Creeping Stroke - Venous thrombosis presenting with pc-stroke.pptx
Basic Life support SLIDE 2023 PRESENT.pptx
1. BASIC LIFE SUPPORT
BLOK KEGAWATDARURATAN DAN TRAUMATOLOGI
FKKH UNDANA 2023
dr. I Made Artawan, M.Biomed., Sp.An
2. GENERAL CONCEPTS OF BLS
• Keys for BLS :
• Quickly start the Chain of Survival.
• Deliver high quality chest compression to circulate oxygen to
the brain and vital organs.
• Know when and how to use Automatic External Defibrilation
(AED).
• Provide rescue breathing.
• Understand how to work with others rescuers as a part of team.
• Know how to treat chocking.
3. BANTUAN HIDUP DASAR
1.Pengenalan dini
2.Aktivasi emergency dan
3.(RJP: Resusitasi Jantung Paru) secara dini
4.Defibrilasi dengan alat kejut listrik otomasis
(AED).
BHD
10. KEMUNGKINAN KEBERHASILAN DALAM
PENYELAMATAN BILA TERJADI HENTI NAFAS DAN
HENTI JANTUNG :
Keterlambatan Kemungkinan
BHD berhasil
1 menit 98 dari 100
3 menit 50 dari 100
10 menit 1 dari 100
11. PERAN TENAGA NON MEDIS
PERANAN
PENTING
!!!!!!
1. Pengenalan dini
kegawatan/Henti
jantung
2.Aktivasi emergency &
(RJP: Resusitasi Jantung
Paru)
3.Defibrilasi dengan alat
kejut listrik otomasis
(AED).
12. LANGKAH MELAKUKAN BHD
• LANGKAH 1
• PASTIKAN KONDISI SEKITARNYA AMAN
• PASTIKAN PENOLONG AMAN
13. KITA JANGAN MENJADI KORBAN BERIKUT
Proteksi Diri
“ Pertolongan Pertama, Jangan Menambah
Cedera Tambahan ”
DANGEROUS
14. LANGKAH MELAKUKAN BHD
• LANGKAH 2
• LAKUKAN PENILAIAN AWAL PADA KORBAN YANG TIDAK SADARKAN DIRI
• CEK KESADARAN KORBAN DENGAN METODE AVPU
• ALERT : SADAR BAIK
• VERBAL : BERESPONS TERHADAP RANGSANGAN SUARA
• PAIN : BERESPONS TERHADAP RANGSANGAN NYERI
• UNRESPONSIVENESS : TIDAK ADA RESPONS TERHADAP RANGSANGAN NYERI
19. LANGKAH MELAKUKAN BHD
• LANGKAH 4
• POSISIKAN KORBAN :
• LETAKKAN DI TEMPAT YANG DATAR DAN BERALAS KERAS
20. LANGKAH MELAKUKAN BHD
• LANGKAH 5
• EVALUASI SECARA SIMULTAN PERNAFASAN DAN DENYUT JANTUNG :
• LIHAT : PERIKSA APAKAH BERNAFAS ATAU TIDAK
• RABA : PERIKSA DENYUT NADI KAROTIS DALAM WAKTU TIDAK LEBIH DARI 10 DETIK
(UNTUK AWAM BISA TIDAK PERLU DILAKUKAN)
• BILA KORBAN MASIH BERNAFAS DAN DENYUT NADI KAROTIS MASIH TERABA MAKA
KORBAN DIOBSERVASI DAN DIEVALUASI SETIAP 2 MENIT SAMPAI BANTUAN DATANG
23. LANGKAH MELAKUKAN BHD
• LANGKAH 6
• PEMBERIAN NAFAS BANTUAN :
• BILA KORBAN TIDAK BERNAFAS ATAU MASIH BERNAFAS NAMUN TIDAK NORMAL DAN
DENYUT NADI KAROTIS MASIH TERABA BERIKAN NAFAS BANTUAN 1 KALI SETIAP 5-
6 DETIK EVALUASI SETELAH 2 MENIT
• BILA RAGU TIDAK BISA ATAU TIDAK MAU MEMBERIKAN NAFAS BANTUAN, CUKUP
TETAP LAKUKAN PIJAT JANTUNG SAJA
24. NAFAS BANTUAN
• Mouth to mouth
• Mouth to nose
• Mouth to stoma
• Mouth to mask
• Bag-valve-mask device
Apnea/tidak bernafas, nafas abnormal, nafas tidak adekuat
27. Breathing Support ( Bantuan Pernafasan )
Frekuensi pernafasan :
Dewasa : 10 –12 X / menit
Anak ( 1-8 th ) ; 20 X / menit
Bayi : lebih dari 20 X /menit
Bayi baru lahir ; 40 X/ menit
28. TEKNIK BANTUAN
NAPAS
Volume cukup utk membuat
dada mengembang,
# Hindari pemberian bantuan
napas yg cepat dan berlebih
Mulut ke masker
Mulut ke mulut
