RESUSITASI ANAK

Airway, Breathing, Circulation Management

in Children

Sub Bagian Pediatri Gawat Darurat RSDK / FK UNDIP

Semarang 2011

RESUSITASI
Reanimasi

menghidupkan kembali yi :

segala usaha diakukan terhadap penderita

gawat darurat dan kritis

CEGAH KEMATIAN

BAYI DAN ANAK ?

TATA CARA = DEWASA

BEDA ?
- Variasi anatomi dan faal sesuai TK
- Variasi Berat badan

PRINSIP RESUSITASI YANG EFEKTIF

Jeli mengantisipasi

Segera melaksanakan prosedur

Trampil dan tepat waktu

TERLAMBAT ?
Upaya resusitasi lebih sulit
Meningkatkan kemungkinan kerusakan otak
dan
organ tubuh lainnya

3 HAL PENTING DALAM RESUSITASI

ANAK
1. Jangan mencelakakan anak dengan

metode yang salah

2. Jangan buang waktu untuk prosedur
diagnostik yang tidak berguna
3. Jangan memulai usaha apapun yang
memakan biaya untuk menunda
kematian bila kasus sudah
irreversibel

WHY TREAT CHILDREN

DIFFERENTLY ???

CHILDREN ARE NOT LITTLE ADULT :

Size & weight
Body proportion
Anatomy & Physiology
Psychology

Communication : no language ability

Fear

Table 1-7 Major Components of

Respiratory System
Component

Function

Central nervous system

Airways
Chest wall

Controls ventilation

Respiratory muscles
Lung tissue

Conduct gas to and from

respiratory surface
Enclose lungs
Contribute to expansion of lung,
stabilization of chest wall, and
maintenance of airway patency

Surface for diffusion

SIGN OF RESPIRATORY DISTRESS

Tachypnea, tachycardia
Retractions
Nasal flaring
Grunting
Stridor or wheezing
Mottled color
Change in responsiveness
Hypoxemia, hypercarbia, decreased Hgb
saturations
LATE: Poor air entry, weak cry
Apnea or gasping
Deterioration in systemic perfusion
Bradycardia

DIFFERENCES IN THE PEDISTRIC AIRWAY

WHEN
COMPARED WITH THAT IN ADULT

Anatomic Differences
1.
2.
3.
4.
5.
6.
7.
8.
9.

Proportionally larger head

Smaller nostrils
Larger Tongue
Decreased muscle tone
Epiglotis longer, stiffer, more
horizontal
Larynx more anterior
Cricoid ring is narrowest
portion
Shorter trachea
Airway more narrow

Clinical Significance

Increases neck flexion and obstruction

Increases airway resistance

Increases airway resistance
Airway obstruction by tongue
Increases airway obstruction
Difficult to perform blind intubation

Cuffed tubes not recommended

Increases right main stem intubation

Increases airway resistance

SAFE APPROACH

ARE YOU ALRIGHT?

Airways opening manoeuvers
Look, Listen, Feel
Two Effective breaths
Check pulse
Start CPR
1 minute

Call emergency services

Figure 4.1. The overall sequence of basic life support
cardiopulmonary arrest (CPR = cardiopulmonary resuscitation)

in

Shout for help

Aproach with care
Free from danger
Evaluate ABC
Figure 4.2. The SAFE approach

Gambar 28. Maneuver chin lift dilakukan bersamaan dengan

maneuver melihat-mendengar dan merasakan

Teknik membuka jalan napas

Gambar 31.A. Sudut antara oral (O), pharyngeal (P) dan trachea
(T), pada anak 2 tahun. Bila anak terbaring datar A dengan
melakukan ganjal pada oksiput S dan T menjadi hampir segaris.
C. dengan mengekstensikan sendi atlanto osipital ketiga sumbu
hampir segaris.

THE CHOKING CHILD

Should be suspected if the onset of

respiratory compromise is sudden &

is associated with coughing, gagging,
and stridor
A spontaneous cough is more
effective than any manouver
no intervention should be made
unless the cough become ineffective
or the child loses conciousness.

BASIC LIFE SUPPORTED

Mouth to
mouth

Airway opening
manouver

Back blows x 5

Alternative
cycles except
in infants

Check mouth
Chest thrusts
x5

Abdominal thrusts x5

Figure 4.12. The sequence of actions

in achoking child

BAG & MASK VENTILATION

Perhatikan :

Self inflating bag

o Equipment
Anesthesia bag

o Seni (sungkup)
o Rate & pressure

BASIC LIFE SUPPORTED

ASSESSMENT & TREATMEN AIRWAY
Looking for chest and/or abdominal
movement
Listening for breath sound
Feeling for breath
Positioning: non traumatic / traumatic
Airway obstruction : suctioning
No finger sweep technique !!

BREATHING
If AIRWAY do not result in adequate breathing
within 10 second
exhalled air rescucitation should be
commenced
CIRCULATION
Inadequacy of the circulation is recognized
by the
absence of a central pulse for up to 10
second
start chest compression if :
No pulse
Slow pulse
No sign of circulation

HENTI JANTUNG
JARANG AKIBAT PRIMER PENYAKIT

JANTUNG
PADA ANAK : SEKUNDER
(HIPOKSIA,DLL), TERBANYAK KARENA
GAGAL SIRKULASI (SYOK)

FLUID
LOSS

FLUID
MALDISTRIBUTION

RESPIRATORY

RESPIRATORY

DISTRESS

DEPRESSION

Septic shock

Convulsion

Cardiac disease

Raised ICP

Anaphylaxis

Poisoning

Blood loss
Gastroente
ritis
Burns

Septic shock
Cardiac disease
Anaphylaxis

CIRCULATORY
FAILURE

RESPIRATORY
FAILURE

CARDIAC ARREST

Table. Summary of BLS techniques in infant &

children
Infant

Small Child

Larger Child

Airway
Head tilt position

Neutral

Sniffing

Sniffing

Breathing

Pulse check
Landmark

Brachial/femoral
One finger
Breath below
Nipple line

Carotid
One finger
Breadth above
Xiphi-sternum

Carotid
Two finger
Breadth above
Xiphi-sternum

Technique

2 fingers or 2
thumbs
5:1

One hand

2 hand

15 : 2

15 : 2

Initial Slow breaths

Circulation

CPR ratio

KAPAN RESUSITASI DIHENTIKAN

???
TIDAK ADA TANDA CURAH JANTUNG
TIDAK ADA AKTIFITAS SEREBRAL 30 MENIT CPR
KEPUTUSAN : TEAM LEADER

TERIMAKASIH