6 Langkah Bantuan Hidup Dasar (BHD) Metode D-R-S-C-A-B

Mind Full Ners – Halo ners, menjadi seorang perawat tentunya kita harus memiliki kemampuan dalam melakukan bantuan hidup dasar atau basic life support yang merupakan keterampilan yang sangat penting dalam penanganan pada pasien henti nafas dan henti jantung.

Nah, berikut ini adalah 6 langkah atau D-R-S-C-A-B yang perlu dilakukan dalam menolong korban henti jantung:

D-anger

Saat kita melihat korban yang tidak sadarkan diri seperti diakibatkan serangan jantung, tersambar petir atau korban kecelakaan, penting melihat kondisi sekitar untuk memastikan keamanan dalam menolong korban. Sebaiknya pastikan bahwa :

  1. Lokasi benar-benar aman bagi penolong, orang-orang di sekitar lokasi kejadian dan korban itu sendiri.
  2. Periksalah segala sesuatu yang dapat yang mengancam keselamatan.
  3. Gunakan pelindung diri yang ada, seperti sarung tangan dan masker untuk mencegah faktor risiko infeksi menular.
mindfullners.com/safe

R-esponse

Setelah itu lakukan penilaian tingkat kesadaran korban, dicek apakah korban dalam keadaan sadar dan merespon dengan baik.

Pemeriksaan tingkat kesadaran dapat menggunakan metode AVPU (alert, voice responsive,  pain responsive, unresponsive). Pasien dikatakan alert apabila sadar penuh, jika tidak ada respon, berikan respon suara (voice), lalu beri rangsang nyeri (pain). Jika tidak ada respon sama sekali pasien dikategorikan sebagai unresponsive.

Selain itu, pada saat cek respon kita juga dapat mengecek apakah korban bernapas spontan atau tidak dan juga apakah jantung masih bertdetak atau tidak. Jika tidak, korban baru bisa mendapatkan penanganan lebih lanjut. Pengecekan napas bisa dilakukan dengan melihat pergerakan dada.

mindfullners.com/carotidartery

Pemeriksaan Nadi dengan cepat dilakukan dengan meraba denyut arteri karotis atau arteri radialis. Penolong tidak boleh memeriksa denyut nadi >10 detik. Jika nadi tidak terasa dalam waktu tersebut, penyelamat harus memulai kompresi dada.

Pemeriksaan Frekuensi dan Pola Pernapasan dilakukan dengan metode look-listen-feel. Metode ini dilakukan dengan melihat gerakan dada pasien, sambil mendekatkan telinga penolong ke hidung dan mulut pasien untuk mendengar dan merasakan hembusan udara dari sistem pernapasan.

S-hout Call EMS / S-hout For Help

Aktifkan Sistem Penanggulangan Gawat Darurat

Saat menemukan orang dengan tanda henti jantung, yaitu tidak berespon, tidak teraba denyut nadi, dan tidak bernapas atau pola pernapasan abnormal, maka penolong harus segera memanggil bantuan untuk mengaktifkan sistem penanggulangan gawat darurat terpadu (SPGDT).

mindfullners.com/panggilbantuan

Jika kejadian di Rumah Sakit  => Aktifkan sistem CODE BLUE

C-ompression

RJP atau CPR adalah kombinasi daru tindakan kompresi dada dan bantuan napas. Ketika jantung tidak bisa berdetak, kompresi dada diperlukan untuk sirkulasi darah yang membawa oksigen. Teknik Compression pada RJP:

mindfullners.com/compression

Posisi Pasien Saat Kompresi :

Posisi pasien terbaik untuk RJP adalah terlentang (supinasi) pada permukaan yang keras, sehingga kompresi jantung di area sternum menjadi efektif. Posisi penolong yang melakukan kompresi dada harus lebih tinggi daripada pasien, untuk mencapai regangan lengan yang cukup sehingga dapat menggunakan berat badannya untuk mengkompresi dada. Jika terdapat 2 orang, penolong yang lain berada di sebelah kepala pasien untuk melakukan bantuan napas.

Syarat Kompresi Dada Yang Baik Adalah:

  1. Kompresi diulang sebanyak 30 kali, dengan kecepatan 100‒120 kali/menit
  2. Kompresi dilakukan dengan cepat dan kuat, dengan kedalaman minimal 5 cm dan maksimal 6 cm
  3. Pastikan dada recoilsempurna, yaitu kembali ke posisi awal sebelum ditekan kembali
  4. Rasio kompresi:ventilasi dengan 1 orang penolong adalah 30:2, sedangkan dengan 2 penolong adalah 15:2
  5. Satu kali rasio kompresi:ventilasi disebut 1 siklus RJP. Untuk mencegah penurunan kualitas kompresi dada akibat kelelahan, penolong diganti setiap 5 kali siklus
  6. Kompresi diizinkan untuk berhenti sementara (<10 detik), yaitu saat pemberian 2 kali ventilasi
  7. Fase jeda kompresi dada sebelum dan sesudah dilakukan shockharus seminimal mungkin

