CODE BLUE

up date on CPR

Guidelines 2015
April Poerwanto Basoeki
Depart. of Anesthesiology and Reanimation of Dr. Soetomo Hospital
School of Medicine of Airlangga University Surabaya

Peraturan Perumahsakitan
Akeditasi KARS, JCI

Semua petugas (medis, non medis) Rumah Sakit,

wajib mengerti dan mampu melakukan
pertolongan awal bila ada seseorang mendadak
tidak sadar

BASIC LIFE SUPPORT

Bantuan hidup dasar

Code Blue

Merriam-Webster's Medical Dictionary

Function: noun
often capitalized C&B :

1. A declaration of or a state of medical emergency and call

for medical personnel and equipment to attempt and
resuscitate a patient especially when in cardiac arrest or
respiratory distress.

Merriam-Webster's Medical Dictionary, 2002 Merriam-Webster, Inc.

Pernyataan kondisi gawat darurat medis dan panggilan minta

bantuan medis dan peralatanuntuk membantu korban henti jantung
atau gawat nafas

Code Blue

often initial capital letters

3 dictionary results for: code blue
Dictionary.com Unabridged (v 1.1)

2. A medical emergency in which paramedics

are dispatched to aid a person undergoing cardiac
arrest.

Kegawatdaruratan medis dimana paramedis dituntut untuk menolong korban

yang mengalami henti jantung
Dictionary.com Unabridged (v 1.1)
Based on the Random House Unabridged Dictionary,
Random House, Inc. 2006.

American Heritage Dictionary

3. A medical emergency in which a team of medical

personnel work to revive an individual in cardiac
arrest.
Kegawatdaruratan medis dimana tim medis
dituntut menyelamatkan pasien henti jantung

The American Heritage Dictionary of the English Language, Fourth Edition

Copyright 2006 by Houghton Mifflin Company.
Published by Houghton Mifflin Company. All rights reserved.

Jantung mendadak berhenti

dapat terjadi:

Kapan saja
Dimana saja
Mengenai siapa saja
Siapapun dapat menolong

Life support for everyone ....

Life support by everyone ....
1999 di Amerika: kematian 460.000 dari total 728.743 C.Arrest setahun
36% terjadi didalam Rumah Sakit (in-hospital CA),
64% terjadi di luar Rumah Sakit (out-of-hospital CA)

(Geocadin et 2008)

Cardiac Arrest

= jantung berhenti

Out-of-hospital Cardiac Arrest = kejadian diluar RS

In-hospital Cardiac Arrest

= kejadian didalam RS

in-patient CARDIAC ARREST :

kejadian DIDALAM, di- ruang tindakan atau di- bangsal

out-patient CARDIAC ARREST :

MEDIK
NON MEDIK

kejadian DILUAR ruang tindakan atau diluar bangsal

BLS - BASIC LIFE SUPPORT

Alur

Contoh:
RSUD dr. Soetomo

Kejadian

Code Blue CSystem

Tim / personil NON MEDIS

= Petugas Tata Usaha/ admin

= Petugas Security
= Petugas cleaning service

Tim Code Blue Lokal

= Petugas Kes. terlatih

Tim Advanced Code Blue

= Petugas terlatih
= Ada Dokter Ahli
= ada defibr , alat
emergency lengkap

Cardiac Arrest

Korban roboh tidak sadar

Siapapun yang paling dekat dengan korban melakukan

pertolongan, melakukan BLS dan Call for help
Teriakkan Code Blue..!!!!!!!
Petugas kesehatan tempat kejadian melanjutkan bantuan,
Melanjutkan BLS.
Call for help - teriakkan Code Blue

Tim Code Blue terdekat datang

melanjutkan bantuan. BLS - ALS
Jantung berdenyut
ROSC

Jantung TIDAK berdenyut

Tidak ROSC

transportasi
ke - ICU

IKK
7

Contoh:
RSUD dr. Soetomo

Code Blue Team

Code Blue System

Center & Sub-center

PED
IRJ
IRNA

GPDT

Zal-A

IRD
GBPT

ICU
RR
GRIU

CODE BLUE CENTER

Rescuers:
Local Non-medic team
Local medic team = Local Code Blue team
ADVANCED team = Advanced Code Blue team

