Basic Life

Support

Emilzon Taslim, dr., SpAn., MKes

Bagian Anestesiologi dan Reanimasi
Fakultas Kedokteran Universitas Andalas/
RS. Dr. M. Djamil Padang
 Triage dan evakuasi
Siapa didahulukan dan siapa dikirim ke mana

4 korban Ratusan korban

Natural disaster
Complex disaster
Kerusuhan
Complex
disaster
Man-made disaster
Kecelakaan kereta api

Mass-casualties small scale

disaster
Silent epidemic
 Introduction
The leading causes of preventable or reversible
sudden death resulting from heart attacks,
accidents, and other medical emergency

hypoxia or anoxia from:

airway obstr. hypoventilation
apnea blood loss
pulselessness brain injury
Irreversible brain damage may occur
when very low oxygen transport or no
oxygen transport lasts longer than a
few minutes.
Cardiopulmonary cerebral Resuscitation

• Phase I : Basic Life Support (BLS)

 Emergency oxygenation. (A,B,C)

• Phase II: Advanced Life Support (ALS)

 Restoration of spontaneous circulation.
(D,E,F)
• Phase III: Prolonged Life Support (PLS)
 Cerebral resuscitation and post resus-
citation intensive therapy. (G,H,I)
CPCR / RJPO (Peter Safar)

1. Basic life support  emergency oxygenation

A : Airway
B : Breathe
C : Circulate
2. Advanced life support  Restoration of spontaneous
circulation
D : Drugs and Fluids
E : EKG
F : Fibrillations treatment
3. Prolonged life support  post resuscitation brain –
oriented therapy
G : Gauging
H : Human mentation
I : Intensive care
Basic Life Support

•Airway control
•Breathing support
•Circulation support
With or without equipment
irway control
PRIORITAS UTAMA

• Airway
Bebas dan terjaga

• Breathing / ventilation
Adekuat

• Supplemen oxygen
Adekuat
 Airway control
Partial
• Cause of airway obstruction: Complete

 Base tongue and epiglottis fall to the

posterior pharyngeal wall.
 the most common.
 Foreign matter (vomitus, blood).
 Laryngospasm.
 in lightly comatous pasient.
• Complete: if one can not hear or feel air
flow at the mouth or nose.
- Spontaneous breathing 
retraction (+) but chest expansion (-).
- Apnea 
when PPV to inflate the lung difficult.
• Partial: is recognized by noisy air flow
 Patient Assessment
• Level of consciousness
• Spontaneous efforts vs. Look, listen, and feel
apnea
• Airway and cervical spine
injury
• Chest expansion
• Signs of airway obstruction
• Breath sounds
• Protective airway reflexes
SUMBATAN JALAN NAFAS

• Look / Lihat
 Perubahan Status Mental
Agitasi / gelisah  Hipoksemia
Obtundasi / teler  Hiperkarbia
 Gerak Nafas
Normal
See saw / rocking
 Retraksi
 Deformitas
 Debris
Darah / sekret
Muntahan
Gigi
 Sianosis
SUMBATAN JALAN NAFAS

• Listen / Dengar
 Bicara normal  Tak ada sumbatan
 Ada suara tambahan
Snoring  Lidah
Gurgling  Cairan
Stridor / crowing  Penyempitan
 Suara parau (hoarseness / dysphonia)

• Feel / Raba
 Hawa nafas
 Krepitasi / fraktur (maxillofacial / laryngeal)
 Deviasi trakhea
 Hematoma
 Getaran di leher
 MACAM SUMBATAN

LOOK LISTEN FEEL

SUMBATAN GERAK SUARA HAWA

NAFAS TAMBAHAN EKSHALASI

BEBAS NORMAL ⊝ ⊕

PARSIAL RINGAN NORMAL ⊕ ⊕

PARSIAL BERAT SEE SAW ⊕ +

TOTAL SEE SAW ⊝ ⊝

PENGELOLAAN PERLU :
CEPAT, TEPAT, CERMAT

Sumbatan Total :

• FRC (Functional Residual Capacity) : 2500 ml

• Kadar O2 15% x 2500 ml : 375 ml

• Kebutuhan O2 permenit : 250 ml

• Bila ada sumbatan total  O2 dalam paru habis dalam

: 375 / 250 : 1,5 menit
PENYEBAB SUMBATAN

• Lidah

• Epiglotis

• Benda asing / muntahan / darah / sekret

• Trauma jalan nafas

PEMBEBASAN JALAN NAFAS

PENYEBAB LIDAH
• Manual :
- Non trauma :
Head tilt
Neck lift
Chin lift
Jaw thrust
- Trauma :
Chin lift
Jaw thrust
Dengan in-line manual immobilization” atau
pasang cervical collar

• Bantuan Alat
- Oropharyngeal airway
- Nasopharyngeal airway
 Airway control (con’t)