29. LANGKAH MELAKUKAN BHD
• LANGKAH 7
• RESUSITASI JANTUNG PARU (RJP) :
• BILA KORBAN TIDAK BERNAFAS DAN DENYUT NADI KAROTIS TIDAK TERABA
LAKUKAN PIJAT JANTUNG LUAR DAN NAFAS BANTUAN DENGAN PERBANDINGAN
• Pada korban dewasa baik 1 ataupun 2 penolong 30 kompresi : 2 nafas bantuan
• Pada korban anak (bila 1 penolong 30 : 2, bila 2 penolong 15 : 2)
• DIEVALUASI KEMBALI SETELAH 5X SIKLUS (2 menit)
30. PIJAT JANTUNG LUAR
Pada pertengahan 1/2 bawah
sternum/tulang dada
Kedalaman 5-6 cm
Recoil sempurna
Rasio Pijat Jantung Luar : Nafas
Bantu 30 : 2
33. 1. Nyalakan AED Ikuti
perintah :
# Tempelkan elektroda
pads..!
## jangan sentuh korban ..!
AED melakukan
analisis irama
jantung
Pasang elektroda
Analisa irama jantung
.... AED datang
34. … Shock diperintahkan..!
# Jangan sentuh korban
## Tekan tombol shock
### Lanjutkan RJP 30:2
.... Jika shock tidak
diperintahkan,
# lanjutkan RJP 30:2, sesuai
dengan perintah
alat AED.
Tekan tombol shock
Lanjutkan RJP
Clear
37. CODE BLUE TEAM (CBT)
Tim Respon Cepat rumah sakit
Tim Advance / Sekunder
Tim Primer & Sekunder mengambil alih
38. POSISI RECOVERY
(PULIH)
Posisi pulih (recovery) digunakan pada korban dewasa yang tidak respon dengan
pernapasan dan sirkulasi yang adekuat.
Mempertahankan patensi jalan napas dan mengurangi resiko obstruksi jalan napas
dan aspirasi
40. BHD DIHENTIKAN
• Kembalinya ventilasi & sirkulasi spontan
• Sudah adanya bantuan petugas medis terlatih
• Penolong kelelahan
• Adanya DNAR
• Tanda kematian yang irreversibel
41. Tanda – tanda pastikematian :
• Lebam Mayat ( terjadi 20 – 30 menit setelah kematian )
• Kaku Mayat ( terjadi antara 1 – 2 jam kemudian )
• Pembusukan ( terjadi setelah 6 – 12 jam setelah kematian )
• Tanda lainnya / Cedera yang mematikan
42. • DNAR (Do Not Attempt Resuscitation)
• Tanda kematian : rigor mortis, dekapitasi
• Sebelumnya dengan fungsi vital yang sudah sangat jelek dengan terapi
maksimal
• Bila menolong korban akan membahayakan penolong
BHD TIDAK DILAKUKAN
57. AIRWAY MANAGEMENT
• The inadequate delivery of oxygenated blood to the brain and other vital
structures is the quickest killer of injured patients.
• Supplemental oxygen must be administered to all severely injured trauma
patients.
• Maintaining oxygenation and preventing hypercarbia are critical in managing
trauma patients, especially those who have sustained head injuries.
58. • Early preventable deaths from airway problems after trauma often result from:
• Failure to adequately assess the airway
• Failure to recognize the need for an airway intervention
• Inability to establish an airway
• Inability to recognize the need for an alternative airway plan in the setting of repeated failed
intubation attempts
• Failure to recognize an incorrectly placed airway or to use appropriate techniques to ensure
correct tube placement
• Displacement of a previously established airway
• Failure to recognize the need for ventilation
59. AIRWAY PROBLEM RECOGNITION
• Airway compromise can be sudden and complete, insidious and partial,
and/or progressive and recurrent.
