Presentasi Anestesi.pptx

8/17/2019 Presentasi Anestesi.pptx

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BAGIAN/SMF ANESTESIOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS SYIAHKUALA

RSUD Dr. ZAINOEL ABIDIN

BANDA ACEH2016

Oleh:

Merysia KarmilaMufti Syarif Alfanshuri

Pembimbing:Dr. Teuku Yassir Sp.An. KIC

2015 Amr!"#$ H#r%A&&'"!#%!'$ G(!)*!$& U+)#%

,'r C#r)!'+(*m'$#r-R&(&"!%#%!'$ #$) Emr$"-

C#r)!'#&"(*#r C#r


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I$%r')("%!'$• Publiati!n !f the 2015 American Heart Association

(AHA) Guidelines Update for Cardiopulmonary

Resuscitation (CPR) and Emerency Cardio!ascular Care

(ECC) mar"s #$ years sine the "rst CP# gui$elines %ere

publishe$ in &'(( by an A$ )! C!mmittee !n

Car$i!pulm!nary #esusitati!n establishe$ by the

*ati!nal Aa$emy !f Sienes !f the *ati!nal #esearh

C!unil. Sine that time+ peri!$i re,isi!ns t! the

-ui$elines ha,e been publishe$ by the A)A in &'/+

&'01+ &'0(+ &''2+ 2111+ 2113+ 21&1+ an$ n!% 21&3.

#!bert 4. *eumar+ Chair5 Mihael Shuster5 Clift!n 4. Calla%ay5 6ana M. -ent5 Dianne 6. Atkins5 7arhan

8han9i5 Ste,en C. 8r!!ks5 Allan #. $e Caen5 Mihael 4. D!nnin!5 !se Maria ;. 7errer5 M!nia ;. Kleinman5Ste,en 6. Kr!nik5 ;ri . 6a,!nas5 Mark S. 6ink5 Mary ;. Manini56aurie . M!rris!n5 #!bert ;. Oabeth ). Sin>5 An$re% ). Tra,ers5 Myra


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@

• The 2010 AHA Guidelines for CPR and ECC

pro!ided a compre%ensi!e re,ie% !f e,i$ene

base$ re!mmen$ati!ns f!r resusitati!n+ ;CC+

an$ "rst ai$. The 2015 AHA Guidelines Update for

CPR and ECC focuses on topics &it% sini'cant

ne& science or !ng!ing !ntr!,ersy+ an$ s!

ser,es as an up$ate t! the 2010 AHA Guidelines

for CPR and ECC rat%er t%an a complete re,isi!n

!f the -ui$elines.#!bert 4. *eumar+ Chair5 Mihael Shuster5 Clift!n 4. Calla%ay5 6ana M. -ent5 Dianne 6. Atkins5 7arhan



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• ;thial Issues

•Systems !f Care an$ C!ntinu!us Buality Impr!,ement

• A$ult 8asi 6ife Supp!rt an$ Car$i!pulm!nary#esusitati!n Buality

• Alternati,e Tehniues an$ Anillary De,ies f!rCar$i!pulm!nary #esusitati!n

• A$ult A$,ane$ Car$i!,asular 6ife Supp!rt• P!stCar$ia Arrest Care

• Aute C!r!nary Syn$r!mes

• Speial Cirumstanes !f #esusitati!n

•

Pe$iatri 8asi 6ife Supp!rt an$ Car$i!pulm!nary#esusitati!n Buality

• Pe$iatri A$,ane$ 6ife Supp!rt

• *e!natal #esusitati!n

• ;$uati!n

• 7irst Ai$

C!ntent


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S(mm#r-

The 2015 AHA Guidelines Update for CPR and ECC

incorporated the e,i$ene fr!m the systemati re,ie%s

!mplete$ as part !f the 21&3 Internati!nal C!nsensus !n

CP# an$ ;CC Siene 4ith Treatment #e!mmen$ati!ns. This 21&3 -ui$elines Ep$ate marks the transiti!n fr!m

peri!$i re,ie% an$ publiati!n !f ne% sienebase$

re!mmen$ati!ns t! a m!re !ntinu!us pr!ess !f

e,i$ene e,aluati!n an$ gui$eline !ptimi>ati!n $esigne$

t! m!re rapi$ly translate ne% siene int! resusitati!n

pratie that %ill sa,e m!re li,es.


