Beruflich Dokumente
Kultur Dokumente
1
SKILL LAB
SHOCK
2
Oleh:
Desi Suryani Dewi, S.Ked.
132011101102
Pembimbing:
dr. Dwi Ariyanti, Sp.JP
3
Shock is an acute clinical syndrome initiated by
ineffective perfusion, resulting in severe
dysfunction of organs vital to survival.
4
NUMBER OF PATIENTS = 43
10 14 20 13 6
100
% MORTALITY RATE
100
Percent
survival
80
60
40
20
0
0 30 60 90
Minutes
6
From: Stene JK, Grande CM, Gieseke A, 1991
UNSUR2 PEMBEDA PADA SHOCK UNSUR YANG
SAMA PADA
SYOK
SYOK SYOK SYOK SYOK - COMMON
HIPOVOLEMIA KARDIOGENIK ANAFILACTIC SEPTIK TERMINAL
- PERDARAHAN PATH WAY
- KEHILANGAN
CAIRAN
8
CELLULAR / METABOLIC
RECOGNITION OF SHOCK STATE
RESPONSE
11
Aetiology and
pathophysiology
12
SHOCK
Hypovolemic shock
absolute hypovolemia due to significant Septic shock
intravascular fluid depletion : internal or By complex mechanism, often including
external haemorage, dehydration, plasma vasodilatation, heart failure and absolute
leaks. hypovolemia
Relative hypovolemia due to vaodilatation
without concomitant increase in intravascular
volume: anaphylactic reaction, acute
Cardiogenic shock
haemolysis Decrease of cardiac output: direct injury to the
myocardium and indirect mechanism
13
Clinical features
Sign common to most form of shock:
Pallor, mottle skin, cold extremities, sweating and thirst
Rapid and weak pulse often only detected on major arteries (femoral or
carotid)
Low BP, narrow pulse preasure, BP sometimes undetectable
CRT > 2 second
Cyanosis, dyspnoe are often present in varying degrees depending on the
mechanism
Consciousness usually maintained (more rapidly altered in children, but
anxiety, confusion, agitation or apathy are common
Oliguria or anuria
14
Sign specific to the mechanism of shock
15
Sign specific to the mechanism of shock
17
In all cases
Emergency: immediate attention to the patient
Warm the patient, lay him flat, elevate legs (except in respiratory distress,
acute pulmonary oedema)
Insert a peripheral IV line using a large calibre catheter (16G in adults). If
no IV access, use intraosseous route
Oxygen theraphy, assited ventilation in the event of repiratory distress
Assited ventilation and external cardiac compression in the event of
cardiac arrest
Intensive monitoring: conciousness, pulse, BP, CRT, respiratory rate,
hourly urinary output (insert a urinary catheter) and skin mottling
18
Management according to the cause
Haemorrhage
Control bleeding (compression, torniquet, surgical haemostasis
Determine blood group
Priority: restore vascular volume as quickly as possible. Insert 2
peripheral IV lines (catheters 16G in adults). RL or 0.9% NaCl: replace
3 times the estimated lossess and/or plasma subtitute: replace 1.5
times the estimated losses
Transfuse: classically once estimated blood loss represents
approximately 30 to 40% of blood volume (25% in children). The
blood must be tested (HIV, hepatitis B and C, syphilis, etc) refer to the
MSF handbook, blood transfusion.
19
OUTLINE
20
Management according to the cause
23
Management according to the cause
Septic Shock
Vascular fluid replacement with RL or 0,9% NaCl or plasma subtitute.
Use of vasoconstrictors:
Dopamine IV at a constant rate by syringe pump: 10 to 20
micrograms/kg/minute or if not available epinephrin IV at a constant
rate by syringe pump: use diluted solution, i.e. add 1 mg epinephrine
(1:1000) to 9 ml of 0,9% NaCl to obtain a 0,1 mg/ml solution
(1:10000). Start with 0,1 microgram/kg/minute. Increase the dose
progressively until a clinical improvement is seen.
25
Management according to the cause
Look for the origin of infection (abscess; ENT, pulmonary, digestive,
gynaecological orurological infection etc) antibiotic therapy according
to the origin of infection:
26
Management according to the cause
Ampicillin IV
Children and adults: 150 to 200 mg/kg/day in 3 injections (every 8
hours)
27
Management according to the cause
31
Management according to the cause
32
TERIMA KASIH
33
34
35
IVF
ISF ICF
Perdarahan
ICF
IVF ISF
36
ECF SHIFT
IVF
ISF ICF
Perdarahan
Squesterasi
IVF
ISF ICF
37
Management according to the cause
38