DEFINISI SYOK

• Syok merupakan suatu sindroma kegagalan sirkulasi yang mengancam

nyawa dan menyebabkan penurunan perfusi jaringan serta hipoksia sel.
• Syok bisa disebabkan oleh kegagalan jantung dalam memompa darah
untuk memenuhi kebutuhan oksigen tubuh, kehilangan cairan intravaskular,
obstruksi pada vaskular, atau dikarenakan kondisi vasodilatasi pembuluh
darah.
• Hipoperfusi jaringan dan organ dapat menyebabkan tidak terpenuhinya
kebutuhan fungsi sel. Perfusi jaringan biasanya dinilai melalu MAP (mean
arterial pressure) yang merupakan cardiac output (CO) dikali dengan
systemic vascular resistance (SVR)
hemorrhagic nonhemorrhagic

HYPOVOLEMIC
HYPOVOLEMIA CAN BE CAUSED BY
hemorrhage
ruptured ectopic pregnancy
gastrointestinal loss
dehydration
burns
diabetic ketoacidosis
Hypovolemic shock results when
there is an acute loss of 15% to
20% of circulating blood volume,
causing a lack of blood to pump
through the circulatory system.3
When the patient loses
intravascular volume, stroke
volume decreases but MAP is
maintained by an increase in
heart rate and vasoconstriction
 CONT.
A significant drop in MAP and CO is seen only when the
patient has a 35% to 45% intravascular volume loss.2
When this occurs, the body tries to compensate for these losses
by shifting fluid from the interstitial spaces into the vascular
space.
Hypovolemia stimulates the release of antidiuretic hormone
(also known as vasopressin) in order to increase water and
sodium retention by the kidneys.
Despite the body’s effort to reverse the cause, if hypovolemic
shock continues, hypoperfusion will lead to anaerobic
metabolism and cellular injury.1
DISTRIBUTIVE
DISTRIBUTIVE SHOCK CAN BE CAUSED BY

Form of vasodilatory shock resulting from loss of vascular tone and

enlargement of the vascular compartment.
This type of shock is mainly caused by a decrease in the sympathetic
control of vasomotor tone or due to excessive release of vasodilatory
substances.1
In distributive shock, the heart pumps effectively but vessel tone is lost,
leading to severely decreased SVR.
The body compensates for decreased SVR by increasing heart rate
and stroke volume, leading to increased CO.
 Anaphylactic
septic shock shock

neurogenic
shock
CARDIOGENIC SHOCK
CARDIOGENIC SHOCK
Disebabkan oleh kegagalan pompa jantung  penurunan CO,
hypotensi dan hypoperfusi  abnormal heart rate atau stroke volume
Penyebab terseringnya karena berkurangnya kontraktilitas myocard
yang disebabkan myocardial infarct atau myocarditis
OBSTRUCTIVE SHOCK
OBSTRUCTIVE SHOCK
Pada shock obstruktif jantung memompa dengan baik, tetapi cardiac
output berkurang akibat adanya obstruksi. Keadaan ini juga dapat
mengakibatkan peningkatan afterload
Penyebab:
cardiac tamponade
constrictive pericarditis
pulmonary emboli
tension pneumothorax
DIAGNOSIS
Monitor tanda vital (TD, HR, RR, nadi, CRT, akral, urine output)
Kateter arteri pulmonalis untuk menentukan tipe syok (risiko trombosis
dan infeksi)
Transesofageal ekokardiogram (TEE) untuk monitoring (inotropik lebih
banyak, fluid loading lebih sedikit)
Laboratorium: CBC, trombosit, BUN/kreatinin, elektrolit, faktor koagulasi, BGA,
marker kardiak, asam laktat, kortisol, fibrinogen, D-dimer, tes fungsi hati,
urinalisis, kultur darah dan urine
Kadar laktat menunjukkan keparahan syok
Penurunan kesadaran, FUO: lumbal pungsi
Radiologi: USG, X ray
EKG
CT scan
EARLY MANAGEMENT
1. Initial assessment for management includes circulation, airway, and breathing
(CAB).
2. Secondly, good peripheral access or central venous access must be
obtained emergently to initiate fl uid resuscitation.
3. After appropriate fluid resuscitation (determined by a stable MAP
and evaluation of the inferior vena cava diameter using ultrasound or
by a central venous pressure [CVP] of more than 12 mm Hg),
vasopressor therapy or inotropic therapy may be started if the patient
has persistent hypotension. Dopamine and norepinephrine are
recommended as first-line vasopressor agents for patient in shock.
4. If the patient is suspected to be in septic shock, initiating
antimicrobial therapy early is very important
KESIMPULAN
Syok merupakan suatu kondisi yang mengancam nyawa sehingga
membutuhkan evaluasi dan resusitasi yang berulang. Identifikasi awal
dari penyebab syok sangat penting untuk menghasilkan penanganan
yang optimal. Pengawasan dari Tanda vital dan perfusi jaringan bisa
menentukan prognosis dari pasien syok.
Resusitasi cairan, ventilasi mekanik, pemberian antiobiotik spektrum
luas, dan penentuan kebutuhan terapi vasopressor atau inotropic
sedini mungkin dapat mencegah suatu kegagalan organ.
Karena pengenalan awal pada pasien syok dan pemberian resusitasi
segera dapat mengurangi mortalitas
SOURCE