dr.

Meddy Setiawan, SpPD

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG

Shock
Shock adalah suatu sindroma klinis
yg ditandai dg kegagalan sistem
sirkulasi untuk mempertahankan
perfusi yg adekuat ke organ-organ
vital tubuh

Klasifikasi Shock
( Menurut Hinshaw and Cox classification)

Definisi

Etiologi

Effects of inadequate perfusion on cell

function

PERJALANAN PATOFISIOLOGI
SYOK
Septic Shock

Hypovolemic Shock
Capillary Leak
Preload

Mediators
Vasodilatation

Cardiac Output

Cardiogenic Shock
Myocardial
Depression
Contractility
Blood Pressure

Sympathetic Discharge
Improved Cardiac
output and blood
pressure
COMPENSATED

Vasoconstriction,

HR Contractility

Vasoconstriction
HR Contractility
COMPENSATED
DECOMPENSATED

Myocardial perfusion
Myocardial O2 Consumption
Cardiac Output

Tissue Ischemia

Mediator Release
Loss of Auto
regulation of
Microcirculation

Cell Function
Cell Death

Death of Organism

Immunoinflamatory respon to
shock

Hypovolemic shock

Mild ( < 20% blood volume )

Moderateural (20-40% blood

volume)

Cool extremities
Increased capilary refil time
Diaphoresis
Collapsed veins
Anxiety

Tachycardia
Tachypnea
Oligouria
Postural changes

Severe ( > 40% blood

volume )

Hemodynamic instability
Marked tachycardia
Hypotension
Coma

Cardiogenic shock

Patofisiologi
Decrease in Cardiac Output
Fall in blood pressure
High Left Ventricular Filling Pressures

Compensatory response
Increase systemic vascular resistance (increase
blood flow to the heart)
Increase heart rate (increase blood to the
tissues)

Resulting physical manifestations

Cool peripheries
Weak pulse
Decreased urine output

Hollenberg, S. M. et. al. Ann Intern Med 1999;131:4759

PEMERIKSAN DIAGNOSTIK
Pemeriksaan foto toraks, biasanya
menunjukkan jantung normal atau
membesar diserta tanda-tanda edema
paru.
Pemeriksan EKG pada syok kardiogenik
sesuai gambaran penyakit yang
mendasari (infark miokard akut, CHF)

PENATALAKSANAAN MEDIS
Pastikan jalan napas tetap adekuat, bila
tidak sadar sebaiknya dilakukan intubasi.
Berikan oksigen 8 15 liter / menit dengan
menggunakan masker untuk
mempertahankan PO2 70 120 mmHG.
Rasa nyeri akibat infark akut yang dapat
memperbesar syok yang ada harus diatasi
dengan pemberian morfin.
Koreksi hipoksia, gangguan elektrolit, dan
keseimbangan asam basa yang terjadi.

Medication
Fluid Resuscitation if
required
Oxygenation and
Airway Protection
Correct electrolyte
imbalance
Analgesia if required
Discontinue - Nitrates,
beta-blocker and ace
inhibitors as they
reduce blood pressure

Inotropic Agents,
increase the force
of muscle
contraction
Diuretics, increase
the excretion of
water and
therefore reduce
the workload of the
heart

Anaphylactic shock

Neurogenic shock
As with hypovolemic shock
but in high spinal injuries
may also be accompanied
by profound bradycardia
due to loss of the cardiac
accelerating nerve fibres
from the sympathetic
nervous system at T1-T4.
The skin is warm and dry
or a clear sweat line exists,
above which the skin is
diaphoretic.
Priapism due to Peripheral
nervous system stimulation

Septic shock
Similar to hypovolemic shock except in the first
stages: Pyrexia (fever), due to increased level of
cytokines
Systemic vasodilation resulting in hypotension
(low blood pressure)
Warm and sweaty skin due to vasodilation
Systemic leukocyte adhesion to endothelial tissue
Reduced contractility of the heart
Activation of the coagulation pathways, resulting
in disseminated intravascular coagulation
Increased levels of neutrophils

..MOGA BERMANFAAT