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anastesi pada
kasus shock
shock
Klasifikasi Shock
Hypovolemic
Cardiogenic
Distributive
Obstructive
Septic
Anaphylactic
Neurogenic
Etiologi
Hypovolemic
Shock
Perdarahan
Kekurangan plasma
Kekurangan cairan ekstraseluler
Cardiogenic
Shock
Distributive
Shock
Septic shock
Anaphylaxis
Neurogenic shock,
Obstructive
Shock
Tamponade perikardiak
Emboli paru (masif)
pneumotorax
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
Hipovolemic shock
Terapi
syok
hipovole
mik
*POSISI SHOCK
HIPOVOLEMIA
-DEHIDRASI
(% x BB)
-PERDARAHAN
(% x EBV)
-LUKA BAKAR
(luasxBBx4)
MEMBAIK
+ SHOCK
ATASI SHOCK
GROJOK 20-40 CC/KG
10-20 MENIT (DEWASA)
30-60 MENIT (ANAK)
MASIH SHOCK ?
GROJOK LAGI
YA
TIDAK
- SISA DEFISIT
-MAINTENANCE
DWS (40cc/kg//hr)
ANAK: 10kg I (100cc/kg/hr), 10kg II (50cc/kg/hr); 10kg III (20cc/kg/hr)
DEHIDRASI
Derajat Dehidrasi
Kriteria Pierce
insterstitiil Sign
plasma sign
Gejala
sedang
ringan
berat
Defisit
(3-5%BB)
(6-8%BB)
( > 10%BB)
Turgor kulit
berkurang
menurun
sangat menurun
Lidah
normal
lunak
kecil keriput
Mata
normal
cowong
Ubun-ubun
normal
cekung
Rasa haus
Nadi
++
sangat cowong
sangat cekung
+++
Tensi
kecil lemah
ttb
tak terukur
Urine
pekat
sangat kecil
anuria
PERDARAHAN
Trauma status giesecke
Class
Lost EBV
Tekanan darah
<15 %
Masih normal
Hipotensi postural +
Sistolik + tetap
II
15 30 %
Diastolik naik
Tekanan/ Nadi turun
Hipotensi postural
Nadi
< 100
>100
III
30 40 %
Sistolik turun
>120
IV
> 40
> 140
Tanda lain
Agak gelisah
Nafas 14 20
Agak gelisah
Nafas 20 30
Cap.refill lambat
Oliguria
Gelisah/ bingung
Nafas 30 40
Kulit dingin ke-abu-abuan
Anuria
Bingung/ lethargy
LUKA BAKAR
4,5
4,
5
9
9
4,5
4,5
4,5
4,5
DEPAN
BELAKANG
Kardiogenik shock
Terapo
syok
kardiog
enik
Distributive shock
Anafilaktic shock
Septic shock
Neurogenic shock
Anaphylactic shock
Terapi
syok
anafilak
tik
Neurogenic shock
Terapi
syok
neuroge
nik
Terapi syok
sepsis
SIRS criteria ( 2)
Temp >38 or <36C
HR > 90
RR > 20 or PaCO2 <
32 mmHg
WBC > 12.000/mm3
or <4.000/mm3.
Obstructive Shock
SYOK OBSTRUKTIF
terapi
Terima kasih....
40 50 ml / kgBB / hari