1

Not SICK SICK

Stable potential unstable. UnStable Level 1

Level 2 Level 3 Level 4 Level 5

Resuscitative Emergent Urgent Less urgent Non-urgent

MENENTUKAN ANAK SAKIT GAWAT

PAT
MELIHAT KEADAAN ANAK GENERAL ASSESSMENT

PENILAIAN

ABCDE
3

INITIAL ASSESSMENT

For the purpose of resuscitation, children are divided into 3 age groups:
Infants: under one year of age
Small children: 1 to 8 years of age Older children/adults: 9 years and over

Circulation, Circulation, Circulation

If you see someone down in the parking lot, ask them if they are ok, if they don't respond, just start chest compressions.
NO mouth to mouth. No more "look, listen, and feel" for breathing. Just start compressions.

 This doesn't apply to hospitalized patients or ER patients. In the hospital, you can have someone bag them right away and intubate them. You don't have to ignore airway

 Advanced airways, central lines, and drug delivery should not interupt chest compressions

Atropine is gone.
Atropine is no longer part of ACLS protocols at all. If they are slow or bradycardic, epinephrine will work just fine. Use an epinephrine drip or dopamine drip if needed.

Determine Responsiveness
Gently tap on shoulder and speak loudly. If responsive, place in position of comfort

10

Basic Life Support

D R
Check for DANGER, stop and look Check RESPONSE, verbal and tactile but do not

shake and shout If conscious, assess carefully, patient may still need urgent medical review

Continue to assess and manage

A B C

Airway

Breathing

Circulation
Slide 12

Basic Life Support Flowchart

Check for DANGER Check for RESPONSE
UNCONSCIOUS
Alert assistance Clear airway Apply head tilt and jaw support Check for breathing

CONSCIOUS
Make comfortable Observe ABC

BREATHING
Lateral position Observe ABC

NOT BREATHING
2 rescue breaths Check for pulse Look for signs of life

INADEQUATE PULSE
No signs of life Commence CPR Slide 13

Airway
Airway may be obstructed by tongue. Use head tilt-chin lift technique or jaw-thrust maneuver to open the airway. Jaw-thrust maneuver is safer if possibility of neck injury exists

14

17

Airway Opening Manoeuvres

Chin lift/head tilt

Infants Neutral head position with chin lift

Smaller children Sniffing position with chin lift

Slide 18

Airway Opening Manoeuvres

Chin lift/head tilt

Older children/adults Backward head tilt with pistol grip

Slide 19

21

Nasopharyngeal Airway

28

Breathing
If breathing is absent or inadequate: n Give 2 rescue breaths allowing about 1 second per inspiration n Sufficient breath to achieve gentle rise and fall of chest, this means puffs for an infant breaths for a child full breaths for an older child/adult
Slide 29

Bag and Mask

Correct mask size: cover mouth and nose only

C
Holding the mask: C-grip

Slide 30

Monitor the Effectiveness of Ventilation

Breathing
Provide rescue breathing if needed. Perform Sellick maneuver to prevent gastric distention

38

39

Circulation
Assess circulation after airway is open and two rescue breaths have been given. Check for pulses. Evaluate for other signs of circulation. Do not spend more than 10 seconds trying to find a pulse

40

Infant CPR
Place infant on firm surface and maintain airway. Place two fingers in the middle of the sternum. Use two fingers to compress the chest about 1" at a rate of least 100/min
41

 Allow sternum to return briefly to its normal position between compressions. Coordinate rapid compressions and ventilations in a 15:2 or 30 :2 ratio.
42

Child CPR
Place child on firm surface and maintain airway with one hand Place heel of other hand over lower half of the sternum.
Avoid the xiphoid process.

Compress chest about 1" to 1 1/2" at a rate of 100/min.

43

44

45

 should be performed 5 times - 30 compressions and 2 breaths check the victim's artery for pulse (for no longer than 10 seconds) and other signs of consciousness. If you not feel a pulse within 10 seconds, you should begin cycles of chest compressions and ventilations.
46

47

48

PULSE Check
Take no more than 10

seconds
Cardiac output in infancy and childhood largely depends on heart rate. No scientific data has identified an absolute heart rate at which chest compressions should be initiated; the recommendation to provide cardiac compression for a heart rate <60 bpm with signs of poor

perfusion

Pulse Check
Do not check for longer than 10 seconds If the patient

shows no sign of life and a pulse cannot be palpated in 10 seconds presume it to be absent!

