Sudden cardiac arrest is the most cause of sudden death in the world.

Many
cardiac arrest victims are saving or can be saved if people around the victim
conducted immediate action while cardiac in fibrillate status (VF). But if
cardiac rhythm is change to arrest/asystole, the fail probability is high.
Chain of survival as a universal chain that already implemented are consist
of :
Immediate recognition of cardiac arrest and activate of emergency response
system.
Early CPR that emphazise chest compressions (new guidelines AHA 20120).
Rapid defibrilation if indicated.
Effective advanced life support.
Integrated post-cardiac arrest care.

When these chain are implemented in an affective way, survival rate can
approach 50% following witnessed out-hospital ventricular fibrilation (VF)
arrest (fibrilation of the heart).
To minimize the time of that chain to make effective, it should be
immediate action in the first chain. The witnesses should fast in
recognition, activate EMS and conduct CPR as soonest. So many people
should know at least know how to conduct the correct CPR before health
proffesionals coming.
Immediate recognition and activation, early CPR, and rapid defibrillation
(when appropriate) are the first BLS links in the adult Chain of Survival. So
many people know how to conduct corect CPR, it will improve save victim
with cardiac arrest.
Key changes and continuesd point of emphasis from 2005 BLS Guidelines
include the following:
Immediate recognition of Sudden Cardiac Arrest based on assessing
unresponsiveness and absence of normal brething (victim is no breathing or
only gasping).
Look, Listen, and Feel removed from the BLS algorthm.
Encouraging Hands-Only (chest compression only) CPR for untrainedlay-rescuer
(continous chest compression over of the middle of the chest).
Sequence change to chest compression before rescue breaths (CAB rather than
ABC)
Health care providers continue effective chest compression/CPR until return of
spontaneous circulation (ROSC) or termination of resuscitative efforts.
Increase focus on methods to ensure that high quality CPR (compression of
adequate rate and depth, allowing full chest recoil between compressions,
minimizing interruptions in chest comperrassion and avoiding excessive
ventilation) is performed.

Continued de-emphasis on pulse check for health care providers.

A simplified adult BLS algorithm is introduced with the revised traditional
algorithm.
Recommendation of simultaneous, choreographed approach for chest
compression, airway management, rescue breathing, rhythm detection, and
shocks (if appropriate) by an integrated team of highly-trained rescuers in
appropriate settings.

Early CPRChest CompressionsChest compressions consist of forceful

rhythmic applications of pressure over the lower half of the sternum. These
compressions create blood flow by increasing intrathoracic pressure and
directly compressing the heart. This generates blood flow and oxygen
delivery to the myocardium and brain.
Effective chest compressions are essential for providing blood flow during CPR.
For this reason all patients in cardiac arrest should receive chest
compressions.
To provide effective chest compressions, push hard and push fast. It is reasonable
for laypersons and healthcare providers to compress the adult chest at a
rate of at least 100 compressions per minute with a compression depth of
at least 2 inches/5 cm. Rescuers should allow complete recoil of the chest
after each compression, to allow the heart to fill completely before the
next compression.
Rescuers should attempt to minimize the frequency and duration of interruptions
in compressions to maximize the number of compressions delivered per
minute. A compression-ventilation ratio of 30:2 is recommended.

Reference
Journal of The America Heart Association, Circulation, 2010.
http://www.medscape.com/viewarticle/730866, 2010 AHA Guidelines: The ABCs
of CPR Rearranged to CAB.

Jumat, 10 Juni 2011

2010 AHA GUIDELINES for ADULT BASIC LIFE SUPPORT ( BLS )

BLS (basic life support) atau dikenal dengan BHD-RJP yaitu tindakan dasar untuk
menyelamatkan nyawa berikut serangan jantung. Aspek dasar dalam BLS antara
lain pengenalan segera serangan jantung mendadak ( Sudden Cardiac Arrest / SCA
) dan aktivasi system tanggap darurat, resusitasi jantung paru awal ( CPR ) dan
defribilasi cepat dengan menggunakan defribilator eksternal otomatis ( AED ).
Pengenalan dini serta respon terhadap serangan jantung & stroke juga dianggap

sebagai bagian dari BLS.

