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Emergency

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Submitted By kingdon
Words 1685
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BAB

2

RESUSITASI JANTUNG DAN PARU
Ns. Muhamad Adam, S.Kp, M.Kep.

B

asic life support atau bantuan hidup dasar (BHD) sudah sering diperkenalkan dalam situasi kegawatdaruratan. Dalam perkembangannya, metode BHD selalu mengalami penyempurnaan. BHD sangat bermanfaat bagi penyelamatan kehidupan mengingat dengan pemberian sirkulasi dan napas buatan secara sederhana, BHD memberikan asupan oksigen dan sirkulasi darah ke sistem tubuh terutama organ yang sangat vital dan sensitif terhadap kekurangan oksigen seperti otak dan jantung. Berhentinya sirkulasi beberapa detik sampai beberapa menit, asupan oksigen ke dalam otak terhenti, terjadi hipoksia otak yang yang mengakibatkan kemampuan koordinasi otak untuk menggerakkan organ otonom menjadi terganggu, seperti gerakan denyut jantung dan pernapasan. Penyelamatan ini akan sangat bermanfaat jika dilakukan sesegera mungkin dan sebaik mungkin. Lebih baik ditolong, walupun tidak sempurna daripada dibiarkan tanpa pertolongan. Pada saat henti napas, kandungan oksigen dalam darah masih tersedia sedikit, jantung masih mampu mensirkulasikannya ke dalam organ penting, terutama otak, jika pada situasi diberi bantuan pernapasan, kebutuhan jantung akan oksigen untuk metabolisme tersedia dan henti jantung dapat dicegah. Keterlambatan BHD 1 menit 3 menit 10 menit Peluang Keberhasilan (Hidup) 98 dari 100 korban 50 dari 100 korban 1 dari 100 korban

Kasus-kasus penyebab terjadinya henti jantung dan henti napas dapat terjadi kapan saja, dimana saja dan pada siapa saja. Contoh kasusnya antara lain adalah tenggelam, stroke, obstruksi jalan napas, menghirup asap, kercunan obat, tersengat listrik, tercekik, trauma, MCI (myocardial infarction) atau gagal jantung, dan masih banyak lagi. Kondisi diatas, ditandai dengan tidak terabanya denyut nadi karotis dan tidak adanya gerakan napas dada. Ketika American Heart Assocation (AHA) menetapkan pedoman resusitasi yang pertama kali pada tahun 1966, resusitasi jantung paru (RJP) awalnya “A-B-C” yaitu membuka jalan nafas korban (Airway), memberikan bantuan napas (Breathing) dan kemudian memberikan kompresi dinding dada (Circulation). Namun, sekuensinya berdampak pada penundaan bermakna (kira-kira 30 detik) untuk memberikan kompresi dinding dada yang dibutuhkan untuk mempertahankan sirkulasi darah yang kaya oksigen. Dalam 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, AHA menekankan fokus bantuan hidup dasar pada: 1. Pengenalan segera pada henti jantung yang terjadi tiba-tiba (immediate recognition of sudden cardiac arrest [SCA]) 2. Aktivasi sistem respons gawat darurat (activation of emergency response system) 3. Resusitasi jantung paru sedini mungkin (early cardiopulmonary resuscitation)

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4. Segera didefibrilasi jika diindikasikan (rapid defibrilation if indicated) Dalam AHA Guidelines 2010 ini, AHA mengatur ulang langkah-langkah RJP dari “A-B-C” menjadi “C-A-B” pada dewasa dan anak, sehingga memungkinkan setiap penolong memulai kompresi dada dengan segera. Sejak tahun 2008, AHA telah merekomendasikan bagi penolong tidak terlatih (awam) yang sendirian melakukan Hands Only CPR atau RJP tanpa memberikan bantuan napas pada korban dewasa yang tibatiba kolaps.

