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SHOCK AND TREATMENT

Dr Samsirun Halim SpPD KIC


Unit Perawatan Intensif
RSD Raden Mattaher Jambi
DEFINISI
Gangguan dari perfusi jaringan yang terjadi akibat
adanya ketidakseimbangan antara suplai oksigen ke
sel dengan kebutuhan oksigen dari sel tersebut.
Semua jenis shock mengakibatkan gangguan pada
perfusi jaringan yang selanjutnya berkembang
menjadi gagal sirkulasi akut atau disebut juga
sindrom shock

IT IS NOT LOW BLOOD PRESSURE !!!


IT IS HYPOPERFUSION…..
TIPE2 SHOCK*
Primary
Type of Shock Clinical causes
mechanism

Exogenous blood,
Hypovolemic Volume loss plasma, fluid or
electrolyte loss

Myocardial infarction,
Cardiogenic Pump failure cardiac arrhythmias,
heart failure

Increased venous
Septic shock, spinal
capacitance or
Distributive shock, autonomic
arteriovenous
blockade, drug
shunting
overdose
Vena caval
Extra-cardiac obstruction, cardiac
Obstructive obstruction of blood tamponade,
flow pulmonary embolism,
aortic compression or
dissection
*MORE THAN ONE TYPE MAY BE PRESENT
1. HYPOVOLEMIC SHOCK
DECREASE IN INTRAVASCULAR
BLOOD VOLUME

Hemorrhage
Vomiting
Diarrhea
Fluid sequestration
Intraluminal – bowel
obstruction
Intraperitoneal – pancreatitis
Interstitial - burns

DECREASE IN CARDIAC
OUTPUT AND TISSUE
PERFUSION
HYPOVOLEMIC SHOCK
1. DECREASE IN
INTRAVASCULAR BLOOD
VOLUME

2. BLOOD DIVERTED FROM SKIN


TO MAINTAIN ORGAN PERFUSION
Pale and cool skin
Postural hypotension and tachycardia

3. BLOOD DIVERTED
PREFERENTIALLY TO HEART AND
BRAIN

Thirst, oliguria
Tachycardia
Labile blood pressure
HYPOVOLEMIC SHOCK
4. DECREASED BLOOD FLOW TO
BRAIN AND HEART

Restless, agitated, confused


Hypotension
Tachycardia
Tachypnea

5. END-STAGE SHOCK

Bradycardia
Arrythmias
Death
2. CARDIOGENIC SHOCK
DECREASED CARDIAC FUNCTION
Decreased ventricular function
MI
Pericaridal tamponade
Tension pneumothorax

Infective cardiac contraction


Arrhythmias

CLINICAL FINDINGS

Hypotension
Tachycardia
Tachypnea
Oliguria
**distended neck veins**
3. SEPTIC SHOCK
SEVERE INFECTION W RELEASE
OF MICROBIAL PRODUCTS
Release of vasoactive mediators

HYPERDYNAMIC STATE
Peripheral vasodilation
Increased cardiac output

Fever, tachycardia, tachypnea, warm skin

MAINTENANCE OF FAILURE TO MAINTAIN


INTRAVASCULAR VOLUME INTRAVASCULAR VOLUME
Hyperdynamic shock Hypodynamic shock

Cool skin, tachycardia,


hypotension, oliguria
4. NEUROGENIC SHOCK
REDUCED VASOMOTOR TONE
FROM LOSS OF SYMPTATHETIC
INNERVATION
Spinal cord trauma
Spinal anesthesia
Acute gastric dilatation

CLINICAL FINDINGS

Bradycardia
Mild hypotension
Flat neck veins
anamnesis
• Riwayat kehilangan cairan tubuh
• Riwayat sakit jantung
• Riwayat sakit panas
• Riwayat trauma
• Riwayat pengobatan
• Lamanya kejadian
• Lamanya tanda-tanda syok
Pemeriksaan fisik
• Kesadaran : compos mentis ---- sopor
• Tensi : hipotensi / normotensi
• Nadi : takikardi, bradikardi, isi dan tegangan,
reguler/ireguler
• Suhu : hipotermi, hipertermi
• Frekwensi nafas : cepat/lambat,
dalam/dangkal
• Kulit : turgor, hangat, dingin
Pem. Fisik ( lanjutan)
• Leher : tegangan vena jugular
• Jantung : irama, frekwensi, bising
• Paru : ronki, wheezing
• Abdomen :hepar, asites, defence musc
• Extremitas : akral hangat, dingin
PATHOGENESIS OF SHOCK
Cardiogenic Distributive
Shock Shock

Inotropes
Vasopressor ( NE,PE,ADR,Dop)
(Dob,Dop,Adr,Amr
)
Release Pump = Pipe = Vascular Blood Pressure
tamponade,e
tc Heart

Obstructive Cardiac Output x SVR


Shock
Volume =
Blood

Hypovolemic
Fluids
Shock
PRINSIP RESUSITASI

 Mempertahankan ventilasi
 Meningkatkan perfusi
 Terapi penyebab
MAINTAIN
VENTILATION
Increased
Especially in: oxygen demand

Sepsis
Hypovolemia
Trauma Hyperventilation

Diversi blood flow


Respiratory
from vital organ
fatigue

Respiratory failure Organ injury


Respiratory acidosis, lethargy-coma,
hypoxia
TREATMENT OF RESPIRATORY
FAILURE
Hypovolemia (blood
loss)

Decreased CO

Decreased oxygen delivery,


increased oxygen requirement

Metabolic acidosis, hypoxemia


tachypnea
TREATMENT:
Primary resuscitation
Oxygen
Mechanical ventilation if needed
TREATMENT CONCEPT OF SHOCK
ENHANCING PERFUSION / OXYGEN DELIVERY

DO2 = CO x CaO2

Cardiac Arterial
output O2
content

Oxygen delivery/DO2 = HR X SV X Hb X S02 X 1.34 + Hb X paO2

Inotropes Partially
Fluids Transfus dependent
e on FIO2 and
pulmonary
status
THERAPI CAIRAN
Body fluid composition
• Total body water is 60% of total body weight
• = distributed into 3 main compartment

• INTRA CELULLAR (ICF) 40%


• INTERSTITIAL (ICS) 15%
• PLASMA VOLUME (IVF) 5%
Jenis cairan intravena
• cairan desktrose
• Cairan kristaloid
• Cairan koloid
• Darah atau komponen darah
Efek pemberian cairan terhadap
komposisi cairan tubuh