A-irway

Setelah memberikan kompresi dada, buka jalan napas atau pastikan jalan nafas dengan manuver head-tilt dan chin-lift. Selain itu, pastikan tidak ada sumbatan jalan napas dengan melihat apakah terdapat benda asing yang menyumbat. Gunaan oropharyngeal airway atau selang intubasi dapat membantu mengamankan jalan napas.

mindfullners.com/airway

B-reathing

Setelah memastikan jalur nafas terbuka, maka penolong harus segera memberikan bantuan pernafasan. Saat ini, pemberian napas buatan mulut ke mulut pada pasien dewasa sudah tidak dianjurkan. Pemberian ventilasi dilakukan menggunakan bag-valve-mask (BVM), jika tidak ada maka penolong cukup melakukan kompresi dada saja.

mindfullners.com/breathing

Prosedur Bantuan Napas Yang Baik Adalah:

  1. Pastikan tidak ada celah antara masker BVM dengan wajah pasien
  2. Bag diremas dengan satu tangan selama +1 detik, untuk memasukkan sekitar 500 mL udara ke paru-paru pasien
  3. Ventilasi dilakukan tidak lebih dari 8‒10 napas/menit, untuk mencegah pasien mengalami hiperventilasi
  4. Rasio kompresi:ventilasi dengan 1 orang penolong adalah 30:2, sedangkan dengan 2 penolong adalah 15:2.
  5. Pada pasien yang terintubasi, ventilasi diberikan kontinyu dengan kecepatan 1 kali setiap 6 detik, atau 10 kali/menit) selama kompresi dada dilakukan

PERHATIAN

Kapan BHD dihentikan ?

  1. Pasien sudah ada yang respon
  2. Datang tim yang lebih ahli (advance)
  3. Penolong kelemahan
  4. Terdapat kematian yang jelas
  5. Do not Resuscitate/DNR (keluarga menolak untuk dilakukan tindakan resusitasi)

Evaluasi Dilakukan Tiap 2 Menit

  1. Jika napas (-)  dan nadi (-) berikan Kompresi dan ventilasi 30:2 untuk 1 penolong, atau 15:2 untuk 2 orang penolong.
  2. Jika napas (-) dan nadi (+) berikan Ventilasi 10 kali/menit
  3. Jika napas (+) dan nadi (+) beri recovery position

Ventilasi dan Oksigenasi

Pasien yang berhasil melewati fase henti jantung harus segera mendapat ventilasi dan oksigenasi yang cukup, yaitu:

  1. Saturasi oksigen dipertahankan ≥94%
  2. Kecepatan terapi oksigen awal 10−12 kali/menit
  3. Kecepatan kemudian dititrasi hingga mencapai target PET CO235−45 mmHg
  4. Hiperventilasi harus dihindari, karena dapat meningkatkan tekanan intratorakal yang berakibat menurunkan curah jantung

Terapi Cairan

Terapi cairan diberikan untuk menangani kondisi hipotensi. Terapi dengan cairan normal salin atau ringer laktat sebanyak 10‒20 mL/kgBB loading.


Golden Period RJP

Idealnya, BHD harus segera dilakukan saat pasien mengalami henti jantung. Terdapat golden period atau waktu emas dalam melakukan bantuan hidup dasar yaitu :

  1. Untuk Keterlambatan BHD selama 1 menit, maka kemungkinan berhasilnya 98 dari 100
  2. Untuk Keterlambatan BHD selama 4 menit, maka kemungkinan berhasilnya 50 dari 100
  3. Untuk Keterlambatan BHD selama 10 menit, maka kemungkinan berhasilnya 1 dari 100

Prosedur standar RJP berdasarkan pedoman AHA tahun 2020terdiri dari kompresi dada (circulation), jalan napas (airway), dan pernapasan (breathing), yang disingkat menjadi C-A-B. RJP harus segera dilakukan dalam waktu <2 menit sejak pasien henti jantung. Angka survival berkurang 10‒15% setiap menitnya jika pasien tidak segera ditolong dengan resusitasi jantung paru.


Pantau Saat Resusitasi

Pemantauan saat tindakan RJP adalah memastikan kompresi dilakukan dengan baik, yaitu:

  1. Kecepatan 100‒120 kali/menit
  2. Kedalaman minimal 5 cm dan maksimal 6 cm
  3. Pastikan dada recoilsempurna

Recovery Position atau Posisi pemulihan

Posisi ini dilakukan jika korban sudah bernapas dengan normal dan sirkulasinya sudah adekuat. Posisi ini dilakukan untuk menjaga jalan napas tetap terbuka dan mengurangi risiko tersumbatnya jalan napas dan tersedak.Korban dimiringkan dengan meletakkan tangan di bawah kepala korban.

mindfullners.com/recoveryposition

Daftar Pustaka

Cardiopulmonary resuscitation (CPR): First aid [Internet]. Mayo Clinic. 2022 . Available from: https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600#:~:text=Cardiopulmonary%20resuscitation%20(CPR)%20is%20a,hard%20and%20fast%20chest%20compressions.

Merchant RM, Topijan AA, Panchal AR, et al. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142 (suppl 2): S337-S357

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