Di bawah ini perubahan pedoman dari BLS menurut AHA 2005 ke AHA 2010 untuk
tenaga awam terlatih dan penyedia layanan kesehatan :
1. Penilaian segera / langsung dari SCA berdasarkan penilaian respond an
pernafasan tidak normal ( korban tidak bernafas/terengah-engah).
2. Tindakan lihat, dengar, rasakan ( LLF ) dihapus dari algoritma BLS.
3. Hanya tindakan kompresi dada secara konvensional ( Hands-Only ) yang
dilakukan oleh tenaga penolong belum terlatih.
4. Perubahan kompresi sebelum bantuan nafas ( CAB bukan ABC ).
5. Tindakan CPR terus dilakukan sampai kembalinya sirkulasi spontan ( ROSC ) /
penghentian upaya pernafasan.
6. Peningkatan fokus pada metode untuk memastikan bahwa kualitas CPR (
kecepatan & kekuatan kompresi yang benar dan memungkinkan kembalinya
pergerakan dada dan penekanan meminimalkan gangguan dalam kompresi dada &
ventilasi untuk menghindari berlebihan ) dilakukan.
7. Lanjutan pemeriksaan cek nadi bagi tenaga penolong.
8. Algoritma sederahana BLS dikenalkan dengan algoritma tradisional.
9. Revisi rekomendasi dari pendekatan simultan, tindakan simultan untuk
penekanan dada, manajemen jalan nafas, bantuan pernafasan, deteksi irama,
guncangan ( jika diperlukan ) oleh tim penolong terlatih dalam pengaturan
yang sesuai.
Tindakan dasar dalam memberikan strategi universal untuk mencapai resusitasi
sukses tersebut lebih dikenal dengan Chain of Survival. Bagi dewasa terdiri dari
aspek :
1. Immediate recognition of cardiac arrest and activation of the emergency
response system.
2. Early CPR that emphasizes chest compressions
3. Rapid defribillation if indicated
4. Effective advanced life support
5. Integrated post-cardiac arrest area
A. Immediate Reconition and Activation of the Emergency Response System.
B. Cek nadi ( dilakukan di bawah 10 dtk )
C. Early CPR
Laju kompresi dada minimal 100 kali per menit.
Kedalaman kompresi paling sedikit 2 inchi ( 5 cm )
Penolong harus memungkinkan recoil thoraks setelah setiap kompresi, untuk
memungkinkan jantung mengisi sepenuhnya sebelum kompresi berikutnya.
D. Managing the Airway
Head Tilt Chin Lift
Jaw Thrust Manuver jika ada indikasi cervical spine injury dan craniofacial
injury
E. Rescue Breaths
1 nafas tiap 6-8 dtk ( 8-10 nafas per menit ) tanpa menyinkronkan nafas
dengan kompresi serta tidak ada jeda dalam kompresi dada untuk pengiriman

ventilasi.
Tujuan utama dari ventilasi selama CPR adalah menjaga oksigenasi dan tujuan
sekundernya untuk menghilangkan karbondioksida.
Tehnik atau cara pemberian bantuan nafas antara lain : mouth to mouth,
mouth to barrier device breathing, mouth to nose and mouth to stoma
ventilation, ventilation with bag and mask, ventilation with a supraglotic
airway ( LMA ), ventilation with an advance airway, passive oxygen versus
positive-pressure oxygen selama CPR, cricoids pressure.
F. AED Defribilation
Defribilasi adalah pilihan penyelamatan untuk korban dengan VF ( durasi pendek )
G. Recovery Position
Posisi pemulihan digunakan untuk korban tidak responsive ( nafas & sirkulasi
efektif ).