• Without equipment:
 Chin lift, jaw thrust, head tilt.
 Lung inflation attempts
 Manual clearing of mouth and throat.
 Pada pasien trauma

head tilt
chin lift

neck lift

neck lift
Don’t do Be careful
JAW THRUST

dianjurkan
 Opening the Airway – the Triple
Airway Maneuver

• Slightly extend neck

(when cervical spine
injury not suspected)
• Elevate mandible
• Open mouth
• Consider adjunctive
devices
 Airway control (con’t)

• With equipment:
 Pharyngeal suctioning.
 Oro/Nasopharyngeal intubation.
 Laryngeal Mask Airway (LMA).
 Endotracheal/bronchial intubation.
 Cricothyrotomy – laringeal jet insufflation.
 Tracheostomy.
Pharyngeal intubation
Endotracheal intubation - technique
Tracheostomy tube Translaryngeal O2 jet
insufflation
 Oro-pharyngeal tube

Perhatikan ukuran
 1 2
OROFARINGEAL
TUBE

3 4
 Naso-pharyngeal
Nasopharyngeal tube tube

Tidak merangsang muntah

Ukuran u/ dewasa 7 mm atau
jari kelingking kanan
NASOFARINGEAL
TUBE
PEMBEBASAN JALAN NAFAS

PENYEBAB BENDA ASING

• Manual

• Penghisap

• Definitive airway

• Pada chocking :
 Back blows
 Abdominal thrust (Heimlich manuver)
 Thoracal thrust
 Cricothyroidotomy
 CHOKING

Back blows

Lima kali hentakan

pada punggung,
diantara dua scapula
CHOKING

Heimlich
Abdominal trust

Korban : sadar
Heimlich Abdominal trust

Korban : Tidak sadar

Membrana cricothyroid

Pada keadaan gawat darurat

- Tempat injeksi transtracheal

obat emergency
- Tempat untuk
needle dan surgical
cricothyroidotomi

Bagaimana caranya ??
Obat apa saja boleh masuk ??
DEFINITIVE AIRWAY

Indications

1. Apnea

2. Risk of aspiration

3. Insecure airway

4. Poor oxygenation

5. Impending airway compromise

7. Closed head injury

TUJUAN INTUBASI ENDOTRAKHEAL

1. Sebagai jalan nafas

2. Untuk oksigenasi
3. Untuk pemberian ventilasi
4. Mencegah aspirasi
5. Jalan pemberian obat (intra trakheal)
6. Bronchial toilet

MACAM INTUBASI ENDOTRAKHEAL

• Orotrakehal  Lewat mulut

• Nasotrakheal  Lewat hidung
ENDOTRACHEAL INTUBATION

The trachea should be intubated by properly

trained personnel
PERALATAN INTUBASI ENDOTRAKHEHAL

• Laryngoscope dengan blade yang sesuai

• Tube dengan ukuran yang sesuai
• Jelly
• Anestetik lokal / spray
• Forceps – magill
• Bite block / oropharyngeal airway
• Adhesive tape / tali
• Suction – metal yang kauer
• Connectors
• Synringe (20 cc)
• Stylet
• Stetoscope
• End tidal CO2 monitor
INTUBASI
INTUBASI ENDOTRAKHEAL

• Oksigenasi + ventilasi (5 menit)

• Alat dan obat siap
• Harus berhasil kurang 30 detik
• Bila > 30 detik belum berhasil  oksigenasi + ventilasi ulang
• Penolong  tak kuat tahan nafas
• Saturasi O2 menurun
• Monitoring :
Saturasi O2 (Pulse oxymeter)
End-tidal CO2 (Capnografi)
reathing support
GANGGUAN VENTILASI

Penyebab
• Tindakan anestesi
• Penyakit
• Kecelakaan trauma

Lokasi
• Sentral
Pusat nafas
• Perifer
Jalan nafas Dinding dada
Paru Otot nafas
Rongga pleura Syaraf & jantung
GANGGUAN VENTILASI
(penderita masih bernafas)

Look / Lihat
Sianosis Takhipnea
Status mental Distensi vena leher
Asimetri dada Paralisis otot nafas

Listen / dengar
Keluhan: “Tak bisa nafas!”
Stridor, wheeze
 atau hilang suara nafas
 …………gangguan ventilasi
(penderita masih bernafas)

Feel / raba
Hawa ekspirasi
Emfisema subkutan
Krepitasi / tenderness / nyeri
Deviasi trakhea

Adjuncts
Pulse oximeter
CO2 detector
Gas darah
X-ray dada
DASAR PEMBERIAN VENTILASI

• Intermittent positive pressure ventilation (IPPV)

• Penderita tak bernafas

Nafas buatan (controlled ventilation)

