Basic skills of medical personnel: CPR / Cardiopulmonary Resuscitation

CHAPTER I

INTRODUCTION

1.1 Background

Cardiac Pulmonary Resuscitation is very important in the life of the medical world, so that every doctor should be able to perform Cardiac Pulmonary Resuscitation. Well as other paramedics. In fact, any layperson who works in a place where a lot of people (the crowd) or the place where a lot of work to contain the risk of work should be able to be trained in Cardiac Pulmonary Resuscitation is a simple to a more competent medical officer. B-gels or in the Indonesian language known as the Emergency First Aid (PPGD) is the set of the first attempts to do in emergency conditions in order to save patients from death. Abroad, PPGD is actually taught in many ordinary people or ordinary people special, but it seems this is still very little known by the people of Indonesia.

1.2 Key Principles

 PPGD is the main principle of saving the patient from death in emergency conditions. Later in the PPGD philosophy is "Saving Time is Life Saving", in the sense that all actions taken during emergency conditions to be truly effective and efficient, because the patient's condition may have lost their lives in just minutes (stopping breathing for 2 -3 minutes can cause death).

1.3 Basic Steps

The basic steps in PPGD known by the acronym ABCD (Airway - Breathing - Circulation - Disability). These four points are the points that should be kept in the response of patients in emergency conditions.

1.4 Pulmonary Resuscitation heart

Stop the breath because:

- Airway Obstruction

- Foreign bodies

- Aspiration

- The tongue falls down

- Pipe folded endotracheal

- Blocked tracheal cannula

- Acute Abnormalities of the glottis and surrounding

- Depression of central respiratory

- Drugs

- Intoxication

- High pCO2

- Low pO 2

- After the cardiac arrest

- Brain tumors

- Sunset

Peripheral:

- Drug muscle paralytic

- Myasthenia gravis

- Poliomyelitis

For the Stop Heart

1. Cardiovascular (heart disease siskemik, IMA, pulmonary embolism and conduction system fibrosis)

2. Acute oxygen deficiency (stopping breathing, and obstruction due to foreign body secretions)

3. Overdose of drugs (digitalis and adrenaline)

4. Acid-base disturbances / electrolyte (K increases or decreases, increased Mg, Ca increases, acidosis)

5. Accidents (electric shock, drowning)

6. Vagal reflex

7. Anesthesia and surgery

8. Medical diagnostic and therapeutic measures

9. Shock, cardiac arrest can be accompanied by electrical phenomena.

Adam Stokes syndrome

Condition caused by high degree AV block heart is characterized by episodic bradycardia or asystole that resulted in the attack who are not aware of themselves suddenly with / without a seizure action.

- Artificial Circulation

- External cardiac massage

Indications CPR: Stop or stopping breathing and circulation.

Contraindications: Cardiac arrest, rib fractures, thoracic fractures, cardiac tamponade, pneumothorax, severe emphysema, Cardiac Arrest over 5-6 minutes.

KEMAMPUAN DASAR MEDIS : RESUSITASI JANTUNG PARU / CARDIO PULMONARY RESUSCITATION ( CPR)

BAB I

PENDAHULUAN

1.1 Latar Belakang

Resusitasi Jantung Paru sangat penting dalam kehidupan dunia medis, sehingga setiap dokter harus bisa melakukan Resusitasi Jantung Paru. Juga petugas paramedis lainnya. Malah orang awam pun yang bekerja di tempat tempat yang banyak orang (keramaian) atau tempat tempat pekerjaan yang banyak yang mengandung resiko kerjaan harus bisa untuk dilatih Resusitasi Jantung Paru yang sederhana sampai petugas medis yang lebih berwenang datang. B-GELS atau dalam bahasa Indonesia dikenal dengan Pertolongan Pertama Pada Gawat Darurat (PPGD) adalah serangkaian usaha-usaha pertama yang dapat dilakukan pada kondisi gawat darurat dalam rangka menyelamatkan pasien dari kematian. Di luar negeri, PPGD ini sebenarnya sudah banyak diajarkan pada orang-orang awam atau orang-orang awam khusus, namun sepertinya hal ini masih sangat jarang diketahui oleh masyarakat Indonesia. 

1.2 Prinsip Utama

 Prinsip Utama PPGD adalah menyelamatkan pasien dari kematian pada kondisi gawat darurat. Kemudian filosofi dalam PPGD adalah “Time Saving is Life Saving”, dalam artian bahwa seluruh tindakan yang dilakukan pada saat kondisi gawat darurat haruslah benar-benar efektif dan efisien, karena pada kondisi tersebut pasien dapat kehilangan nyawa dalam hitungan menit saja ( henti nafas selama 2-3 menit dapat mengakibatkan kematian). 