Langkah bila terjadi

CODE BLUE

1. Penolong pertama datang

teriakkan CODE BLUE !!
2. Lakukan BLS s/d
Tim Bantuan datang

Area-I

Poli/ R. KONSULTASI ANESTESI

Area-II

IRD RUANG RESUSITASI

RES Tilp. 1234

Area-III

RUANG RECOVERY GBPT- L3

Area-IV

ICU GBPT L2 / IRIR

Tilp. 1823 & 1876

Area-V

BEDAH A
Tilp. 1307

Minta bantuan
AREA MANA
YANG TERDEKAT?

GPDT LT - 1 Tilp. 3118

CENTER
CODE BLUE

RR Tilp. 1831 & 1832

Area-VI

POLI KARDIOLOGI
IRJ Tilp. .1453

Area-VII

UPI - IRNA ANAK

Tilp. 1683

Area-VIII

GRAHA AMERTA Lt-3

Tilp. 501245 & 5012903

GBPT

SUB-CENTER
CODE BLUE

Pin dan Poster untuk sosialisasi

Poster dipasang di-dinding@ RSUD dr.Soetomo

Consensus Guidelines

The major contributor for ILCOR

Resuscitation Council of
Southern Africa (RCSA)

Inter American Heart Foundation

(IAHF)

Resuscitation Council of ASIA

(RCA)

NEW Guidelines 2015

CARDIO PULMONARY RESUSCITATION

Since 2000, researchers from the ILCOR member councils have evaluated

resuscitation science in 5-yearly cycles.

The most recent International Consensus Conference was held in Dallas in
February 2015 and the published conclusions and recommendations from
this process form the basis of these ERC Guidelines 2015.

New Guidelines 2015

~ Guidelines 2010

Key Points

Adult basic life support (BLS):

1. Bystanders should initiate compression-only CPR.
2. Compression rate should be 100120 per minute (updated from
at least 100 per minute).
3. Compression depth should be 22.4 inches (upper limit added).
4. Compression time should be maximized.
5. Social media may be used to summon rescuers to perform CPR.

Chest Compression-Only CPR

The AHA recommends that anyone who sees an adult suddenly collapse
should call 911 and push hard and fast on the center of the chest,
a technique known as Hands-Only CPR.
2015 AHA

Treatment Recommendation
Chest compressions alone are recommended for untrained
laypersons
Professional rescuers should provide chest compressions
with ventilations for cardiac arrest victims
Performing chest compressions alone is reasonable for
trained laypersons if they are incapable of delivering
airway and breathing maneuvers
2010 ILCOR

ERC AHA - ILCOR

ERC Guidelines 2015

AHA Guidelines 2015

Since 2010 The 2010 Guidelines
were most notable for the
re-orientation of the universal
sequence from

A-B-C (Airway, Breathing,

Compressions) to C-A-B

(Compressions, Airway,
Breathing) to minimize time
to initiation of chest compressions.
HEAD TILT CHIN LIFT

"Look, Listen, and Feel" is no

longer recommended

ERC 2015 = ILCOR 2015

"Look, Listen, and Feel"
is recommended

ERC Guidelines 2015

HEAD TILT CHIN LIFT

LOOK LISTEN FEEL

ILCOR 2010

3 5 seconds

Kapan pijat jantung harus segera dilakukan??

Bila mendadak tidak sadar dan tidak bernafas
atau
Mendadak tidak sadar, nafas ter-sengal2 (gasping)
Treatment Recommendation
It is reasonable that lay rescuers and healthcare professionals use the combination
of unresponsiveness and absent or abnormal breathing to identify cardiac arrest.
Palpation of the pulse as the sole indicator of the presence or absence of cardiac
arrest is unreliable.
Agonal gasps are common during cardiac arrest and should not be considered
normal breathing.
2010 ILCOR
April_Surabaya

Sel otak : normal

reversible injury irreversible injury

4-6

menit

19

Push hard and fast but not too hard or too fast!

Pijat dibagian tengah dada

(setengah bagian bawah tulang dada)

Dengan berat badan penolong,

agar tulang dada tertekan 5-6 cm

BLS - awam

100-120x per menit

Mendadak tidak sadar ...??

