Chains of Survival

TEAM
Heart Attack!
Signs & Symptoms of a Heart Attack
(Victim experiences one or more…often for days or weeks)

 Chest Pain/Discomfort
 Radiation to Arm, Neck or Jaw
 Profuse Sweating
 Difficulty Breathing
 Fearful, Confused or Irritable
 Denial of Symptoms
 Rarely Becomes Unconscious
The patient has a good chance to survive…
…but he needs the EMS System ASAP!
 100

90

80
Changes of success
70 reduced 10% to 15%
each minute
60
%success
50

40

30

20

10

0
1 2 3 4 5 6 7 8 9 minute
Composite data illustrating relationship between probability of survival
to discharge (indicated as success in figure), after VF cardiac arrest 7
and interval between collapse and defibrillation
Minutes count

• when the heart stops,

damage occurs to the
brain within < 5 minutes

• start BLS early

8
PERTOLONGAN

CEPAT,
TIM,
PROFESIONAL
 Siapa yang harus mendapatkan
pertolongan ?
1. Victim yang menurut kita pantas
dilakukan pertolongan
 Usia muda trauma
 Witness cardiac arrest yang bukan sakit
kronis atau terminal stage
2. Victim yang tidak perlu ditolong
• Pasien usia lanjut dengan sakit yang lama
• Terminal stage (cancer, GGK , sakit sukar
sembuh berobat lama)

10
Push Fast but not Too Hard
100-120 x per menit

30 x pijatan
dalam waktu 15-
18 detik

5 cm
<6 cm
 Full chest
wall recoil,
DO NOT
leaning on
chest wall
 berhitung

•1,2,3,4,5,6,7,8,9,10
•1,2,3,4,5,6,7,8,9,10
•1,2,3,4,5,6,7,8,9,10
30 hitungan dalam 15-18 detik
 LANGKAH 7

• BREATHING

– 2 kali tiupan setelah jalan nafas bebas

– Tiap kali hembusan 1 detik, disusul dengan
hembusan ke-dua, setelah ekshalasi
- Nafas buatan 10 kali/ menit ( bila sudah
ter-intubasi )

- Usahakan dada terangkat.

- @ 500-600 ml atau Volume Tidal 6-8 cc/kgBB
– Beri oksigen 100% lebih dini
NO MORE
THAN 10 s
Cara memberi nafas buatan
Pertahankan posisi kepala tetap tengadah
• Jepit hidung dengan tangan
yang mempertahankan kepala tetap tengadah
• Buka mulut penolong lebar-lebar sambil menarik nafas
panjang
• Tempelkan mulut penolong diatas mulut korban dengan
rapat.
• Hembuskan udara kemulut korban sampai terlihat
dada terangkat/ bergerak naik
• Lepaskan mulut penolong, biarkan udara keluar dari
mulut korban, dada korban tampak bergerak turun.
• Berikan hembusan nafas kedua dengan cara yang sama.
10/05/2018 29
Mouth to barrier device breathing
Deliver 1 breath every 6 seconds (10
breaths per minute)
KOMPRESSI JANTUNG LUAR
SATU atau DUA PENOLONG

30:2
A-Systole

PEA

VF

VT
40
 VT
pulseless pulse (+) pulse (+)
Shock no shock
(un-stable) (stable)
DC-Shock
360 joule
Cardioversion Lidocaine
50 joule
(xylocaine)
1 mg/kg/iv
AUTOMATED EXTERNAL
DEFIBRILLATOR - AED

42
 Unresponsive

Call for help

Open airway
Not breathing properly?
Send / go for
AED
CPR 30:2
Until AED Attached

AED
Assesed
Rhythm
No Shock
Shock Advised
Advised

Immediately
1 Shock
resume CPR 30:2

Immediately
resume CPR 30:2 Continue CPR until pt
wakes up; move; open
eyes, breathe normally
Public Access Defibrilator (PAD)
programmes are recommended
for locations where the expected
use of an AED for witness cardiac
arrest exceeds once in two years

Emergency defibrillator
Bandara Schipol di - Belanda
44
LOS ANGELES, USA,
INTERNATIONAL 45
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice
prompts
 Switch on AED
• Some AEDs will automatically switch
themselves on when the lid is opened
Attach pads to victims bare chest
Analysing Rhythm: Do not touch victim
 Shock indicated
• Stand clear
• Deliver shock
 Shock delivered:
Follow AED instructions

30 2
If no shock is advised

• check for signs of a circulation

 if none present:
 start CPR
 continue CPR until the AED tells you
to stop

 if signs of circulation are present

(including normal breathing):
 recovery position
 check regularly

53
 ADVANCED LIFE
SUPPORT

 Bila korban sudah diintubasi, lanjutkan kompresi dada tanpa

berhenti (kecuali untuk defibrillasi atau pemeriksaan denyut
nadi), kecepatan 100 -120 x/menit, dan ventilasi paru 10
x/menit.
 Hindari hiperventilasi.
 Ventilasi mekanis menghemat kerja
 Segera lakukan kompresi dada sesaat setelah tindakan
defibrillasi untuk meminimalkan pemberhentian terhadap
kompresi dada, tanpa terlebih dahulu memeriksa ritme EKG
korban
 Usahakan untuk meminimalkan pemberhentian kompresi
dada.
 Hentikan pertolongan
1. pasien sudah kembali berdetak
jantungnya (ROSC), atau nafas sdh
kembali (+)
2. Datang penolong lebih ahli
3. Pasien tdk tertolong lagi
(lebam mayat , dinyatakan sdh mati,
dll)
4. Penolong terlalu lelah,
membahayakan diri sendiri.
55
Thank you for listening
 Terima kasih atas perhatiannya
Venezia, 14 April 2011
Terima Kasih