acls

1. Advanced
Cardiac Life Support
(ACLS)
Updated AHA 2020

2. Lingkup Bahasan
Chain Of
Survival
AHA 2020
Cardiac
Arrest
BLS AHA
Updated
2020
ACLS AHA
Updated
2020
Post
Cardiac
Arrest Care

3. Keadaan terhentinya aliran darah dalam sistem sirkulasi tubuh
akibat terganggunya efektivitas kontraksi jantung
Cardiac Arrest

4. Sumber :
Ashish R. Panchal. Circulation. Part 3: Adult Basic and Advanced Life Support: 2020
American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care, Volume: 142, Issue: 16_suppl_2, Pages:
S366-S468, DOI: (10.1161/CIR.0000000000000916)
Chain of Survival AHA 2020

5. Sumber :
Ashish R. Panchal. Circulation. Part 3: Adult Basic and Advanced
Life Support: 2020 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care, Volume: 142, Issue: 16_suppl_2,
Pages: S366-S468, DOI: (10.1161/CIR.0000000000000916)

6.  Danger
 Respon
 Call/Shout For Help
 Circulation
 Airway
 Breathing
D
R
C C A B
: Bahaya.
: Respon.
: Panggil bantuan.
: Sirkulasi.
: Jalan napas.
: Pernapasan.

7. ANJURAN & LARANGAN
BLS UNTUK CPR BERKUALITAS TINGGI
Pada Pasien
Dewasa
Penolong HARUS Penolong TIDAK boleh
Melakukan kompresi dada dengan kecepatan
100 – 120 x/ mnt
Kompresi dada dengan kecepatan lebih
rendah dari 100 x/ menit atau lebih cepat
dari 120 x/ menit
Kompresi dada dengan kedalaman minimal 2
inchi (5 cm)
Kompresi dada dengan kedalaman kurang
dari 2 inchi atau lebih dari 2,4 inchi (6 cm)
Rekoil penuh setelah setiap kali kompresi Bertumpu di atas dada di antara kompresi
yang dilakukan
Meminimalkan jeda (berhenti) dalam
kompresi
Menghentikan kompresi lebih dari 10 detik
Memberikan ventilasi yang cukup (2 nafas
buatan setelah 30 kompresi, setiap nafas
buatan diberikan lebih dari 1 detik, setiap kali
diberikan dada akan terangkat
Memberikan ventilasi berlebihan (mis: terlalu
banyak nafas buatan atau memberikan nafas
buatan dengan kekuatan berlebihan)
Sumber:
http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf

8. CPR
CPR
CPR
Survival with CPR
Early CPR

9. Early CPR

10. TEHNIK RJP PADA KEHAMILAN
Manual Left Uterine Displacement Technique
• Performed from the
patient’s left side with
the 2-handed technique
• Performed from the the
patient’s right side with
the 1-handed technique

12. 1. Melihat kedalaman dan kecepatan kompresi
2. Perabaan nadi di arteri dorsalis pedis
3. Gelombang saturasi (Pulse Oximetry)
4. Gelombang arteri line (invasive Monitoring)
Arterial waveform
. X
Probe saturasi
Pulse Oximetry Waveform
Evaluasi High Quality CPR
Saat CPR Berlangsung...

13. Sumber :
Ashish R. Panchal. Circulation. Part 3: Adult Basic and Advanced
Life Support: 2020 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care, Volume: 142, Issue: 16_suppl_2,
Pages: S366-S468, DOI: (10.1161/CIR.0000000000000916)

18. Cardiac Arrest / Henti Jantung
1. Pasien tidak sadar
2. Tidak ada nafas dan tidak teraba nadi
3. EKG:
Ventricular Fibrillation (VF)
Pulseless Ventricular Tachycardia (VT)
Pulseless electrical activity (PEA)
Asistole
Gbr EKG pada saat terjadi serangan
jantung , sekitar 60%-70% adalah irama
Ventricular Fibrilasi (VF)

19. Henti Jantung
Not shockable
Do chest compression
Shockable
DC Shock 360 J
monofasik/
200J bifasik
Chest
compression
CPR
CPR

20. Shock First VS CPR
First
 Henti jantung dewasa yang disaksikan / diketahui

Defibrillator / AED digunakan sesegera mungkin
 Henti jantung yang tidak diketahui / Defibrillator (AED)
belum siapMulai CPR, jika indikasi
dan alat sudah siap maka lakukan defibrilasi
sesegera mungkin
(Sumber:
http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf)
(Guidelines Update for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Part 5-Circulation. 2015;132(suppl 2):S414–S435)

