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DEFINISI
suatu syndroma dimana perfusi jaringan tidak adekwat, akibat dari ketidak mampuan sistim sirkulasi untuk mensuplai oksigen
Jika sel tidak menerima oksigen yang cukup atau tidak bisa menggunakan oksigen dengan baik maka terjadilah metabolisme anaerob Syok pada awalnya terjadi pada tingkat sellular (mikrosirkulasi) , kemudian berkembang ke tingkat jaringan ,tingkat organ / multiple (MOD) dan pada akhirnya menyebabkan kematian
A. Glycolisis, metabolisme anaerob (tanpa oksigen),menghasilkan asam piruvat--- asam laktat dengan sedikit energy (2ATP) + panas (32 Kcal)
Anaerobic Metabolism
Metabolic Failure
Cell Death!
Metabolic Acidosis
Penyebab:
Keadaan apapun yang membuat/mempengaruhi kemampuan sistim sirkulasi untuk menyalurkan oksigen ( mikrosirkulasi ) Komponen pada sisitim sirkulasi : 1. Jantung --- sebagai pompa. 2. Darah + plasma----- sebagai pembawa oksigen ( + nutrisi ) 3. Pembuluh darah ---- sebagai wadah. jika terjadi suatu masalah pada ke 3 komponen tersebut, maka akan menyebabkan perfusi jaringan terganggu / tidak adekwat
Jantung
Sebagai pompa , memompa darah dari sistim vena ke paru untuk oksigenisasi, dan memompakan darah yang teroksigenisasi lewat arteri ke jaringan periperal. Stroke Volume / isi volume sekuncup dipengaruhi : 1. Preload = jumlah darah yang diterima jantung selama diastole 2. Contractility = kekuatan kontraksi otot jantung Hukum Frank starling 3. Afterload = tahananan terhadap kontraksi ventrikel.
Hukum Frank-Starling
peregangan serabut miokardium selama diastole melalui peningkatan volume akhir diastole akan meningkatkan kontraksi pada saat sistole
Darah
Darah : berisi sel darah (ery,leu, platelets ) plasma, oksigen transports, CO,nutrisi,hormon, zat sisa dan panas harus dalam keadaan cukup. - berkurangnya volume : pendarahan, dehidrasi dsb. Menyebabkan syok
Pembuluh darah.
Renin-Angiotensin-Aldosterone
Plasma volume
Detected by
&/Or [Na+]
Via ACE (Angiotensin Converting Enzyme)
Renin
Converts
Renin-AngiotensinAldosterone
vasoconstriction
Angiotensin II thirst ADH (anti-diuretic hormone) Adrenal cortex
Releases
PVR
Fluid volume
BP!
Aldosterone
Na+ reabsorption
Tissue perfusion
Stimulation of clotting cascade & inflammatory response Intracellular Na+ & water
TAHAP-TAHAP SYOK
Compensated Shock
Defense mechanisms are successful in maintaining perfusion Presentation
Tachycardia Decreased skin perfusion Altered mental status
Uncompenstated Shock
Defense mechanisms begin to fail Presentation
Hypotension Prolonged Cap refill Marked increase in heart rate Rapid, thready pulse Agitation, restlessness, confusion
Irreversible Shock
Complete failure of compensatory mechanisms Death even in presence of resuscitation
. HYPOVOLUMIC SHOCK: blood loss, git loss, third space loss -CARDIOGENIC SHOCK
Hypovolemic Shock
Penyebab : kehilangan cairan intravascular Internal atau external hemorrhage. Trauma. Dehydration. Plasma loss from burns. Excessive sweating. Diabetic ketoacidosis with resultant osmotic diuresis.
-Penurunan kesadaran :
-Nadi : mula-mula meningkat, sampai tak teraba -Hypoperfusi : Capillary refill memanjang, acral dingin / basah.
