Basic Life Support - Bantuan Hidup Dasar

Istilah Basic Life Support (Bantuan Hidup Dasar) merujuk pada Usaha untuk mempertahankan kehidupan saat penderita mengalami keadaan yang mengancam nyawa.

Karena sifatnya yang dasar berarti tanpa melibatkan penggunaan alat bantu yaitu tanpa :

•  Cairan intra vena
•  Obat
•  Kejutan listrik

Untuk penanganan selanjutnya setelah suatu BSL dilakukan, maka dilakukanlah Bantuan Hidup Lanjut yang terdiri dari :
RS :

•  ATLS
•  ACLS
•  PALS
•  Dll

Pra-RS :

•  PHTLS
•  PHCLS

Pada prinsipnya suatu BSL harus dilakukan sedini mungkin pada saat suatu kegawatdaruratan yang mengancam nyawa terjadi. Dimana bila dalam 3 - 8 menit otak dan jantung tidak mendapat suplai Oksigen, mereka akan berhenti bekerja dan dapat terjadi kematian.

kematian sendiri dapat dibagi dalam dua penjelasan yakni :

Mati Klinis :

•  nafas (-)
•  jantung (-)

Mati biologis :
Kerusakan sel otak

“mati betulan”

Keterlambatan melakukan suatu BSL akan menurunkan kemungkinan selamat seorang pasien dengan presentase sebagai berikut :

• 1 menit :  98 dari 100
• 3 menit  : 50 dari 100
• 10 menit : 1 dari 100

Kemudian apakah yang dinilai pertama kali sebelum melakukan suatu tindakan BSL ? ada tiga hal yang harus selalu dinilai pertama kali pada pasien yang mengalami kegawatdaruratan apapun penyebabnya , yakni :


A. Airway ( jalan nafas )
B. Breathing ( pernafasan )
C. Circulation ( jantung dan pembuluh darah )


A. AIRWAY

Cara menilai Airway baik yakni :

• Pasien sadar : Masih dapat berbicara berarti Airway baik (tanpa suara tambahan)
• Pasien tidak sadar : Look,Listen , Feel.

Ada dua macam obstruksi (sumbatan) yang dapat terjadi pada jalannafas , yakni :

• Total : akut dan insidous
• Partial 

OBSTRUKSI TOTAL 

Gejalanya adalah tersedak yakni adanya benda asing pada airway. Cara penanganan :

• Ferasat Heimlich : Pasien masih berdiri
• Hentakan Perut (Abdominal Thrust) : Pasien baring

Waspadalah pada pasien yang tidak sadar,sebab gejala obstruksi seringkali tidak dikenali

Penanganan pada gangguan obstruksi yang berat meliputi :

• finger sweep
• abd. thrust
• instrumental

OBSTRUKSI PARSIAL

Biasanya pasien masih dapat bernafas namun nafasnya berbunyi. Nafas yang berbunyi merupakan tanda penting dari adanya suatu obrstruksi yang parsial.

Penyebab	Gejala	Tindakan
Cairan	gurgling   (bunyi kumur-kumur)	suction
Lidah	Snoring (mengorok)	Manual / airway sementara
Larinks / trachea (penyempitan)	Crowing (stridor)	Airway definitif

Jenis Stridor :

• Inspiratoir : Terjadi sumbatan parsial pada upper respiratory.tract Misalnya diakibatkan benda asing, edema laring,difteri, dan hematoma. Seringkali stridor jenis ini juga memerlukan jalan nafas definitif.
• Ekspiratoir : Terjadi sumbatan parsial pada lower respiratory tract.

Jenis suction:

Jalan Nafas Sementara pada obstruksi parsial :

• Oropharingeal airway ( “Guedel” ) --> Pasien tidak sadar
• Nasopharingeal airway --> Pasien sadar / ada refleks

B. BREATHING

Hal penting yang harus dilakukan mengenai breathing (pernafasan) adalah :

• Menilai (asses)
• Oksigenasi
• ventilasi

Menilai Pernafasan baik :

Pasien Sadar :

Berbicara kalimat panjang
Laju pernafasan ( dewasa ) : 12 - 20
Tanda dispnu\sianosis (-)
Pemeriksaan fisik baik

Pasien Tidak Sadar :

Gunakan prinsip Look - Listen - Feel

Beberapa gejala gangguan breathing :

Dispnu :

• rasa sesak
• pernafasan cuping hidung
• retraksi

Sianosis :