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A)(*% B#&!" L!, S(++'r% #$)C#r)!'+(*m'$#r- R&(&"!%#%!'$ (#*!%-

• N D*'+m$%& !$ B#&!" L!, S(++'r%S"!$" S!$" 2010

The 21&1 -ui$elines %ere m!st n!table f!r the

re!rientati!n !f the uni,ersal seuene fr!m A8C

FAir%ay+ 8reathing+ C!mpressi!nsG t! CA8

FC!mpressi!ns+ Air%ay+ 8reathingG t! minimi>e

time t! initiati!n !f hest !mpressi!ns.




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H!34(#*!%- CR !m+r'& &(r!#* ,r'm"#r)!#" #rr&%. C'm+'$$%& ', !34(#*!%-CR !$"*()

H ;nsuring hest !mpressi!ns !f a$euate rate

H ;nsuring hest !mpressi!ns !f a$euate $epth

H All!%ing full hest re!il bet%een !mpressi!ns

H Minimi>ing interrupti!ns in hest !mpressi!ns

H A,!i$ing e=essi,e ,entilati!n




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S!$!7"#$% N #$) U+)#%)R"'mm$)#%!'$&

Stu$ies :ina$euate

!mpressi!nrate an$ $epth5b!th err!rs may

re$ue sur,i,al.

21&3 -ui$elines : upper limits !fre!mmen$e$ !mpressi!n rate

base$ !n preliminary $ata suggestingthat e=essi,e rate may beass!iate$ %ith l!%er rate !f return !fsp!ntane!us irulati!n F#OSCG.


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• a$ult ,itims !f ar$ia arrest: &11 t! &21min

• During manual CP#: hest !mpressi!ns at a$epth !f at least 2 inhes !r 3 m

• In a$ult ar$ia arrest %ith an unpr!tete$ air%ay:

perf!rm CP# %ith the g!al !f a hest !mpressi!nfrati!n as high as p!ssible+ %ith a target !f atleast (1J+ t! limit interrupti!ns in !mpressi!nsan$ t! ma=imi>e !r!nary perfusi!n an$ bl!!$!% $uring CP#.

• If the patient is un!nsi!us %ith abn!rmal !rabsent breathing+ it is reas!nable f!r theemergeny $ispather t! assume that the patientis in ar$ia arrest


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Chest !mpressi!ns an$

,entilati!n L has an a$,ane$air%ay resuers n! l!nger $eli,eryles !f 1 !mpressi!ns an$ 2

breaths. & breath e,ery (se!n$s F&1 breaths per minuteG


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#!bert 4. *eumar+ Chair5 Mihael Shuster5 Clift!n 4. Calla%ay5 6ana M. -ent5 Dianne 6. Atkins5 7arhan8han9i5 Ste,en C. 8r!!ks5 Allan #. $e Caen5 Mihael 4. D!nnin!5 !se Maria ;. 7errer5 M!nia ;. Kleinman5Ste,en 6. Kr!nik5 ;ri . 6a,!nas5 Mark S. 6ink5 Mary ;. Manini56aurie . M!rris!n5 #!bert ;. Oabeth ). Sin>5 An$re% ). Tra,ers5 Myra

7!r ,itims %ith suspete$ spinal in9ury+resuers sh!ul$ initially use manual spinal

m!ti!n restriti!n Feg+ plaing & han$ !neither si$e !f the patientati!n $e,ies+beause use !f imm!bili>ati!n $e,ies by

lay resuers may be harmful


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A*%r$#%! T"$!4(& #$) A$"!**#r-D!"& ,'r C#r)!'+(*m'$#r-R&(&"!%#%!'$

Three ran$!mi>e$ linial trials !mparing the use!f mehanial hest !mpressi!n $e,ies %ith!n,enti!nal CP# ha,e been publishe$ sine the21&1 -ui$elines. *!ne !f these stu$ies

$em!nstrate$ superi!rity !f mehanial hest!mpressi!ns !,er !n,enti!nal CP#.