• Penderita masih bernafas / tak adekuat

Nafas bantuan (assisted ventilation)
Diberikan pada akhir ekspirasi

• Tekanan oropharing > 25 cm H2O  udara masuk

 esophagus  distensi lambung
 ………….dasar pemberian ventilasi

• Sellick’s maneuver
Menekan cricoid kebelakang sehingga esophagus
terjepit diantara cricoid dan corpus vertebra leher

Agar :
Udara tak masuk lambung
Isi lambung tak mengalir ke oropharing
Tak boleh pada cedera tulang leher

• Nafas buatan :
Tidak volume 10-15ml/kg
Frequensi 12-15 / m
CARA PEMBERIAN VENTILASI

Tanpa Alat
Mouth to mouth
Mouth to nose
Mouth to mouth and nose

Dengan Alat
Safar airway
Esophageal obturator airway
Face mask / pocket mask
Laryngeal mask
Bag-valve-mask
Bag-valve-tube
Ventilator
 Breathing support

Goals: Emergency artificial ventilation and oxy-

genation.
Without equipment:
Mouth to mouth/nose ventilation.
With equipment: (with or without oxygen)
• Mouth to adjunct.
• Manual bag-mask (tube) ventilation.
• Mechanical ventilation.
 Breathing support (con’t)

Position your cheek close to victims' nose and

mouth, look toward victims' chest.

Look, listen, and feel for breathing (5-10 seconds).

If not breathing, pinch victim's nose closed and give

2 full breaths into victim's mouth.

If breaths won't go in, reposition head and try again

to give breaths.
Nafas buatan
Nafas berhenti

Nafas ada
 Manual Assisted Ventilation

• Open the airway

• Apply face mask and
obtain seal
• Deliver optimal
minute ventilation
from resuscitation bag
• Consider cricoid
pressure
 Single-Handed Method
of Face Mask Application
• Base of mask placed over
chin and mouth opened
• Apex of mask over nose
• Mandible elevated, neck
extended (if no cervical
spine injury), and
downward pressure by
mask hand
 Two-Handed Method of
Face Mask Application
• Helpful when mask
seal difficult
• Fingers placed along
mandible on each
side
• Assistant provides
ventilation
Inadequate Mask-to-Face Seal

• Identify leak
• Reposition face mask
• Improve seal along cheek(s)
• Change mask inflation or size
• Slightly increase downward pressure
over face
• Use two-handed technique
irculation support
C (Circulation)

Assessment of organ perfusion

- Level of conciousness

- Skin color and temperature

- Pulse rate and character

- Urinary output
 SHOCK

An abnormality of the circulatory system

that result in inadequate organ perfusion

and tissue oxygenation

GANGGUAN SIRKULASI

• Syok
• Disritmia
• Henti jantung
• dll
 SHOCK RECOGNITION AND MANAGEMENT

• Recognize signs of inadequate perfusion

and oxygenation
• Identify probable cause
• Restore perfusion
• Re-evaluate patient response
• Immediate involvement by specialists
CLINICAL SIGNS

1. Tachycardia
2. Vasoconstriction
3.  cardiac output
4. Narrow pulse pressure
5.  MAP
6.  blood flow
Remember :
Compensatory mechanisms
 Circulation support

• Control of external hemorrhage.

• Position for shock.

• Pulse checking.
• Manual chest compressions.
 BLEEDING
Apply direct pressure to
the wound (at this time a
direct pressure bandage
may be used)
Elevate (do not further
harm)
Pressure Point additional
pressure may be applied to
a pressure point to help
reduce bleeding.
CARE FOR SHOCK
 Keep the victim laying down
(if possible).
 Elevate legs 10-12 inches…
unless you suspect a spinal
injury or broken bones.
 Cover the victim to maintain
body temperature.
 Provide the victim with
plenty of fresh air.
 If victim begins to vomit -
place them on their left side.
 Circulation (con’t)

Check for carotid pulse by feeling for 5-10

seconds at side of victims' neck.

If there is a pulse but victim is not

breathing, give Rescue breathing at rate
of 1 breath every 5 seconds Or 12
breaths per minute.
 Circulation (con’t)

• If there is no pulse, begin chest com-

pressions as follows:
– Place heel of one hand on lower part of
victim's sternum. With your other hand
directly on top of first hand, Depress
sternum 1.5 to 2 inches.
• Perform 15 compressions to every 2
breaths.
Conclusion
CARDIOPULMONARY RESUSCITATION
CPR ABC’s
AIRWAY - Open the
airway with the tilt-
chin method.
Breath - give two
breaths.
Check circulation.

 If there is no pulse or
breathing…..(next slide)
 CPR Continued

… Perform chest compressions.

15 compressions and two breaths.
…Count = 1&2&3&4&5…&15
 RESCUE BREATHING

1 breath every 5 seconds - 12 per

minute.

Compressions : ventilations = 15:2