Brachial is recommended in the infant as carotid pulse is difficult to find and extension of the neck may compromise the airway Carotid pulse locate thyroid cartilage and feel to side, dont feel too high due to the risk of inadvertently massaging the carotid sinus, inducing bradycardia and hypotension

Slide 51

 Locating and palpating carotid artery

pulse ( < 1 year)

( > 1 year)

Locating and palpating brachial pulse

52

Brachial pulse check in infant

Circulation 2000;102:253I--290I-

Copyright 2000 American Heart Association

Carotid pulse check in child

Circulation 2000;102:253I--290I-

Copyright 2000 American Heart Association

Look for signs of life

No signs of life = unconscious unresponsive not moving not breathing normally
No signs of life commence external cardiac

compressions

Slide 55

Circulation
Assess for pulse

and signs of life

If no pulse,

inadequate pulse or no signs of life commence ECC

Slide 57

CPR of the pediatric patient

58

PIJAT JANTUNG LUAR

If no pulse palpated, begin chest compression

60

Patient should be on a hard surface eg. cardiac board Rhythmic action, equal time for compression and relaxation Aim for a rate of 100 compressions per minute

Slide 61

CPR Ratio
CIRCULATION INFANT Hand Position Depth of Compression

The ratio describes the number of compressions in relation to breaths, the rate is the number of compressions/breaths given per minute.

SMALL CHILD

OLDER CHILD

Lower half of sternum

1/3 depth of chest

Ratio and Rate 30 compressions: 2 breaths 1 rescuer 5 cycles / 2 min Ratio and Rate 15: 2 5 cycles/min 2 rescuers
Slide 62

30: 2 5 cycles/2 min

CPR Infant
Infant Locate the lower half of the sternum Two fingers one operator CPR Two thumbs / two fingers if two operators Ratio

Lone health care provider/ lay rescuer

30 compressions : 2 breaths (5 cycles per 2 minute)

Two health care providers 15 compressions : 2 breaths (5 cycles per 1 minute) Aim for a rate of 100 compressions per minute
Slide 63

CPR Infant
Compression depth: 1/3 of the depth of the chest Finger/Thumb position: lower 1/2 of the sternum

Slide 64

 Locating finger position for chest

compressions in infant (< 1 year)

Imagine Place

a line drawn between the nipples

2 fingers on sternum 1 fingers width below line. - 1 in. least 100 per min

Depress At

65

CPR Ratio
CIRCULATION INFANT Hand Position

SMALL CHILD

OLDER CHILD

Lower half of sternum

1/3 depth of chest

Depth of Compression

Ratio and Rate 30 compressions: 2 breaths 1 rescuer 5 cycles / 2 min Ratio and Rate 15: 2 5 cycles/min 2 rescuers
Slide 69

30: 2 5 cycles/2 min

CPR Small Child

Child: Up to 8 years
Use the heel of one hand Locate lower half of sternum

Ratio
Lone health care provider/ lay rescuer 30 compressions : 2 breaths (5 cycles per 2 minute) Two health care providers 15 compressions : 2 breaths (5 cycles per 1 minute) Aim for a rate of 100 compressions per minute

Slide 70

CPR Ratio
CIRCULATION INFANT Hand Position

SMALL CHILD

OLDER CHILD

Lower half of sternum

1/3 depth of chest

Depth of Compression

Ratio and Rate 30 compressions: 2 breaths 1 rescuer 5 cycles / 2 min Ratio and Rate 15: 2 5 cycles/min 2 rescuers
Slide 71

30: 2 5 cycles/2 min

CPR Older Child/Adult

Older child/adult i.e.>9years
Use two hands Locate lower half of sternum

Ratio: Lone health care provider/ lay rescuer or two health care providers

30 compressions : 2 breaths (5 cycles per 2 minute)

Aim for a rate of 100 compressions per minute

Pressure is exerted through the heel of the

hand, with arm/s straight, using body weight as the compression force
Slide 72

CPR
(Small and older child)

1/3

CPR small child

CPR older child/ adult

Compression depth: 1/3 of chest

Slide 73

CPR
ARC recommend minimum interruptions

of ECC and CPR should not be interrupted to check for signs of life Ineffective CPR: too gentle too slow incorrect hand position too many interruptions
Slide 74

 Locating hand position for chest

compressions in child (> 1 year)

Use

2-3 fingers to locate lower margin of rib cage. Follow rib margin to base of sternum (xiphoid process) 8 yr

Over

Place other hand on top of hand on sternum Depress 1 - 2 in

at least 100 per min

2 breaths to every 15 compressions
75

~ 8 yr
Use heel of one hand
Depress 1 1 in 100 per min

One-rescuer
1 breath to every 5 compressions

Two-rescuer
2 breaths to every 15 compressions

76

One-hand chest compression technique in child

Circulation 2000;102:253I--290I-

After each compression

allow the chest to recoil fully because complete chest reexpansion improves blood flow into the heart