• First step : recognize objective signs of airway obstruction and identify any
trauma or burn involving the face, neck, and larynx.
• A “talking patient” provides momentary reassurance that the airway is
patent and not compromised.
• Patients with an altered level of consciousness are at particular risk for airway
compromise and often require a definitive airway
60. Maxillofacial Trauma
• Trauma to the midface can produce
fractures and dislocations that
compromise the nasopharynx
and oropharynx.
• Facial fractures can be associated
with hemorrhage, swelling, increased
secretions, and
dislodged teeth, which cause additional
difficulties in
maintaining a patent airway.
61. Burn Trauma
• Patients with facial burns and those
with potential inhalation injury are at
risk for insidious respiratory
compromise .
• Consider preemptive intubation in burn
patients.
62. OBJECTIVE SIGNS OF AIRWAY OBSTRUCTION
• Observe the patient to determine whether he or she is agitated (suggesting
hypoxia) or obtunded (suggesting hypercarbia).
• Cyanosis indicates hypoxemia from inadequate oxygenation and is identifed
by inspecting the nail beds and circumoral skin.
• Look for retractions and the use of accessory muscles of ventilation.
• Pulse oximetry used early in the airway assessment can detect inadequate
oxygenation before cyanosis develops.
63. OBJECTIVE SIGNS OF AIRWAY OBSTRUCTION
• Listen for abnormal sounds :
• Snoring
• Gargling
• Stridor
• Hoarseness (dysphonia)
• Evaluate the patient’s behavior. Abusive and belligerent patients may in
fact be hypoxic do not assume intoxication.
64. VENTILATION
• A patent airway benefits a patient only when ventilation is also
adequate.
• Ventilation can be compromised by :
• airway obstruction,
• altered ventilatory mechanics,
• central nervous system (CNS) depression
65. OBJECTIVE SIGNS OF INADEQUATE VENTILATION
• Look for symmetrical rise and fall of the chest and adequate chest wall
excursion.
• Listen for movement of air on both sides of the chest.
• Beware of a rapid respiratory rate, as tachypnea can indicate respiratory
distress.
• Use a pulse oximeter to measure the patient’s oxygen saturation and gauge
peripheral perfusion.
• Use capnography in spontaneously breathing and intubated patients to
assess whether ventilation is adequate.
66. AIRWAY MANAGEMENT
• Clinicians must quickly and accurately assess patients’ airway patency and
adequacy of ventilation.
• Restriction of cervical spinal motion is necessary in all trauma patients at risk
for spinal injury until it has been excluded by appropriate radiographic
adjuncts and clinical evaluation.
• High-flow oxygen is required both before and immediately after instituting
airway management measures.
67. PREDICTING DIFFICULT AIRWAY MANAGEMENT
• Factors that indicate potential difficulties with airway maneuvers include:
• C-spine injury
• Severe arthritis of the c-spine
• Signifcant maxillofacial or mandibular trauma
• Limited mouth opening
• Obesity
• Anatomical variations (e.g., receding chin, overbite, and a short, muscular
neck)
• Pediatric patients
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76. AIRWAY MANAGEMENT TECHNIQUES
Without device :
• Head tilt
• Chin-Lift Maneuver
• Jaw-Thrust Maneuver
With device :
• Nasopharyngeal Airway
• Oropharyngeal Airway
• Extraglotic and Supraglotic
Devices
• Laryngeal Mask Airway and
Intubating LMA
• Laryngeal Tube Airway and
Intubating LTA
• Multilumen Esophageal
Airway
85. DEFINITIVE AIRWAY
• Three types of definitive airways :
• Orotracheal tube,
• Nasotracheal tube,
• Surgical airway (cricothyroidotomy and tracheostomy)
• The criteria for establishing a definitive airway are based on clinical fndings and
include:
• A — Inability to maintain a patent airway by other means, with impending or
potential airway compromise (e.g., following inhalation injury, facial fractures,
or retropharyngeal hematoma)
• B — Inability to maintain adequate oxygenation by facemask oxygen
supplementation, or the presence of apnea
• C — Obtundation or combativeness resulting from cerebral hypoperfusion
• D — Obtundation indicating the presence of a head injury and requiring
assisted ventilation (Glasgow Coma Scale [GCS] score of 8 or less), sustained
seizure activity, and the need to protect the lower airway from aspiration of
blood or vomitus