HEMORRHAGE CONTROL
-SHOCK POSITION
AIRWAY
Open airway : head tilt & chin lift , modification jaw trust(trauma)
BREATHING
AIR pO2 150 20,9% O2 + 80% N2
ALVEOLI
pO2 120
deoxyhemeglobin
Pressure
pH 7.35
deoxyhemeglobin
Pressure
Shock Position
auto-transfusion 300-500 cc
HYPOVOLUMIC SHOCK
SHOCK POSITION 2 LARGE I.V CATHETER LINE ( 14,16G ) TAKEN BLOOD SAMPLE RINGER LAKTAT 1000 CC
Hemodilution technic
Estimate Wieght : 60 kg Estimate Blood volume: 70 ml/kg x 60 = 4200 ml Estimate blood loss : ---- % EBV = ml
120 80 warm
EBL Infusion
600
1200
2000 ml 4000-8000ml
1200-2000 2500-5000
Cardiogenic shock
The heart loses its ability to supply all body parts with blood. Usually the result of left ventricular failure secondary to acute myocardial infarction or CHF. Many patients will have normal blood pressures.
Cardiogenic Shock
R.A.S. Activation
CO
Catecholamine Release
Volume/ Preload
Myocardial O2 demand
SVR
O2 supply Peripheral & pulmonary edema
Dyspnea
Edema paru akut : Difficulty breathing. As fluid levels rise, wheezes, crackles, or rales may be heard. There may be a productive cough with white or pink-tinged foamy sputum. Cyanosis, altered mentation, and oliguria.
-BREATHING
-CIRCULATION AND CARDIAC IMPROVING & MONITORING UP POSITION + + KEEP WARM
-HEAD&SHOULDER
DISTRIBUTIVE SHOCK
Neurogenic Shock
Results from injury to brain or spinal cord causing an interruption of nerve impulses to the arteries. The arteries dilate causing relative hypovolemia. Sympathetic impulses to the adrenal glands are lost, preventing the release of catecholamines with their compensatory effects.
Neurogenic Shock
Sympathetic Tone Or Parasympathetic Tone Vascular Tone
Tissue perfusion
Massive Vasodilation
Cardiac Output
TANDA &GEJALA
Warm, dry, red skin. Tekanan Darah rendah Bradycardia
Penatalaksanaan
Airway control. Maintain body temperature. Immobilization of patient. Consider other possible causes of shock. IV access and medications that increase peripheral vascular resistance.
Anaphylactic Shock
A severe immune response to a foreign substance. Signs and symptoms most often occur within a minute, but can take up to an hour. The most rapid reactions are in response to injected substances:
Penicillin injections. Bees, wasps, hornets.
Anaphylactic Shock
Container failure Massive & systemic allergic reaction Large release of histamine Increases membrane permeability & vasodilation
Respiratory system:
Breathing difficulty, sneezing, coughing, wheezing, stridor, laryngeal edema, laryngospasm.
Tanda &Gejala
Cardiovascular system:
Vasodilation, increased heart rate, decreased blood pressure.
Gastrointestinal system:
Nausea, vomiting, abdominal cramping, diarrhea.
Nervous system:
Altered mental status, dizziness, headache, seizures, tearing.
Penatalaksanaan
Airway protection, may include endotracheal intubation. Establish an IV of crystalloid solution. Pharmacological intervention:
Epinephrine, antihistamines, corticosteroids, vasopressors, inhaled beta agonists.
Septic Shock
An infection that enters the bloodstream and is carried throughout the body. The toxins released overcome the compensatory mechanisms. Can cause the dysfunction of an organ system or result in multiple organ dysfunction syndrome.
PENATALAKSANAAN
Airway control. Support brething if necessary IV of crystalloid solution. Dopamine to support blood pressure. Monitor heart rhythm.
KESIMPULAN
SHOCK ADALAH SYNDROMA KARENA TIDAK ADEKUATNYA PERFUSI JARINGAN SEHINGGA MENGURANGI SUPLAI OKSIGEN DAN NUTRISI YANG DIBUTUHKAN PROSES METABOLISME TUBUH. ORGAN TUBUH AKAN BEREAKSI TERHADAP SHOCK SEBAGAI MEKANISME KOMPENSASI, BILA GAGAL AKAN TERJADI ISKEMIK VASKULER, KEGAGALAN FUNGSI ORGAN DAN AKHIRNYA KEMATIAN
SEMOGA BERMANFAAT