Setiap orang dapat menjadi penolong pada korban yang tiba-tiba mengalami henti jantung. Keterampilan RJP dan penerapannya bergantung pada pelatihan yang pernah dijalani, pengalaman dan kepercayadirian penolong. Kompresi dada merupakan fondasi RJP sehingga setiap penolong baik terlatih maupun tidak, harus mampu memberikan kompresi dada pada setiap korban henti jantung. Karena pentingnya, kompresi dada harus menjadi tindakan prioritas pertama setiap korban dengan usia berapapun. Penolong yang terlatih, harus memberikan kompresi dada yang dikombinasikan dengan ventilasi (napas bantuan). Sedangkan penolong yang telah sangat terlatih diharapkan bekerja secara bersama-sama dalam bentuk tim dalam memberikan ventilasi dan kompresi dada. Pedoman baru ini juga berisi rekomendasi lain yang didasarkan pada bukti yang telah dipublikasikan, yaitu: - Pengenalan segera henti jantung tiba-tiba (suddent cardiact arrest) didasarkan pada pemeriksaan kondisi unresponsive dan tidak adanya napas normal (seperti, korban tidak bernapas atau hanya gasping/terengah-engah). Penolong tidak boleh menghabiskan waktu lebih dari 10 detik untuk melakukan pemeriksaan nadi. Jika nadi tidak dapat dipastikan dalam 10 detik, maka dianggap tidak ada nadi dan RJP harus dimulai atau memakai AED (automatic external defibrilator) jika tersedia. - Perubahan pada RJP ini berlaku pada korban dewasa, anak dan bayi tapi tidak pada bayi baru lahir. - “Look, Listen and Feel" telah dihilangkan dari algoritme bantuan hidup dasar. - Jumlah kompresi dada setidaknya 100 kali per menit - Penolong terus melakukan RJP hingga terjadi return of spontaneous circulation (ROSC) - Kedalaman kompresi untuk korban dewasa telah diubah dari 1 ½ - 2 inchi menjadi sedikitnya 2 inchi (5 cm) - Peningkatan fokus untuk memastikan bahwa RJP diberikan dengan high-quality didasarkan pada : o Kecepatan dan kedalaman kompresi diberikan dengan adekuat dan memungkinkan full chest recoil antara kompresi

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BAB 2

o o

Meminimalkan interupsi saat memberikan kompresi dada Menghindari pemberian ventilasi yang berlebihan

Tujuan dari BHD adalah: 1. Mencegah berhentinya sirkulasi darah atau berhentinya pernapasan 2. Memberikan bantuan eksternal terhadap sirkulasi (melalui kompresi dada) dan ventilasi (melalui bantuan napas penolong) dari pasien yang mengalami henti jantung atau henti napas melalui rangkaian kegiatan Resusitasi Jantung Paru (RJP).

A. RANGKAIAN (SEKUENS) BANTUAN HIDUP DASAR Rangkaian bantuan hidup dasar pada dasarnya dinamis, namun sebaiknya tidak ada langkah yang terlewatkan untuk hasil yang optimal. Berikut ini adalah algoritma bantuan hidup dasar berdasarkan 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovacular Care, yaitu :

Korban ditemukan
Cek respon korban Tidak ada respon (unresponsive) Tidak bernapas atau tidak bernapas normal (hanya gasping/terengah-engah) Cek nadi : Pastikan nadi dalam 10 detik?
Ada denyut nadi

Tak ada denyut nadi

 Beri 1 napas tiap 5 – 6 detik  Cek ulang tiap 2 menit

Mulai siklus 30 KOMPRESI dan 2 NAPAS

AED / defibrilator datang

Rekam irama jantung, apakah bisa didefibrilasi atau tidak ?

Berikan 1 shock Segera lanjutkan RJP untuk 5 siklus (2 menit)

Segera lanjutkan RJP selama 2 menit Cek irama setiap 2 menit, sampai tim dengan alat lebih lengkap datang.

Catatan : Kotak dengan garis putus-putus dilakukan oleh penolong profesional, bukan oleh penolong awam

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1. Response
Pastikan situasi dan keadaan pasien dengan memanggil nama/sebutan yang umum dengan keras disertai menyentuh atau menggoyangkan bahu dengan mantap. Prosedur ini disebut sebagai teknik “touch and talk”. Hal ini cukup untuk membangunkan orang tidur atau merangsang seseorang untuk bereaksi. Jika tidak ada respon, kemungkinan pasien tidak sadar. Terdapat tiga level tingkat kesadaran, yaitu:    Sadar penuh: sadar, berorientasi baik terhadap diri, waktu dan tempat Setengah sadar: mengantuk atau bingung/linglung Tidak sadar: tidak berespon

