Shock - Revisi
Transcript of Shock - Revisi
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dr. Meddy Setiawan, SpPD
FAKULTAS KEDOKTERANUNIVERSITAS MUHAMMADIYAH MALANG
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“Shock”
• Shock adalah suatu sindroma klinisyg ditandai dg kegagalan sistem
sirkulasi untuk mempertahankanperfusi yg adekuat ke organ-organvital tubuh
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Klasikasi Shock( Menurut Hinsha and !o" classication#
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$enisi
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%tiologi
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&%'ects of inadeuate perfusion on cellfunction&
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PERJALANAN PATOFISIOLOGIPERJALANAN PATOFISIOLOGI
SYOK SYOK Septic Shock Cardiogenic Shock
Hypovolemic Shock
Capillary Leak MediatorsMyocardialDepression
↓ Preload Vasodilatation ↓ Contractility
↓ Cardiac Output↓ Blood Pressure
Sympathetic Discharge
Vasoconstriction,
H Contractility
!mproved Cardiacoutput and "loodpressure
COMP#$S%D
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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
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&)mmunoin*amatory respon toshock&
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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
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!ardiogenic shock&
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.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
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Holl#+b#,- S. M. #'. &l. A++ I+'#+ M#d /1//3)4
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.%M%2)KS+5 $)+65S,)K
.emeriksaan foto toraks7 biasanyamenun8ukkan 8antung normal atau
membesar diserta tanda-tanda edemaparu4
.emeriksan %K6 pada syok kardiogeniksesuai gambaran penyakit yang
mendasari (infark miokard akut7 !H/#
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.%5+,+0+KS+5++5 M%$)S
.astikan 8alan napas tetap adekuat7 bilatidak sadar sebaiknya dilakukan intubasi4
9erikan oksigen : ; menit dengan
menggunakan masker untukmempertahankan .? @A ;
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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
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+naphylactic shock&
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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 ,
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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
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6..MOGA 7ERMANFAAT6