Beruflich Dokumente
Kultur Dokumente
Pembimbing :
Dr. Pulung M. Silalahi Sp.A
RS POLRI Said Sukanto
Kramat Jati
2015
Defenition
Shock is emergency acute syndrome due to insufficiency
perfution in fulfilling the body needs .This caused by an
increase in needs metabolic (the need for oxygen) or decrease
in supply metabolic.
If the oxygen perfution to tissue continue to decline so
response of the
endocrine system, blood vessels ,
inflammatory , metabolism , cellular and systemic will appear
and resulting in the patient becomes unstable .
Shock is a progressive process, where when no body capable
of tolerate so it can result in damage irreversible on an organ
vital and can lead to death
Epidemilogy
The shock for children and adolescence about 2% in hospitals
in the united states. Where the death toll about 20-50% case .
Almost all patients are not died in phase hypotension but
because the result of one or more complications brought on by
the shock. Dysfunction multiple organ increase the risk of
death (one organ 25% death, two organs 60% death, three
organ or more 85%). The death toll was shocked to the decline
in proportion to the extent good education, where a
preliminary introduction shock and management good and fast
contributing more .
Classification
Hypovolemic shock
Hypovolemic shock happened due to lack of volume blood intravascular in
large quantities. This is a major cause child mortality in the united states
and throughout the world, although a causal agent Hypovolemic shock
may be different around the world.Children with acute diarrheal may have
lost 10-25 % of the volume of circulating them in 1-2 hours. Rehidrasi often
is hampered by vomiting usually occurred the same by diarrhea, and
decrease in the amount of intravasculer fluid on child usually occurring in a
short time
Distributive Shock
Distributive shock is shock occurring due to lack of volume blood is
relatively , in the sense of the amount of blood in enough blood vessels but
happened dilatation of the veins and if volume blood in blood vessels
diminished ( hipovolemia relative ) even if a patient is just lost track of
bodily fluids . But, physiological disturbance common that affects DO2 in all
its forms shock distributive is a reduction preload that is the result of
volume
intravascular
vasodilation
effective
inadequate
as
result
of
massive
Distributive Shock
Divided by 3 form
Anaphylactic Shock
Skin Eruption
Vasodilatation and
escalating cardiac output
Neurogenic Shock
Same sign as hypovolemic
shock
Cardiogenic Shock
Decrease
of
heart
contractility
is
base
that
cause
cardiogenic
Myocarditis
Cardiomyopathi
Heart tamponade
Cardiogenic Shock
Obstructive Shock
Terdapat penyumbatan pada jantung (penyakit jantung obstruktif)
yang menyebabkan aliran darah terganggu, pada beberapa
kondisi hal ini bisa menyebabkan timbulnya syok.
Contoh syok obtruktif
Cardiac tamponade
Tension pneumothoraks
Pulmo massive emboli
Stenosis aorta
Tanda dan gejala sama dengan syok hipovolemik tapi ditambah
dengan peningkatan JVP
Monitoring
The monitoring conducted by in shock covering monitoring hemodynamics
respiration and metabolic. Do monitoring against:
1) Conciusness
2) Respiratory rate and type of breath
3) Cardiovascular parametric :
Body temp and skin
Pulse and pulse volume
Blood Pressure
Capillary refill time
Central venous pressure
4) Urine productionnormal in adult 0,5 cc/kg/hour , child1-2 cc/kg/hour
5) Oxymetrix pulse Oxygenation of tissue set by perfution, the hb and
saturation oxygen that could be monitors with oxymetric pulse, used routinely
to judge shock.
Treatment
1. General treatment
Patient should be kept in cold
Raising foot end of the patient bed by 6 to 12 inch
2. Airway and breathing
Clear the Airway and give 100% of oxygen to relieve the
hypoxia
3. Cardiac output and Blood Volume at the circulation
Vasoactive drugs
Resucitation
Treatment
1. pertahankan jalan nafas berikan oksigen ( FIO2 100%) bila perberikan
tunjangan ventilator
2. Pasang akses vaskular secepatnya ( 60-90 detik), berikan cairan
cristaloid 20ml/kgbb dalam waktu 10 menit
d
In shock hipovolemik any cause, resuscitation a liquid started with a liquid crystalloids ( rl
or salt physiological ) as many as 20 ml per kilogram for from ten minutes.If not look
improvement and alleged still happens hipovolemia is given similar liquid as many as 20 ml
per kilogram and patients evaluated back.
In shock septic , resuscitation liquid useful to restore volume intravaskular .A kind of liquid
still konroversial , a liquid crystalloids can cause pulmonary edema resulting from
decreased pressure onkotik intravaskular and heavier leak capillary .While liquid colloidal ,
although it can maintain pressure onkotik will eventually seeping into the resulting from the
loss of integrity interstitial vascular .Resuscitation in shock septic need a combination of
liquid crystalloids and colloid to restore perfusi that adekuat .
In shock distributive, the provision of liquid crystalloids rapid has been proven save a life.
Vasoactive drug