21. 1. CPR
2. Pasang Elektrode EKG tanpa menghentikan CPR
3. EKG terpasang  Stop CPR sebentar
4. Identifikasi EKG :
5. Jika Defibrilator belum siap, Lanjut CPR
6. Siapkan Defibrilasi
Bi phasic = 120-200 J
Monophasic = 360 J
7. Defib siap  Stop
CPR, Lakukan
Defibrilasi
dengan
menggunakan aba-
aba
8. Defibrilasi sudah diberikan Lanjutkan CPR
selama 2 menit
9. Setelah CPR 2 mnt Stop RJP, Analisa EKG,
Switch Role (SAS)
10. Jika irama indikasi Shock lanjut ke tahap
berikutnya (Kotak No. 5)

22. Early Defibrilation

23. Defibrillation
Position & Joules
Adult :
Bi phasic = 120-200 J
Monophasic =360 J
Pediatrik:
1st = 2 J/kg
2nd = 4 J / kg
Maks = 10 J/kg

27. • Siapkan defibrilator
• Siapkan paddle
• berikan Jelly
• Isi energi: CHARGE
• Stop CPR
• Tempel paddle
• I’m clear, you’re clear,
everybody’s clear..!!!
• Lakukan shock
• Angkat paddle
• Lanjutkan CPR
• Evaluasi monitor
Defibrillation

28. Defibrillation

29. Aba –aba saat akan melakukan defibrilasi..Wajib.

30. Obat-Obatan Resusitasi
(Cardiac Arrest)
Epinephrine
Jenis Pasien
Jenis Obat
Adrenalin
(1 amp = 1 mg)
Cara Pengoplosan
obat
DEWASA 1 ampul = 1mg bolus
tiap 3-5 menit
1 amp adrenalin
murni
ANAK 1 amp=1mg
diencerkan dengan
WFI menjadi 10 cc
1 amp adrenalin
ditambahkan WFI 9 cc
dengan spuit 10 cc
• The recommended dose of epinephrine hydrochloride is 1.0 administered IV
every 3 to 5 minutes during resuscitation.
• Each dose given by peripheral injection should be followed by a 20-mL
flush of IV fluid to ensure delivery of the drug into the central compartment.
Sumber :
https://www.ahajournals.org/doi/epub/10.1161/circ.102.suppl_1.I-129

31. Obat-Obatan Resusitasi
(Cardiac Arrest : VF & pVT)
Antiarrhythmic Drugs : Amiodarone
Contraindications:
Do not use amiodarone for individuals with polymorphic VT
associated with a prolonged QT interval because this may
worsen the patient’s condition.
Administration:
 Bolus doses: in 100 ml D5W over 10 min (maximum infusion rate
30 mg/min)
 Cardiac Arrest:
First dose: Give 300 mg (6 mL) IV direct UNDILUTED.
Second dose: If patient remains in pulseless ventricular
tachycardia or ventricular fibrillation 5 minutes after the first
dose, give a second dose of amiodarone 150 mg (3 mL).

32. VT Polymorphic

33. Antiarrhythmic Drugs : Lidocaine
Dosis 1 : 1-1.5 mg/Kg – IV / IO
Dosis 2 : 0.5-0.75 mg/Kg
Obat-Obatan Resusitasi
(Cardiac Arrest : VF & pVT)
 Lidocaine is not on the crash carts. Amiodarone should be considered the first-line
drug for VT/VF rhythms (unless long QT syndrome).
 Lidocaine can terminate a re-entry ventricular arrhythmia by
decreasing
ventricular excitability and increasing stimulation threshold of the ventricle.
 Lidocaine can be an alternative for VT/VF arrhythmias if the patient has a:
• Known allergy to Amiodarone
• Documented prolonged QT interval
2 - 3 mg of Lidocaine may be given via the ETT if
there is no venous access

34. 1. CPR
2. Pasang Elektrode EKG tanpa menghentikan CPR
3. EKG terpasang  Stop CPR sebentar
4. Identifikasi EKG :
5. Berikan Epineprine segera
6. Lanjut CPR selama 2 menit
7. Setelah CPR 2 mnt Stop RJP, Analisa EKG,
Switch Role (SAS)
8. Jika irama bukan indikasi Shock lanjut ke
Kotak No. 11
9. Lanjut ke tahap atau nomor berikutnya
10. Jika irama indikasi Shock lanjut ke Kotak
no. 5 atau 7 (Jalur VF/VT)

35. Penatalaksanaan Lanjutan
Henti Nafas & Henti Jantung di RS
tidak dapat dilakukan oleh 1 atau
2 orang
“Call For Help”….
Atau aktifkan Code Blue...!!!

