000 c Blue and New Guidelines2025

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

6

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

8

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 100–120 per minute (updated from “at least” 100 per minute). 3. Compression depth should be 2–2.4 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 32–36°C 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