Jika pasien berespon Tinggalkan pada posisi dimana ditemukan dan hindari kemungkinan resiko cedera lain yang bisa terjadi. Analisa kebutuhan tim gawat darurat.   Jika sendirian, tinggalkan pasien sementara, minta bantuan Observasi dan kaji ulang secara regular Jika pasien tidak berespon   Berteriak minta tolong Atur posisi pasien. Sebaiknya pasien terlentang pada permukaan keras dan rata. Jika ditemukan tidak dalam posisi terlentang, terlentangkan pasien dengan teknik „log roll’, secara bersamaan kepala, leher dan punggung digulingkan. Atur posisi penolong. Berlutut sejajar dengan bahu pasien agar secara efektif dapat memberikan resusitasi jantung paru (RJP). Cek nadi karotis o AHA Guideline 2010 tidak menekankan pemeriksaan nadi karotis sebagai mekanisme untuk menilai henti jantung karena penolong sering mengalami kesulitan mendeteksi nadi. Jikan dalam lebih dari 10 detik nadi karotis sulit dideteksi, kompresi dada harus dimulai. o Penolong awam tidak harus memeriksa denyut nadi karotis

 

Anggap cardiac arrest jika pasien tiba-tiba tidak sadar, tidak bernapas atau bernapas tapi tidak normal (hanya gasping)

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2. Circulation (Sirkulasi)
Compressions
Bila tidak ada nadi


Mulai lakukan siklus 30 kompresi dan 2 ventilasi 1. Lutut berada di sisi bahu korban 2. Posisi badan tepat diatas dada pasien, bertumpu pada kedua tangan 3. Letakkan salah satu tumit telapak tangan pada ½ sternum, diantara 2 putting susu dan telapak tangan lainnya di atas tangan pertama dengan jari saling bertaut atau dua jari pada bayi ditengah dada 4. Tekan dada lurus ke bawah dengan kecepatan setidaknya 100x/menit (hampir 2 x/detik) AHA Guideline 2010 merekomendasikan : 1. Kompresi dada dilakukan cepat dan dalam (push and hard) 2. Kecepatan adekuat setidaknya 100 kali/menit 3. Kedalaman adekuat o Dewasa : 2 inchi (5 cm), rasio 30 : 2 (1 atau 2 penolong) o Anak : 1/3 AP (± 5 cm), rasio 30 : 2 (1 penolong) dan 15 : 2 (2 penolong) o Bayi : 1/3 AP (± 4 cm), rasio 30 : 2 (1 penolong) dan 15 : 2 (2 penolong) 4. Memungkinkan terjadinya complete chest recoil atau pengembangan dada seperti semula setelah kompresi, sehingga chest compression time sama dengan waktu relaxation/recoil time.



3. Airway (Jalan Napas)
Pastikan jalan napas terbuka dan bersih yang memungkinkan pasien dapat bernapas Bersihkan jalan napas
 



Amati suara napas dan pergerakan dinding dada Cek dan bersihkan dengan menyisir rongga mulut dengan jari, bisa dilapisi dengan kasa untuk menyerap cairan. Dilakukan dengan cara jari silang (cross finger) untuk membuka mulut.

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Membuka jalan napas


Secara perlahan angkat dahi dan dagu pasien (Head tilt & Chin lift) untuk buka jalan napas 1. Head Tilt & Chin Lift a. Membaringkan korban terlentang pada permukaan yang datar dan keras b. Meletakkan telapak tangan pada dahi pasien c. Menekan dahi sedikit mengarah ke depan dengan telapak tangan d. Meletakkan ujung jari telunjuk dan jari tengah dari tangan lainnya di bawah bagian ujung tulang rahang pasien e. Menengadahkan kepala dan menahan/menekan dahi pasien secara bersamaan sampai kepala pasien pada posisi ekstensi 2. Jaw Trust a. Membaringkan korban terlentang pada permukaan yang datar dan keras b. Mendorong ramus vertikal mandibula kiri dan kanan ke depan sehingga barisan gigi bawah berada di depan barisan gigi atas, atau, c. Menggunakan ibu jari masuk ke dalam mulut korban dan bersama dengan jari-jari yang lain menarik dagu korban ke depan, sehingga otot-otot penahan lidah teregang dan terangkat d. Mempertahankan posisi mulut pasien tetap terbuka Ambil benda apa saja yang telihat Pada bayi, posisi kepala harus normal Cek tanda kehidupan: respon dan suara napas Jangan mendongakkan dahi secara berlebihan, secukupnya untuk membuka jalan napas, karena bisa berakibat cedera leher. AHA Guideline 2010 merekomendasikan untuk : o Gunakan head tilt-chin lift untuk membuka jalan napas pada pasien tanpa ada trauma kepala dan leher. Sekitar 0,12-3,7% mengalami cedera spinal dan risiko cedera spinal meningkat jika pasien mengalami cedera kraniofasial dan/atau GCS

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