36. MISSION IMPOSIBLE

37. Saat kode diaktifkan tim menuju ruangan di mana pasien berada
& melakukan tindakan resusitasi jantung paru

38. Saat kode ini diaktifkan maka tim kan menuju ruangan di mana
pasien berada dan melakukan tindakan resusitasi jantung paru

39. Uncoordinated Cardiac Arrest Team

40. ACLS Team Positions

41. Perawatan Pasca Henti Jantung
Di Ruang ICU

42. ABC
Management
• Target Tek. Darah Sistolik : > 90 mmHg
• Target suhu : 32-36C selama 24 jam
• Pertahankan status normal oksigenasi, PCO2, Gula Darah
• Target sat O2 = 92%-98%

44. BLS & ACLS
In Covid-19 Patient.???
Sumber :
Edelson, D. P., Sasson,Topjian, A. A. (2020). Interim Guidance for Basic and Advanced
Life Support in Adults, Children, and Neonates with Suspected or Confirmed
COVID-19: From the Emergency Cardiovascular Care Committee and Get with
the Guidelines-Resuscitation Adult and Pediatric Task Forces of the American
Heart Association. Circulation, E933–E943.
https://doi.org/10.1161/CIRCULATIONAHA.120.047463

49. RJP Dengan Pasien Terpasang Sungkup Oksigen
Pada Kasus Covid-19

50. In Prone Position… How To Do CPR..???

51. CPR & Defibrilation in Prone Position
CPR
When patient in Supine position  rescuers to provide CPR with
the patient in the prone position, particularly in hospitalized
patients with an advanced airway in place. (Class IIb, LOE C-LD
/ Lemah, Data terbatas).
• 2 hands Together
• Put Hands on T 7 from scapula
• While performing a prone CPR, it is important to ensure
high- quality CPR
Defibrillator
• Defibrillator should be applied using maximum energy
discharge and should be shocked at the end
of expiration with the lowest positive end
expiratory pressure to minimize the chest
impedance.
• One of which is the one electrode technique placed to
the left lower sternal border and the
other posteriorly below the scapula.
• Successful electrical defibrillation has been reported in
patients having spinal surgery in the prone position

52. Kesimpulan
• Pencegahan dengan EWS dapat mengurangi angka kejadian
henti jantung di Rumah Sakit
• BHD dan BHL merupakan tatalaksana yang wajib dilakukan
dalam tatalaksana henti jantung
• RS harus memiliki system untuk melakukan tatalaksana
kegawatan di RS yaitu dengan sistem Code Blue
• Dibutuhkan kompetensi, kerjasama dan koordinasi antar
petugas kesehatan dalam melaksanakan EWS dan System
Code Blue atau Bantuan Hidup Lanjut (BHL) di RS
• Dalam tatalaksana kegawatan pada pasien dengan PDP & Positif
Covid-19 diperlukan kewaspadaan tinggi dan APD yang sesuai

53. Daftar Pustaka
1. Ashish R. Panchal. Circulation. 2018 American Heart Association Focused Update on Advanced Cardiovascular
Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to
the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care, Volume: 138, Issue: 23, Pages: e740-e749, DOI: (10.1161/CIR.0000000000000613)
2. Bansal, M. (2020). Since January 2020 Elsevier has created a COVID-19 resource centre with free information in
English and Mandarin on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on
Elsevier Connect , the company ’ s public news and information. 14(3), 247–250
3. Bellomo R GD, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical
emergency team. MJA. 2003;179:283-7.
4. Chen J, Ou L, Hillman K, Flabouris A, Bellomo R, Hollis SJ Assareh H. Cardiopulmoary arrest and mortality trends
and their association with rapid response system expansion. MJA 2014; 201: 167-170
5. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
6. Edelson, D. P., Sasson,Topjian, A. A. (2020). Interim Guidance for Basic and Advanced Life Support in Adults,
Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular
Care Committee and Get with the Guidelines- Resuscitation Adult and Pediatric Task Forces of the
American Heart Association. Circulation, E933–E943.
https://doi.org/10.1161/CIRCULATIONAHA.120.04746
7. European Society of cardiology. (2020). ESC Guidance for the Diagnosis and Management of CV Disease during the
COVID-19
8. Pandemic. European Heart Journal, 1–115.
9. Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 5-Circulation.
2015;132 (suppl 2):S414–S435
10.http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf

56. TERIMAKASIH...
HP: 081316006831
IG : YudiElyas
Email : yudielyas@gmail.com