resusitasi bayi
TRANSCRIPT
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Resuscitation in PediatricDr. Afriyan Wahyudhi, SpA, MKes
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A Airway
B Breathing
C CirculationD Disability
E Exposure
Penilaian Klasik
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Look, Listen, Feel
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kepala besar, leher pendek -> fleksi leher gigi / rahang -> rapuh
lidah besar -> obstruksi jalan nafas trakhea pendek dan kecil -> over ekstensi -> kompresi
trakhea berbeda sesuai dengan usia maka berbeda problem
o < 6 bulan : nasal breather o 3-8 thn : hipertrofi adeno tonsilar
Pada Anak
Airway
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Suara Penyebab
Stridor Obstruksi jalan nafas atas
Mengi Obstruksi jalan nafas bawahmerintih Oksigenasi tidak adekuat
Ronkhi basah Cairan, lendir, darah pada jalan nafas
Suara nafas –Usaha nafas
Obtruksi jalan nafas totalGangguan transmisi suara
Interpretasi Suara Nafas Abnormal
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laju/ frekuensi pernafasanretraksistridor inspirasi / ekspirasigruntingpenggunaan otot bantu nafasnafas cuping hidung
Gangguan pernafasan berat
Depresi SSPPenyakit neuromuskular
tidak bisa dinilai
pada
BREATHING
Usaha Nafas/Kinerja Pernafasan
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dipengaruhi : demam, nyeri, emosi/ takut
frek > 60 : potensial gagal nafas
retraksi , kesadaran
Frekuensi Nafas
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frekuensi jantung/kompensasiHipoksia takikardiHipoksia berat dan lama bradikardi
warna kulithipoksia vasokonstriksi pucat
kesadaran
hipoksia/ hiperkapnia agitasi dan /atau mengantuk
Efek Gangguan Breathing pada Organ Lain
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frekuensi denyut Takikardi : tanda hipoksia, perfusi buruk
demam, sakit, takut
bradikardi: hipoksia, iskemia
isi dan tekanan(volume nadi)
Kuat, filiformis
capillary refil normal < 2 detik
tekanan darah
produksi urin
hipotensi
1 – 2 cc/ kgbb/jam
Circulation
Status Cardio Vaskular
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DISABILITYStatus Neurologik
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Untuk evaluasi fungsi fisiologis dan identifikasikelainan anatomis
Monitor suhu
Pertahankan lingkungan sekitar yang hangat
Hangatkan cairan infus
Exposure
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CPR
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Basic Life Support
• The big change: no longer ABC
• Now it’s C-A-B
• Why?• Don’t delay compressions for
positioning airway, obtaining a seal
for mouth-to-mouth, etc
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The change from ABC to CAB applies to infantsand children as well as adults
• High quality compressions are essential togenerate blood flow to vital organs
• Beginning CPR with 30 compressions rather
than 2 ventilations leads to shorter delays tofirst compression
• All rescuers should be able to deliver
compressions almost immediately. Positioningthe head and attaining a seal for ventilation
takes time and delays the initiation of CPR
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The change from ABC to CAB applies to infantsand children as well as adults
• Hypoxic arrest is more common than VF ininfants and children and ventilations are
extremely important in pediatric resuscitation
• Starting with compressions only delaysventilations by approximately 18 seconds for
alone rescuer and even shorter for two
rescuers
• CAB simplifies training with the hope that more
victims will receive bystander CPR
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The Guideline..........
• Chest compressions should be immediately started by
one rescuer, while a second rescuer prepares to startventilations with a bag and mask. Ventilation is
extremely important in pediatrics because of the large
percentage of asphyxial arrests in which best results are
obtained by a combination of chest compressions andventilations. Unfortunately ventilations are sometimes
delayed because equipment (bag, mask, oxygen,
airway) must be mobilized. Chest compressions require
only the hands of a willing rescuer. Therefore, start CPR
with chest compressions immediately, while a second
rescuer prepares to provide ventilations (Class I, LOE
C).
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Rules
In less than 10 sec, start compression if :
Unresponsive
Not breathing normally or only gasping
No sign of life
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How to do chest compression ?
Two finger chest compression in infant (1 rescuer)
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2 thumb-encircling hands chest compression
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Compression ratio
• Single rescuer = 30 comp : 2 breaths
• 2 or more rescuer = 15 comp : 2 breaths
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CPR
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The EC clamp technique of bag mask ventilations
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• The effectiveness, dependent on high-qualityCPR, which requires an adequate compression
rate (at least 100 compressions/ min), an
adequate compression depth (at least one third
of the AP diameter of the chest or approximately11 ⁄2 inches [4 cm] in infants and approximately 2
inches [5 cm] in children), allowing complete
recoil of the chest after each
compression,minimizing interruptions incompressions, and avoiding excessiveventilation
The Guideline..........
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It’ l b t ibilit th i d f
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• It’s only about responsibility, the wisdom of adoctor, and pride.
A great Doctor will be.....
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Terimakasih