is Patient is immersedimmersed in water in water Following serious traumaFollowing serious trauma

Returning to AED ReadinessReturning to AED Readiness

Clean AreaClean Area Clean AED PlusClean AED Plus Replace Batteries Replace Batteries (if necessary)(if necessary)

Replace CPR-D PadzReplace CPR-D Padz Repack & Restore Unit Repack & Restore Unit

LogisticsLogistics