• AHA 2010 (new)

• “ A change in the 2010 AHA Guidelines for

CPR is to recommend the initiation of
chest compression before
ventilation.”
• AHA 2005 (old)
• “ The sequence of adult CPR began with
opening of the airway, checking for normal
breathing , and then delivering 2 rescue
breaths followed by cycles of 30
compressions and 2 breaths.”
• Airway ( buka jalan nafas)
• Breathing (bantuan pernafasan)
• Ciculation ( kompresi dada )

• Sekarang
• Circulation , kemudian tatalaksana fokus
pada Airway dan selanjutnya Breathing.
• Pengecualian , neonatus ( bayi baru lahir),
karena penyebab utama jalan nafas ( asfiksia)
 AHA 2010 (new)
 “ Look, listen and feel for breathing
was removed from the sequence for
assessment of breathing after opening the
airway.
 “After delivery of 30 compressions, the

home rescuer opens the victim`s airway

and delivers 2 breaths.”
Posisi penolong Push Hard and Push Fast
tegak lurus diatas dada
pasien dengan siku
lengan lurus menekan
tengah-tengah
tulang dada ,tekan
sedalam at least 5 cm.

Pijat jantung 30 x
disusul dg nafas 2 x

At least 100x per menit

• “Beginning CPR with 30
compressions rather than 2
ventilations leads to a shorter
delay to first compression”
• Resque Breath ditiadakan
Resque Breath: tindakan pemberian nafas
buatan dua kali pada korban henti nafas (
setelah Look, Listen, and Feel ).
. Menyita waktu
• Pengaktivasian Emergency Respons
System ( ERS).
• “Check for response while looking at
the patient to determine if breathing
is absent or not normal. Suspect
cardiac arrest if victim is not
breathing or only gasping.”
• Pengaktivasian ERS: meminta pertolongan
sekitar , menelpon,menyuruh minta bantuan tetap merupakan prioritas,
tetapi sebelumnya telah dilakukan pemeriksaan kesadaran dan ada
tidaknya henti nafas (terlihat tidak nafas/gasping) secara simultan dan
cepat.
• AHA 2005( old ). ”Activated the emergency response system
after finding an unresponsive victim, then returned to the victim and
opened the airway and checked for breathing or abnormal breathing.”
 Kompresi dada berhenti Aliran darah ke
otak berhenti  Kematian Jaringan Otak.
 Kompresi dada terus Defibrilator datang

 Pernafasan dari mulut ke mulu t

 Prinsip :

◦ Push Hard, Push Fast, Allow

complete chest recoil, and
Minimize Interruption and
Avoiding excessive ventilation.
• “The routine use of cricoid
pressure in cardiac arrest is not
recommended”
• 2005 ( old)
–Cricoid pressure should be use only
if the victim is deeply unconscious,
and it usually requires a third
rescuer not involved in rescue
breaths or compressions
 Cricoid Pressure
◦ Menghambat / mencegah
pemasangan jalan nafas
◦ Aspirasi masih bisa terjadi .
 Metoda penekanan tulang rawan krikoid
korban tidak sadar dan boleh dilakukan
pada penolong ketiga
• 2010
• The precordial thump should
not be used for unwitnessed
out-of-hospital cardiac arrest.
• The precordial thump may be considered
for patients with witnessed, monitored,
unstable VT ( including pulseless VT) if a
defibrillator is not immediately ready for
use, but it should not delay CPR and
shock delivery.”
 Kerugian :
◦ Tidak bisa mengubah ventrikel
fibrilasi ke irama sinus.
◦ Tidak bisa ke Return of
Spontaneous Circulation (ROSC)
◦ Fractur sternum, osteomyelitis,
stroke, dan bahkan aritmia.
 CPR followed by
defibrillation within 2 to 3
minutes of collapse has
produced survival rate of up
to 50% in some studies. With
each minute of delay,
chance of survival decreases
by 7-10%
 Bentuk gelombang khas
◦ shockable, harus segera DC-shock
◦ CPR menunggu DC-shock, CPR saja sukar ROSC
◦ DC-shock < 5 mnt bisa mencapai > 50% ROSC
◦ tanpa DC-shock akan memburuk jadi asystole

VT = Ventricular Tachycardia VF = Ventricular Fibrillation

21
 • ada gelombang mirip ECG normal
– TETAPI nadi carotis tidak teraba
– terapi sama seperti Asystole

P-ulseless E-lectro
E-lectrical M-echanical
A-ctivity D-issociation

22
TERIMA KASIH