Beruflich Dokumente
Kultur Dokumente
Dr. Sunto
Departemen Perawatan Kritis
Eka Hospital Pekanbaru
Most sepsis-associated deaths were unlikely to be
preventable through better hospital-based care
Outline
• Definisi
• Syok, sepsis dan syok sepsis
• Diagnosis
• Quick SOFA dan SOFA score
• Gangguan metabolik dan disfungsi organ
• Platelet, Lekositosis, Albumin, Elektrolit, Laktat
• Tatalaksana
• Resusitasi cairan
• Vasopresor
• Antibiotik
• Lainnya: Ventilasi mekanik, kortikosteroid, renal support
BANGSAL
Hepar ↑
glikogenolisis
↑ Laktat
Hiperlaktatemia
Otot ↑
↑ Pyruvate
glikogenolisis
↑ Piruvat
dehidrogenase
1. Resusitasi cairan
2. Vasopresor
3. Antibiotik, kultur darah, sputum, urin
4. Lainnya: Ventilasi mekanik, kortikosteroid, renal support
Outdated?
2012 Recommendation for
Initial Resuscitation.
We recommend the protocolized, quantitative resuscitation of
patients with sepsis- induced tissue hypoperfusion. During the
first 6 hours of resuscitation, the goals of initial resuscitation
should include all of the following as a part of a treatment
protocol:
a) CVP 8–12 mm Hg
b) MAP ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Scvo2 ≥ 70%.
CVP 8–12 mm Hg as a target for fluid resus?
Marik, 2008
Mau ikut siapa?
Fluid responsiveness
Antibiotik
• Nuke them with M-bomb (meropenem)?
• Variabel lain yang perlu jadi pertimbangan?
• Berapa lama?
• Kultur urin, darah, sputum
Terapi lain
• Ventilasi mekanik
• Renal support
• Kortikosteroid
Exit