• kebiruan

Pemeriksaan Fisis

Inspeksi : Ekspansi simetris
Perkusi : Sonor Ki=Ka
Auskultasi : Bising Nafas Ki=Ka

"  Berikanlah Oksigen Bila Keadaan Umum Penderita tidak baik"

Pemberian Oksigen :

• Kanul Hidung
• Face Mask
• Non Rebreathing Mask

Konsentrasi Oksigen :

• Udara bebas ± 21 %
• Kanul hidung dengan O2 2 LPM ± 24 %
• Kanul hidung dengan O2 6 LPM ± 44 %
• Face mask ( rebreathing, 6-10 LPM ) ± 35 - 60 %
• Non rebreathing mask ( 8-12 LPM ) ± 80 - 90 %

Nafas buatan / bantuan Pernafasan :

• Mouth to mouth ventilation
• Mouth to mask ventilation 
• Bag-valve-mask ( ambu-bag )

Dimana frekuensi ventilasi tambahan untuk dewasa adalah 10 - 20 kali / menit dan anak/bayi  20 kali per menit.

CIRCULATION

Frekuensi Denyut Jantung Normal permenitnya adalah :

• Dewasa : 60 - 80 kali
• Anak : 60 - 140 kali
• bayi : 85 - 200 kali

Pada Orang dewasa dikatakan takikardia bila denyut jantung > 100 kali per menit.

"  Bila jantung berhenti berdenyut maka lakukan masase jantung luar"

Resusitasi Jantung Pulmonar (RJP) adalah pemberian nafas buatan + Masase Jantung Luar

Trauma and orthopaedic surgery

Trauma & Orthopaedic Surgery for the MRCS

Trauma is defined as any body wound or shock produced by sudden physical injury, as from accident, injury, or impact. Trauma patients may require specialized care, including surgery and blood transfusion, within the so-called golden hour of emergency medicine, the first sixty minutes after trauma occurs. This is not a strict deadline, but recognizes that many deaths which could have been prevented by appropriate care occur a relatively short time after injury. In many places organized trauma referral systems have been set up to provide rapid care for injured people. Research has shown that deaths from physical trauma decline where there are organized trauma systems.

Techniques

In a prehospital setting, also called the "field", emergency medical technicians, paramedics, specialized nurses, firefighters and other trained providers known as 'first responders', use stabilization techniques to improve the chances of a trauma patient surviving the transport to the nearest hospital or trauma center. After ensuring their own safety and taking Body substance isolation precautions, professionals begin performing a primary survey, consisting of an assessment of the level of consciousness of the patient, then checking and treating airway, breathing, and circulation (called the "ABC's"). The method was published by Peter Safar in his 1957 book, ABCs of Resuscitaion. The basic principle is that death primarily resulted from a lack of oxygen to the brain (anoxia). The main priority is therefore to ensure that oxygenated blood is circulating.

The purpose of the primary survey is to identify life-threatening problems. Ensuring that the injured person is not disabled by unnecessary movement of the spine is paramount. On most patients, and all unconscious patients, the neck is secured with a Cervical collar, and the back is secured to a long spine board with head supports, or other medical transport device such as a Kendrick Extrication Device, before moving the patient. This is called clearing the cervical spine, also know as doing "C-spine." Unless the victim is in imminent danger of death, first responders will usually "load and go" transporting the victim immediately to the nearest appropriate trauma-equipped hospital.

Upon completion of the primary survey, the secondary survey is begun. This may occur during transport or upon arrival at the hospital. The secondary survey consists of a systematic assessment of the abdominal, pelvic and thoracic viscera, complete inspection of the body surface to find all injuries, and neurological exam. The purpose of the secondary survey is to identify all injuries so that they may be treated. A missed injury is one which is not found during the initial assessment (for example, as a patient is brought into a hospital's Emergency Department), but rather manifests itself at a later point in time, sometimes with baleful consequences (i.e., a liver laceration is sometimes missed and a patient sent home, who will abruptly go into shock shortly thereafter.)

The appropriate first aid for a trauma patient is to immediately call for help using the emergency medical service, then treat for shock. Do not move the victim unless failure to do so would create a greater risk to their life (i.e. hazardous chemicals or a spreading fire). Also see wilderness first aid if immediate emergency help is unavailable.

In case of traumatic accidents, health care providers use the ABC of life (airway, breathing and circulation) as their primary survey in identifying and assessing the condition of the patient. Airway is considered as the most important factor to be assessed then the breathing and circulation. From this technique the appropriate intervention will be identified immediately and prioritization of action can be done according to the most important aspect to be assessed.