Alth!ugh se,eral !bser,ati!nal stu$ies ha,e beenpublishe$ $!umenting the use !f ;CP#+ n!ran$!mi>e$ !ntr!lle$ trials ha,e e,aluate$ thee?et !f this therapy !n sur,i,al.



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A)(*% A)#$") C#r)!'#&"(*#r L!,S(++'r%

The ma9!r hanges in the 21&3 a$,ane$ar$i!,asular life supp!rt FAC6SG gui$elinesinlu$e

pr!gn!stiati!n $uring CP# base$ !n en$ti$al

arb!n $i!=i$e measurements+use !f ,as!pressin $uring resusitati!n+

timing !f epinephrine a$ministrati!n strati"e$ bysh!kable !r n!nsh!kable rhythms+

the p!ssibility !f bun$ling ster!i$s+ ,as!pressin+an$ epinephrine a$ministrati!n f!r treatment !fI)CA



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'&%8C#r)!#" Arr&% C#r

The entral priniples !f p!st arrest are are

F&G t! i$entify an$ treat the un$erlying eti!l!gy !fthe ar$ia arrest

F2G t! mitigate ishemiareperfusi!n in9ury an$

pre,ent se!n$ary !rgan in9ury+ an$FG t! make aurate estimates !f pr!gn!sis t!

gui$e the linial team an$ t! inf!rm the family%hen seleting g!als !f !ntinue$ are.



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A"(% C'r'$#r- S-$)r'm&

These up$ate$ re!mmen$ati!ns plae ne%emphasis !n !btaining a preh!spital ;C- an$ !nb!th the neessity f!r an$ the timing !f reei,ingh!spital n!ti"ati!n.

H A preh!spital &2lea$ ;C- sh!ul$ be auire$early f!r patients %ith p!ssible ACS FClass I+ 6O;8*#G.

H Preh!spital n!ti"ati!n !f the h!spital Fif"brin!lysis is the likely reperfusi!n strategyG

an$!r preh!spital ati,ati!n !f theatheteri>ati!n lab!rat!ry sh!ul$ !ur f!r allpatients %ith a re!gni>e$ ST;MI !n preh!spital;C- FClass I+ 6O; 8*#G.



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S+"!#* C!r"(m&%#$"& ',R&(&"!%#%!'$

• Pre,enti!n an$ management !f resusitati!nemergenies relate$ t! !pi!i$ t!=iity+ an$ f!r ther!le !f intra,en!us lipi$ emulsi!n FI6;G therapy f!rtreatment !f ar$ia arrest $ue t! $rug !,er$!se.

• Ep$ate$ gui$elines f!r the management !far$ia arrest !urring $uring the se!n$ half !fpregnany+ ar$ia arrest ause$ by pulm!naryemb!lism+ an$ ar$ia arrest !urring $uring PCIare inlu$e$.



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)!#%r!" B#&!" L!, S(++'r% #$)C#r)!'+(*m'$#r- R&(&"!%#%!'$(#*!%-

• The ma9!r CP# pr!ess harateristis that %eree,aluate$ inlu$e CA8 FC!mpressi!n+ Air%ay+8reathingG+ !mpressi!n !nly CP#+ !mpressi!n$epth an$ rate.

• C!mpressi!n $epth !f at least !ne thir$ !f theanteri!rp!steri!r $iameter+ appr!=imately &+3inhes F/ mG f!r infants an$ 2 inhes F3 mG f!rhil$ren+ %as aNrme$.

• C!mpressi!n rate %as n!t re,ie%e$ beause !f

insuNient e,i$ene+ an$ %e re!mmen$ thatresuers use the a$ult rate !f &11 t! &21min.