Tidak bernapas ...??
Pijat jantung saja ....
sampai bantuan datang atau
korban sudah mulai
bergerak2 sebagai tanda
adanya kehidupan

5-6 cm

Korban mendadak roboh

Code Blue

Kepala di-tengadahkan
Bila ternyata tidak sadar & tidak bernafas
segera lakukan pijat jatung dan
berteriak minta tolong .....Code Blue
Pijat jantung dan teruskan .......
sampai bantuan tim medis datang
Pijat ditulang dada bagian bawah
Kecepatan pijatan 100-120 x/ menit

Perhatikan
posisi tangan penolong
(tumit tangan)

Korban mendadak tidak sadar

Berteriak-lah
minta bantuan
Kepala ditengadahkan

Check Nafas
Bila anda tidak mau atau
tidak mampumemberikan
tiupan nafas

korban tidak bernafas

atau nafas tersengal-sengal

Lakukan pijat jantung saja

sd bantuan medis datang

Pijat jantung 30 X
disusul dengan

2 x tiupan nafas

otomatis
A E D - Defibrilator
Automated External Defibrillator
AED dapat dioperasikan orang awam
terlatih disediakan di tempat-tempat
umum (Misal: bandara)
Surabaya

Amsterdam
Ternate

Kobe _Japan

AED di Bandara2

Munchen

PAD programmes

are recommended for locations

where theexpected use of an
AED for witnessed cardiac
arrest exceeds once in 2 years
ILCOR 2005

AP_2006 Amsterdam

AED

Automated External Defibrillator

Korban mendadak tidak sadar

Berteriak-lah
minta bantuan

Kepala ditengadahkan
Check Nafas

korban tidak bernafas

atau nafas tersengal-sengal

Pijat jantung 30 X
tidak teraba

Pijat jantung 30 X
2 x tiupan nafas

Raba nadi karotis

teraba

Stop Pijatan

Cardiac Arrest, jantung berhenti berfungsi sbg pompa

Penelitian: 70% ECG arrest awalnya adalah VT/VF,
ketika akhirnya ATP di miokard habis
ECG menjadi asystole
Jika ECGnya VT/VF, 50-70% bisa ROSC jika ditolong
dalam waktu < 5 menit, dgn melibatkan defibrilator
biphasic
Jika ECG-nya asystole hanya 7-10% yang bisa ROSC
AED
berperan

Ventrikel Fibrilasi kasar

Ventrikel Fibrilasi halus

Asystole

Key Points

New Guidelines 2015

Advanced Cardiovascular Life Support (ACLS):

Advanced Life Support (ALS):
1. Vasopressin is out; stick with epinephrine.
2. Extracorporeal CPR is an alternative to CPR in patients for whom
the suspected etiology is reversible.
3. Maximize oxygenation during CPR, but titrate down after return of
spontaneous circulation (ROSC).
4. After 20 minutes of CPR, a low end-tidal CO2 level may be used to
help determine whether to terminate resuscitation in intubated patients.
5. Ultrasound may be used to confirm endotracheal tube placement.

Capnography Waveforms

Key Points

New Guidelines 2015

Post Cardiac Arrest Care

After ROSC:

In comatose patients, target temperature to 3236C for

at least 24 hours, and prevent fever.

Sel cortex otak, normotermia

Banyak sel apoptosis (mati)

Sel cortex otak, teknik hipotermi

Banyak sel normal (hidup)

GOALS of CPR
The goals of resuscitation are not only to
preserve cardiac and neurologic function but
also to improve quality of life for survivors
Return of cardiac function does not automatically
restore normal cerebral circulation. Depending on
the duration of the ischemic period, cerebral vessel
dysfunction develops which likely contribute to
neuronal damage.
Reperfusion Injury
2010

Kapan giliran anda berkesempatan menghidupkan

seseorang kembali ...............???
Berlatihlah agar
senantiasa siap
Kesempatan indah itu
bisa tiba-tiba muncul
dimuka Anda

Tidak ada waktu untuk berfikir dua kali,

kerjakan .....
.....atau
atau kesempatan itu hilang
ED_2013