RJP
Ni Luh Widani
2010 - AHA ECC Adult Chain of Survival
Sumbatan Jalan Nafas
• Benda asing :
makanan, mainan ,
gigi palsu Harus
dikeluarkan
• Korban tidak sadar
lidah kebelakang
Mengeluarkan Benda Asing
• Pada klien sadar yang tersedak
heamlik manuver letakkan tangan
diantara PX dan umbilikus
Mengeluarkan sumbatan benda
asing korban tidak sadar
Abdominat trust
Mengeluarkan benda asing
• Klien hamil / obesitas
• Letakkan tangan
di sternum
Mengeluarkan benda asing
• Bila benda asingnya tampak finger sweep
Choking:
Conscious Infants
• Position with head downward
• 5 back blows
• 5 chest thrusts
• Repeat
Open the Airway
• Head-tilt/chin lift (no trauma)
– The most common cause of obstruction is
the tongue!
Open the Airway
• Jaw thrust (trauma)
Oropharyngeal Airway
• Keeps tongue from blocking the airway
• Cannot be used in patients with gag
reflex
Oropharyngeal Airway
• Insertion
– Upside down until resistance
– Rotate and advance until flange
is in contact with teeth or gums
Oropharyngeal Airway
• Other methods of insertion
1. Insert right side up, and use a tongue
depressor.
2. Insert at corner of mouth and rotate 90º
while
advancing.
• Preferred for infants
Oropharyngeal Airway
• Must use correct size
– Measure from corner of
mouth to tip of ear
• Too big could push, tongue
into airway
• Too small, won’t reach back
of throat
• Have a selection of sizes available
Oropharyngeal Airway
• Wrong!
Nasopharyngeal Airway
• Keeps the tongue from blocking the
airway
• Better tolerated by patients with gag reflex
• May be used in patients
with locked jaws
Nasopharyngeal Airway
• Must use correct size
– Measure from tip of nose to tip of ear
• Lubricate with water soluble gel
• Try right nostril first
Assess for Breathing
• Is the patient breathing?
– Look, listen, & feel for 10 seconds
• If the victim is not
breathing, give two
breaths (1 and ½ - 2 sec.)
– Pinch the nose
– Seal the mouth with yours
• If the first two don’t go in,
re-tilt and give two more
breaths (if breaths still
do not go in, suspect
choking)
Ventilate the Patient
• Mouth to mask Bag--Valve
Bag Valve--Mask Ventilations
Bila KU penderita tdk baik OKSIGEN
• Kanul hidung ( 2 – 4 l ) O2: 24-44 %
• Face mask (6-8 l) O2 : 35 – 60 %
• Non rebreathing mask (8-12l) O2 : 80 –
90%
• Pernafasan Buatan
– Ventilasi mouth to mouth O2 16 – 17 %
– Ventilasi mouth to mask udara ekspirasi
– Ambu – bag
Bag--Valve-
Bag Valve-Mask Ventilations
• Making a good mask to face seal
– Use two hands
• For mouth to mask ventilation
• For two person bag-valve-masking
Bag--Valve-
Bag Valve-Mask Ventilations
• Two person BVM (preferred)
– Good seal
• No air leak around mask
– Two hands on bag
• Good volume delivered
• Good control of breath
Bag--Valve-
Bag Valve-Mask Ventilations
• One person BVM
– Prone to inadequate tidal volumes
• Air leaks around mask
• Less air delivered by bag
• Fatigue
Oxygen
• For all patients with
inadequate or absent
breathing
• For all patients with
difficulty breathing
• For all patients in shock
• For all patients with
decreased responsiveness
Circulation
• Assess circulation
– 10 seconds
– Carotid pulse in adults
and children
– Brachial in infants
Observe:
Breathing, coughing,
movement, normal skin
temp. and color, improved
level of responsiveness,
pulse
Check pulse at carotid
artery NEAREST YOU
Rescue Breathing
• If victim shows signs of circulation but is
not breathing:
• Give one rescue breath every 5 seconds
• Reassess after 1 minute and every few
minutes thereafter
– Loosen restrictive clothing around the
neck
• No chest compressions when there are
signs of circulation
Hand Placement for CPR
Letakkan 2-3 jari diatas sternum, lakukan kompresi 30x kedalaman 1,5-2 inchi
Recovery Position
• Used in unresponsive, uninjured patients,
breathing adequately
• Gravity helps the airway to drain
Menghentikan RJP
• Teraba arteri karotis, pernafasan spontan
• Petugas kelelahan & tidak ada petugas yg
mengantikan dan RJP sudah dilakukan
selama 30 menit tapi tidak ada tanda-
tanda kehidupan
• Klien dinyatakan meninggal
Komplikasi RJP
• Fraktur iga posisi tangan salah
• Perdarahan intraabdominal posisi
tangan salah
• Distensi lambung ventilasi berlebihan
