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STROKE
VOLUME
HEART RATE
CARDIAC OUTPUT
HEMODINAMIK
Ilmu yang mempelajari
Fungsi jantung sebagai pompa
Sistem sirkulasi darah
Autoregulasi sistem
kardiovaskuler
Cardiac Output
Cardiac Output is the volume of blood pumped each
minute, and is expressed by the following equation:
CO = SV x HR
Where:
COis cardiac output expressed in L/min
(normal ~5 L/min)
SVis stroke volume per beat
HRis the number of beats per minute
Ukuran( Size )
Panjang pembuluh darah
Tahanan
Viskositas
KONTROL SISTEM
KARDIOVASKULER
Kontrol jangka pendek
Baroreseptor
Sistem Simpatik/Para simpatik
Jantung dan Pembuluh darah
Shock
Suatu keadaan dimana perfusi jaringan
tidak adekuat menyebabkan kekurangan
oksigen dan pengkutan bahan bahan
metabolik terganggu.
Gangguan produksi dan pemanfaatan
energi, perubahan metabolisme sel,
asidosis, cedera sel, rusaknya integritas
sel, disfungsi jaringan dan organ dan
akhirnya kematian bila tidak di atasi
secara cepat dan agresif.
Gambaran Klinis
A. Tanda Vital
B. Kulit
C. Volume Urine
D. Status Mental
Tanda Vital
Pulsa Nadi : Takikardia
Tekanan Darah :
TDS < 90 mmHg
Shock Index :
HR
TD
N = 0.5 0.7
Kulit
Dingin
Clammy (lembab dan basah)
Diaphoretic
Volume Urine
Pekat
Jumlah urine menurun
Oliguria < 0.5 cc/kg/jam
Anuria
Status Mental
Confuse
Agitasi
Lethargi
Coma
Triad kardiovaskular
1. Problem irama atau frekuensi j
antung.
2. Problem pompa Jantung.
3. Problem volume atau tahanan v
askular
Irama Lambat
Sinus bradikardia
Junctional Rhythm
AV block
Myokardial Infark
Cardiomyopathy
Myocarditis
IVS rupture
Disfungsi katup akut
Myxoma atrium
Tamponadde jantung
Emboli Paru
Tension Pneumothorak
Obstruksi vena kava
Obat yang dapat mendepresi myocard
Sekunder
Perdarahan
Muntah/diare
Luka bakar
Diabetes Insipidus
dll
Anaphylaxis
CNS injury
Toxin
Obat-obtan
Pasien Monitor
Monitor ketat
Tanda Vital
Irama Jantung
Saturasi Oksigen ( Pulse Oximetry)
Volume Urine
Penilaian pasien
Monitor Invasif
Artery Line
Central venous Pressure
Pulmonary artery catheterization ( Swan-Ganz )
Outline
Cardiogenic Shock
Etiologies
Pathophysiology
Clinical Findings
Treatment
Shock Kardiogenik
Definition
<90 mmHg
<2.2 li/min.m2
>15 mmHg
SHOCK Registry
Respiratory
Distress
Hypotension Hypoperfusion
21%
22%
1.4%
5.6%
70%
60%
28%
65%
Clinical Manifestations:
Multiple organ failure
Hypotension
Schematic
LVEDP elevation
Hypotension
Decreased coronary
perfusion
Ischemia
Further myocardial
dysfunction
Neurohormonal
activation
Vasoconstriction
Endorgan hypoperfusion
Hemodynamic Parameters
Systemic Vascular Resistance
(SVR)
Cardiac Output (CO)
Mixed Venous Oxygen
Saturation (SvO2)
Pulmonary Capillary Wedge
Pressure (PCWP)
Central Venous Pressure (CVP)
Normal Values
Right Atrial
Pressure, CVP
Mean
0-6mmHg
Pulmonary
Systolic
Artery Pressure End-diastolic
mean
15-30mmHg
4-12mmHg
9-19mmHg
PCWP
4-12mmHg
Mean
Cardiac Output
4-8 L/min
Mixed Venous
O2 Sat
>70%
SVR
800-1200
Differentiating Types of
Shock
Clinical Findings
Physical Exam: elevated JVP, +S3, rales,
oliguria, acute pulmonary edema
Hemodynamics: dec CO, inc SVR, dec
SvO2
Initial evaluation: hemodynamics (PA
catheter), echocardiography,
angiography
4 Potential Therapies
Pressors
Intra-aortic Balloon Pump (IABP)
Fibrinolytics
Revascularization: CABG/PCI
Refractory shock: ventricular assist
device, cardiac transplantation
IABP
Contraindications to
IABP
Significant aortic regurgitation or
significant arteriovenous shunting
Abdominal aortic aneurysm or aortic
dissection
Uncontrolled sepsis
Uncontrolled bleeding disorder
Severe bilateral peripheral vascular
disease
Bilateral femoral popliteal bypass grafts for
severe peripheral vascular disease.
Complications of IABP
Cholesterol Embolization
CVA
Sepsis
Balloon rupture
Thrombocytopenia
Hemolysis
Groin Infection
Peripheral Neuropathy
Revascularization
SHOCK trial
Overall 30-Day Survival in the Study
SHOCK trial