ALL ABOUT SHOCK

IN PEDIATRIC
Devi Andarwati, dr. SP.A
 Pathophysiology

Hipovolemic

Cardiogenic
Poor
Shock Obstructive
Perfusion

Distributive
O2 Delivery

Hb (o2 capacity)
O2 Content O2 binding (SpO2) Disosiative
O2 dissolved (PaO2)
Hypovolemik Shock
◦ Disebabkan oleh penurunan volume darah di intravascular
◦ Sering terjadi pada anak – anak
◦ Etiologi : GEA, DKA, atau Hemorrhage
◦ Intravascular blood volume  Preload  Stroke volume  cardiac output  Oxygen delivery
Cardiogenic Shock
◦ Etiologis : infections, Myocarditis, Myocardial infark, Heart rate abnofmalities (SVT, Ventricular Arrythmias ), metabolic
disorders, toxin ingestion
◦ Pathophysiology : Systolic dysfunction and Diastolic dysfunction
◦ Systolic dysfunction : impaired Ca2+ metabolism, poor cardiac contractility, and decreased CO  decreased DO2
◦ Diastolic dysfunction : Impaired relaxation, increased LV end diastolic pressure, and increased pulmonary venous pressure 
pulmonary edema
Obstructive Shock
◦ Decreased cardiac output
◦ Normal intravascular volume and myocardial function
◦ Etiologies : Acute pericardial tamponade, tension pneumothorax, pulmonary embolism
◦ Acute pericardial tamponade : impaired cardiac filling  decreased cardiac output  Decreased DO2
◦ Exam findings : Pulsus paradoxus, Narrowed pulses pressure, pericardial rub, and Jugular venous Distention
Distributive Shock
◦ Maldistribution of blood flow
◦ Etiologies : Anaphylaxis, Spinal trauma, Vasodilatory medications, and Drug overdoses
◦ Pathophysiology : Similar with Hypovolemik shock  Decreased Intravascular blood volume  Decreased Preload 
Decreased Stroke volume  Decreased cardiac output  Decreased Oxygen delivery