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  • Shock Anaphylactic - DAN Revise

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    I Putu Sakamekya Sujaya
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    World Allergy Week 2021 focuses on anaphylaxis awareness and preparedness. The document discusses anaphylactic shock, which is a life-threatening reaction that can occur from severe allergic reactions. It describes anaphylactic shock management in three stages - symptom-oriented, goal directed therapy focusing on oxygen delivery and extraction, and use of vasoactive substances like epinephrine. For prolonged anaphylactic shock, therapy involves four priority phases - salvage to ensure survival, optimization to improve oxygen availability and hemodynamics, stabilization to prevent organ damage, and de-escalation to achieve balance and reduce support needs. Early and aggressive treatment is emphasized to improve patient survival.

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    World Allergy Week 2021 focuses on anaphylaxis awareness and preparedness. The document discusses anaphylactic shock, which is a life-threatening reaction that can occur from severe allergic reactions. It describes anaphylactic shock management in three stages - symptom-oriented, goal directed therapy focusing on oxygen delivery and extraction, and use of vasoactive substances like epinephrine. For prolonged anaphylactic shock, therapy involves four priority phases - salvage to ensure survival, optimization to improve oxygen availability and hemodynamics, stabilization to prevent organ damage, and de-escalation to achieve balance and reduce support needs. Early and aggressive treatment is emphasized to improve patient survival.

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    6 views18 pages

    Shock Anaphylactic - DAN Revise

    Uploaded by

    I Putu Sakamekya Sujaya
    World Allergy Week 2021 focuses on anaphylaxis awareness and preparedness. The document discusses anaphylactic shock, which is a life-threatening reaction that can occur from severe allergic reactions. It describes anaphylactic shock management in three stages - symptom-oriented, goal directed therapy focusing on oxygen delivery and extraction, and use of vasoactive substances like epinephrine. For prolonged anaphylactic shock, therapy involves four priority phases - salvage to ensure survival, optimization to improve oxygen availability and hemodynamics, stabilization to prevent organ damage, and de-escalation to achieve balance and reduce support needs. Early and aggressive treatment is emphasized to improve patient survival.

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    © All Rights Reserved
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    of 18

    World Allergy Week 2021

    Anaphylaxis: Be Aware, Be Prepared, Save Life

    ANAPHYLACTIC SHOCK

    A.P.Pradhana
    Anesthesiology and Intensive Care Udayana University Hospital - Bali
    ANAFILAKTIK
    VS ? ? ??
    SHOCK ANAFILAKTIK
    SHOCK ANAFILAKTIK

     kegagalan sirkulasi yang terjadi akibat reaksi alergi berat 


    Reaksi Anafilaktik

    Derajat keparahan
    SHOCK ANAFILAKTIK
    MANAJEMEN

    GOAL DIRECTED THERAPY

    ???
    SHOCK ANAFILAKTIK
    MANAJEMEN

    SYMPTOMPS-ORIENTED
    SHOCK ANAFILAKTIK
    MANAJEMEN OXYGEN
    DELIVERY /
    EXTRACTION

    RESPIRATORY
    CARDIOVASCULAR
    COMPROMISE PROBLEM
    TDS <90 MMHG / >30%

    SKIN/ MUCOSAL
    MEDIATOR PROBLEM
    ALERGEN
    ALERGI
    SHOCK ANAFILAKTIK
    MANAJEMEN

    • SUPLEMENTASI OKSIGEN
    • VASOACTIVE SUBSTANCE (+BRONCHODILATOR)
    • SUBTISUSI CAIRAN
    • ANTIHISTAMIN
    • STEROID
    • MENGHENTIKAN ALLERGEN EXPOSURE
    VASOACTIVE SUBSTANCE
    EPINEPHRINE
    - First line therapy
    - mixed alpha dan beta reseptor agonis
    - Onset cepat, durasi singkat
    - Sangat poten
    - Efek samping
    - Murah dan mudah didapatkan
    VASOACTIVE SUBSTANCE

    EPINEPHRINE
    - Rute pemberian menentukan dilusi
    - 0.2 – 0.5 mg (0.01 mg/kg) tiap 5-15 menit
    - 1-4 mcg/menit (0.01-0.05 mcg/kg/menit)
    VASOACTIVE SUBSTANCE

    Alternatif??
    - Ephedrine
    - Norepinephrine
    - Dopamin
    - Dobutamin
    VASOACTIVE SUBSTANCE
    Persistent / Prolonged Anaphylactic shock
    Prioritas & Target Terapi
    Salvage (fase 1)

    • Goal: survival

    • Minimum BP dan CO adekuat

    • Prosedur lifesaving
    Optimization (fase 2)

    • Goal: meningkatkan availabilitas O2 selular dan target hemodinamik


    optimal

    • Resusitasi adekuat = mengurangi inflamasi + menjaga kerusakan


    mitokondrial + mencegah aktivasi caspase

    • Monitoring CO, SvO2, Laktat


    Stabilization (fase 3)

    • Goal: mencegah kerusakan organ permanen

    • Tahap dimana supply oksigen untuk jaringan sudah bukan jadi


    masalah utama

    • Organ support
    Deescalation (fase 4)

    • Goal: penyapihan

    • Mencapai kondisi balance

    • Mengurangi kebutuhan topangan


    Keypoint

    • Medical shock is medical emergency


    • Early identification + aggressiveness = improve patient
    survival
    • Prolonged anaphylactic shock is real

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