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)!#%r!" A)#$") L!,S(++'r%

•

*e% literature suggets limite$ sursi,al bene"t t!the r!utine use !f atr!pine as a preme$iati!n f!remergeny traheal intubati!n !f n!n ne!nates+an$ that any bene"t in pre,enting arrhythmias is!ntr!,ersial. *e% e,i$ene als! suggesting there

is n! minimum $!se reuaire$ f!r atr!pine use.• *e% e,i$ene suggests that either ami!$ar!ne !r

li$!aine is aeptable f!r treatment !f sh!krefrat!ry pe$iatri ,entriular "brillati!n an$pulseless ,entriular tahyar$ia.



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N'$#%#* R&(&"!%#%!'$

• Embilial !r$ management

• Assessment !f heart rate

• Maintaining n!rmal temperature !f the ne%b!rnafter birth

• Management !f the me!nium staine$ infant

• O=ygen use f!r preterm infants in the $eli,eryr!!m

• O=ygen use $uring ne!natal ar$ia !mpressi!ns

• Struture !f e$uati!nal pr!grams t! teahne!natal.

• Etility !f a sustaine$ inati!n $uring the initialbreaths after birth.

• Determinati!n !f heart rate.


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E)("#%!'$

• #esearh !n resusitati!n e$uati!n nee$s higheruality stu$ies that a$ress imp!rtant e$uati!naluesti!n.

• Out!mes fr!m e$uati!nal stu$ies sh!ul$ f!us

!n patient !ut!mes+ perf!rmane in the linialen,ir!ntment+ !r at least l!ng term retenti!n !fpsy!m!t!r an$ beha,i!ral skills in the stimulate$resusitati!n en,ir!ntment.


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F!r&% A!)

• ;,i$ene sh!%s that the early re!gniti!n !f str!ke byusing a str!ke assessment system $erease the inter,albet%een the time !f str!ke !nset an$ arri,al at ah!spital an$ $e"niti,e treatment.

• )yp!glyemia is a !n$i!n that is !mm!nlyen!untere$ by "rst ai$ pr!,i$ers+ !ral glu!see sh!ul$be gi,en t! attempt t! res!l,e the hyp!glyemia.

• As a result !f the lak !f e,i$ene f!r use !f an!lusi,e $ressing an$ the risk !f unre!gni>e$ tensi!npneum!th!ra=+ %e re!mmen$ against the appliati!n

!f an !lusi,e $ressing !r $e,ie by "rst ai$ pr!,i$ersf!r an in$i,i$ual %ith an !pen hest %!un$.

• ;,i$ene shg!%s that e$uati!n in the "rst ai$ aninrease sur,i,al rates+ impr!,e re!gniti!n !f auteillness+ an$ res!l,e sympt!mat!l!gy.


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S(mm#r-

The 2015 AHA Guidelines Update for CPR and ECC

incorporated the e,i$ene fr!m the systemati re,ie%s

!mplete$ as part !f the 21&3 Internati!nal C!nsensus !n

CP# an$ ;CC Siene 4ith Treatment #e!mmen$ati!ns. This 21&3 -ui$elines Ep$ate marks the transiti!n fr!m

peri!$i re,ie% an$ publiati!n !f ne% sienebase$

re!mmen$ati!ns t! a m!re !ntinu!us pr!ess !f

e,i$ene e,aluati!n an$ gui$eline !ptimi>ati!n $esigne$

t! m!re rapi$ly translate ne% siene int! resusitati!n

pratie that %ill sa,e m!re li,es.


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@

The Appen$i= t! this Part !ntains a list !f all

re!mmen$ati!ns publishe$ in the 21&3

-ui$elines Ep$ate an$+ in a$$iti!n+ lists the

re!mmen$ati!ns fr!m the 21&1 -ui$elines. The

21&3 re!mmen$ati!ns %ere ma$e !nsistent

%ith the ne% A)A Classi"ati!n System f!r

$esribing the riskbene"t rati! f!r eah Class an$

the 6e,els !f ;,i$ene supp!rting them.


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