Shock - Revisi

8/16/2019 Shock - Revisi

1/21

dr. Meddy Setiawan, SpPD

FAKULTAS KEDOKTERANUNIVERSITAS MUHAMMADIYAH MALANG


2/21

“Shock”

• Shock adalah suatu sindroma klinisyg ditandai dg kegagalan sistem

sirkulasi untuk mempertahankanperfusi yg adekuat ke organ-organvital tubuh


3/21

Klasikasi Shock( Menurut Hinsha and !o" classication#


4/21

$enisi


5/21

%tiologi


6/21

&%'ects of inadeuate perfusion on cellfunction&


7/21


8/21

PERJALANAN PATOFISIOLOGIPERJALANAN PATOFISIOLOGI

SYOK SYOK Septic Shock Cardiogenic Shock

Hypovolemic Shock

Capillary Leak MediatorsMyocardialDepression

↓ Preload Vasodilatation ↓ Contractility

↓ Cardiac Output↓ Blood Pressure

Sympathetic Discharge

Vasoconstriction,

H Contractility

!mproved Cardiacoutput and "loodpressure

COMP#$S%D


9/21

D#COMP#$S%D

↓ Myocardial per'usion

Myocardial O( Consumption

↓ Cardiac Output

Mediator elease

↓ Cell )unction

Cell Death Death o' Organism

&issue !schemia

Loss o' %utoregulation o'

Microcirculation

COMP#$S%D

VasoconstrictionH Contractility


10/21

&)mmunoin*amatory respon toshock&


11/21

Hypovolemic shock&

• Mild ( < 20% blood ol!"# $

– !ool e"tremities

– )ncreased capilary rel time

– $iaphoresis

– !ollapsed veins

–

+n"iety• Mod#&'#!&l (20)0% blood

ol!"#$

– ,achycardia

– ,achypnea

– ligouria

– .ostural changes• S### ( * )0% blood

ol!"# $ – Hemodynamic instability

– Marked tachycardia

– Hypotension

–

!oma


12/21

!ardiogenic shock&


13/21

.atosiologi•

$ecrease in !ardiac utput – /all in blood pressure

– High 0eft 1entricular /illing .ressures

• !ompensatory response – )ncrease systemic vascular resistance (increase

blood *o to the heart# – )ncrease heart rate (increase blood to the

tissues#

• 2esulting physical manifestations – !ool peripheries

– 3eak pulse – $ecreased urine output

4


14/21

Holl#+b#,- S. M. #'. &l. A++ I+'#+ M#d /1//3)4

5


15/21

.%M%2)KS+5 $)+65S,)K

.emeriksaan foto toraks7 biasanyamenun8ukkan 8antung normal atau

membesar diserta tanda-tanda edemaparu4

.emeriksan %K6 pada syok kardiogeniksesuai gambaran penyakit yang

mendasari (infark miokard akut7 !H/#


16/21

.%5+,+0+KS+5++5 M%$)S

.astikan 8alan napas tetap adekuat7 bilatidak sadar sebaiknya dilakukan intubasi4

9erikan oksigen : ; menit dengan

menggunakan masker untukmempertahankan .? @A ;


17/21

Medication•

/luid 2esuscitation ifreuired

• "ygenation and+iray .rotection

•!orrect electrolyteimbalance

• +nalgesia if reuired

• $iscontinue - 5itrates7

beta-blocker and aceinhibitors as theyreduce blood pressure

• )notropic +gents7increase the forceof musclecontraction

• $iuretics7 increasethe e"cretion ofater and

therefore reducethe orkload of theheart


18/21

+naphylactic shock&


19/21

5eurogenic shock&

• +s ith hypovolemic shockbut in high spinal in8uriesmay also be accompaniedby profound bradycardiadue to loss of the cardiac

accelerating nerve bresfrom the sympatheticnervous system at ,


20/21

Septic shock&

• Similar to hypovolemic shock e"cept in the rststagesC .yre"ia (fever#7 due to increased level ofcytokines

• Systemic vasodilation resulting in hypotension(lo blood pressure#

• 3arm and seaty skin due to vasodilation

• Systemic leukocyte adhesion to endothelial tissue

•

2educed contractility of the heart• +ctivation of the coagulation pathays7 resulting

in disseminated intravascular coagulation

• )ncreased levels of neutrophils


21/21

6..MOGA 7ERMANFAAT6

Documents

Shock - Revisi