1.3 Langkah-langkah Dasar 

Langkah-langkah dasar dalam PPGD dikenal dengan singkatan A-B-C-D ( Airway - Breathing – Circulation – Disability ). Keempat poin tersebut adalah poin-poin yang harus sangat diperhatikan dalam penanggulangan pasien dalam kondisi gawat darurat.

1.4 Resusitasi jantung Paru

Sebab Henti nafas :

- Sumbatan jalan nafas

- Benda asing

- Aspirasi

- Lidah jatuh kebawah

- Pipa endotrakeal terlipat

- Kanul trakeal tersumbat

- Kelainan akut glottis dan sekitarnya

- Depresi pernafasan sentral

- Obat

- Intoksikasi

- pCO2 tinggi

- pO2 rendah

- Setelah henti jantung

- Tumor otak

- Tenggelam 

Perifer  :

-    Obat pelumpuh otot

- Miastenia gravis

- Poliomielitis

Respiratory management with intubation for emergency personnel (SURGERY)

Chapter I

INTRODUCTION

Since the surgery, the medical community has actually attempted to perform acts of anesthesia aims to reduce and eliminate pain or pain. (Anonymous, 1989) In principle, a patient will be unconscious to perform actions that are performed physical such as hitting, choking, and so forth. It had to be done so that the patient does not feel pain, and finally jumped off the table which resulted in disruption of the proceedings of operation. (Anonymous, 1986).
Since the introduction of ether gas usage by William Thomas Greene Morton in 1846 in Boston United States, then gradually in ways that physical violence is often done to achieve a state of anesthesia becoming obsolete. Discovery was a turning point in the history of surgery, because it opens up the possibility of surgical horizons broader, easier and humane. (Anonymous, 1986).
In an operation, a surgeon can not work alone in dissecting patients while creating a state of anesthesia. Required the presence of an anesthetist to seek, handle and maintain a state of anesthesia the patient. The job of an anesthesiologist in an operating event include:
A. Relieve pain and emotional stress during the process of doing surgery or other medical procedures.
2. To manage common medical measures to the patients operated, keeping the functions of the organs of the body goes in the normal range so that patient safety is maintained.
3. Create the best possible operating conditions so that the surgeon can perform their duties easily and effectively.

One business that absolutely must be performed by an anesthesiologist is to maintain the functioning of organs in normal patients, with no significant effect due to the surgical process. Airway management became one of the most important part in an act of anesthesia. Because some of the effects of drugs used in anesthesia may affect the state of the airway goes well.

One attempt to maintain the patient's airway with endotracheal intubation action, namely by inserting a tube into the upper respiratory tract. Because the main requirements that must be considered in the general anesthesia is to keep the airway and breathing are always free to run smoothly and orderly. In fact, according to Halliday (2002) use of endotracheal intubation is also recommended for neonates with complicating factors that can interfere with the airway. This paper will elaborate on endotracheal intubation, and will only be limited to the issue.
Chapter II
Anatomy and Physiology


2.1 Anatomy - Upper Respiratory Physiology.

            Endotracheal intubation in action we must first understand the anatomy and physiology of the upper airway where intubation was installed. In the discussion of the anatomy and physiology, the authors will elaborate on some matters relating to the physiology of the oropharynx cavity, naso pharynx and some will be more emphasized in the larynx.
Human respiratory system has a picture of a common design that can be attributed to a number of important activities. This system would essentially consist of surface respiration and branched into conducting passages that make up the respiratory tree. Surface respiration is an area of approximately 200 m2, and forming something very thin, moist barrier to air and blood capillaries surrounding the millions of bags called alveoli that eventually form a mass of lung (Williams, 1995: 1630).

2.2 Internal and External Respiration

            Respiration is a combination of physiological processes in which oxygen is inhaled and carbon dioxide released by cells in the body. This is an important process of gas exchange. Respiration is divided into two phases. The first phase of external expiratory in the same sense with breathing. It is a combination of movement and skeletal muscle, where the air for the first time pushed into the lungs and then removed. These events include the inspiration and expiration. Phase to another is internal respiration which includes transfer / movement of the molecules of the respiratory gases (oxygen and carbon dioxide) through the membrane, fluid displacement, and the cells of the body as needed.

2.3 Respiratory Organs

Respiratory tract include: (a) nasal cavity (b) of the larynx (c) trachea (d) bronchi (e) lung and (f) pleura. Pharynx has two functions: to the respiratory system and digestive system. Some of the muscles involved in breathing process. The diaphragm is the most important respiratory muscle in addition to the internal and external muscular intercostalis some other muscles.