Professional Documents
Culture Documents
Hasanul Arifin
26/08/2010
glucose
oksigen
38 Mol ATP
glucose
oksigen
Definition of Shock
Reduced perfusion of vital organs leading to inadequate oxygen and nutrients necessary for normal tissue and cellular function. DO2 < VO2
Cellular level:
Lactic Acidosis
SHOCK
IT IS NOT LOW BLOOD PRESSURE !!!
IT IS HYPOPERFUSION..
26/08/2010
SHOCK
B1 nafas sesak,, RR , cuping hidung B1, sesak B2, HR , nadi halus cepat,, TD. N/ cepat
PulsePulse-press , perfusi dingin, pucat, basah, dingin, pucat, basah, capill.refill > 2 det., lactic-acid lactic-
26/08/2010
Hasanul, 2003
Shock in Trauma
Clinical differentiation
1. Hemorrhagic Shock 2. Non Hemorrhagic Shock
Cardiogenic Tension pneumothorax Neurogenic Septic Anaphylactic
PREPRE-LOAD
CONTRACTILITY
AFTER-LOAD AFTER-
STROKE VOLUME
HEART-RATE HEART-
CARDIAC OUTPUT
BLOOD PRESSURE
26/08/2010 Hasanul, Hasanul, 2009
Tissue Perfusion
11
Pathophysiology
The human body responds to acute hemorrhage by activating the following major physiologic systems:
the hematologic, cardiovascular, renal, and neuroendocrine systems.
The cardiovascular system also responds by redistributing blood to the brain, heart, and kidneys and away from skin, muscle, and GI tract.
ADH indirectly leads to an increased reabsorption of water and salt (NaCl) by the distal tubule, the collecting ducts, and the loop of Henle.
HEMORRHAGE HYPOVOLEMIA
Baroreceptor reflex (arterial & cardiopulmonary) Circulating vasoconstrictors Chemoreceptor reflexes Renal reabsorption of Na+ and water Cerebral ischemia
survival
Intervention / stabilization
Maintenance of perfusion Blood flow shunted to vital organs (heart,lung,brain) Continued volume loss Cellular hypoxia / anaerobic metabolism
18
PATHOPHYSIO, CONTN
Intervention / stabilization
Irreversible shock
intervention No. intervention
DEATH
26/08/2010 19
CELLULAR EDEMA
STAGES OF SHOCK
21
COMPENSATED SHOCK
Body defense mechanisms attempt to preserve major organs Precapillary sphincters close, blood is shunted Increased heart rate and strength of contractions Increased respiratory function, bronchodilation
22
COMPENSATED SHOCK
Will continue until problem solved or shock progresses to next stage Can be difficult to detect with subtle indicators Tachycardia Decreased skin perfusion Alterations in mental status Some medications such as propranolol can hide signs and symptoms
23
UNCOMPENSATED SHOCK
Physiological response Precapillary sphincters open, blood pressure falls Cardiac output falls Blood surges into tissue beds, blood flow stagnates Red cells stack up in rouleaux
24
UNCOMPENSATED SHOCK
Easier to detect than compensated shock Prolonged capillary refill time Marked increase in heart rate Rapid thready pulse Agitation, restlessness, confusion
25
IRREVERSIBLE SHOCK
Compensatory mechanisms fail, cell death begins, vital organs falter Patient may be resusitated but will die later of (ARDS, renal and liver failure, sepsis)
26
Decompensation
Initial assessment
Airway , Breathing ok?
Circulation
HR within normal limit Pulse pressure WNL Warm, Pink, Dry
NO SHOCK
Initial assessment
Airway , Breathing ok?
Circulation
Tachycardia Cutaneous vasoconstriction Pulse pressure Calmy
SHOCK
Clinical differentiation
1. Hemorrhagic Shock 2. Non Hemorrhagic Shock
Cardiogenic Tension pneumothorax Neurogenic Septic Anaphylactic
Cardiogenic Shock
Myocardial dysfunction Blunt cardiac trauma Cardiac tamponade Air embolism Valve rupture ECG monitoring Isoenzynme-CPK Echocardiography
Tachycardia Blowing heart sound Venectasia regio colli Hypotension
Tension Pneumothorax
Ventil mechanism/flap-valve Sesak nafas , RR > Emphysema subcutan Perkusi hypersonor Suara paru menghilang pada ipsilateral Trakhea terdorong kontralateral Tachycardia Hypotension
Septic Shock
Jarang terjadi segera setelah trauma Dapat terjadi pada kasus trauma yang terlantar Luka tembus abdomen, perforasi Shock septik pada periode awal :
Tachycardia Perifer hangat Systolik bisa normal Pulse pressure lebar
Pneumothorax
Myocardial Contussion
Hematothorax
Spinal Shock
26/08/2010
39
Hemorrhagic Shock
Perdarahan ( Hemorrhage)
Volume Darah (EBV, Estimated Blood Volume) Dewasa : 70 mL/kg Anak anak : 80 90 mL/kg
Resusistasi cairan harus segera dimulai bila tanda tanda dan gejala kehilangan darah tampak atau diduga, JANGAN menunggu s/d tanda tanda shock jelas.
Klassifikasi Perdarahan
Class II
750-1500 75015-30% 15>100 Normal Decreased 20-30 2020-30 20Midly anxious
EBV = 70 ml/kg
26/08/2010 48
Sources of Hemorrhage
Femur fracture ( 1500 mL) Chest Abdomen (liver, spleen) Retroperitoneal ( 2-4 L) Muscle compartments