BEDSIDE MANAGEMENT

OF SHOCK
MAYA PUSPA
030.11.182

Pembimbing:
dr.Bambang priyambodo, Sp.An

Kepaniteraan Klinik Ilmu Anestesi

Rumah Sakit Angkatan Udara DR Esnawan Antariksa
2017
PENDAHULUAN
 KLASIFIKASI
Syok terbagi menjadi 4 kategori, yang kebanyakan pasien dapat timbul
dengan lebih dari satu tipe:
SYOK HIPOVOLEMIK
SYOK DISTRIBUTIF
Pada tahun 2012, surviving sepsis campaign mendefinisikan
sepsis berat sebagai adanya dari suspek atau pasti infeksi dengan
terkait hipoperfusi atau disfungsi organ, meliputi [3]:
 Tujuan dini langsung terapi pada pengobatan dari syok septik
adalah yang mengganggu dalam perbaikan akhir pasien [9]
Rangkaian harus dilakukan dalam 3 jam Rangkaian harus dilakukan dalam 6 jam
Penghitungan kadar serum laktat Pemberian vasopressor untuk
Pengambilan kultur darah (sebelum mempertahankan tekanan arteri rerata
pemberian antibiotik jika mampulaksana) 65mmHg dalam keadaan hipotensi arteri
Antibiotik yang tepat dalam 1 jam persisten walau resusitasi volume atau inisial
30mL/kg kristaloid untuk hipotensi atau laktat 4mmol/L
laktat 4mmol/L Penghitungan tekanan vena sentral
Penghitungan saturasi oksigen vena sentral
(ScvO2)
Penghitungan ulang laktat jika inisial laktat
meningkat
SYOK KARDIOGENIK
ETIOLOGI
AGEN VASOAKTIF
 DAFTAR PUSTAKA
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J
Med 345: 1368-1377.

Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, et al. (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic
shock. SHOCK Investigators. Should we Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 341: 625634.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlack H et al., (2013) Surviving Sepsis campaign: international guidelines for management of severe sepsis
and septic shock:2012. Crit Care Med 41: 580-637.

Marik PE, Cavallazzi R, Vasu T, Hirani A (2009) Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated
patients: a systematic review of the literature. Crit Care Med 37: 2642-2647.

Marik PE, Baram M, Vahid B (2008) Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven
mares. Chest 134: 172-178.

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, et al. (2001) Epidemiology of severe sepsis in the United States: analysis of incidence,
outcome, and associated costs of care. Crit Care Med 29: 1303-1310.

Kidokoro A, Iba T, Fukunaga M, Yagi Y (1996) Alterations in coagulation and fibrinolysis during sepsis. Shock 5: 223-228.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, et al. (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care
Med 31: 1250-1256.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J
Med 345: 1368-1377.
 DAFTAR PUSTAKA
10. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, et al. (2008) Intensive insulin therapy and pentastarch resuscitation in severe
sepsis. N Engl J Med 358: 125-139.

11. Guidet B, Martinet O, Boulain T, Philippart F, Poussel JF, et al. (2012) Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch
130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study. Crit Care 16: R94.

12. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, et al (2012) Hydroxyethyl starch 130/0.42 versus Ringers acetate in severe sepsis.
N Engl J Med 367:124134.

13. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, et al. (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med
367:1901-1911.

14. De Backer D, Aldecoa C, Njimi H, Vincent JL (2012) Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*. Crit Care
Med 40: 725-730.

15. Gaieski DF, Mikkelsen ME, Band RA, Pines JM, Massone R, et al. (2010) Impact of time to antibiotics on survival in patients with severe sepsis or
septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 38: 1045-1053.

16. Kumar A, Zarychanski R, Light B, Parrillo J, Maki D, et al. (2010) Early combination antibiotic therapy yields improved survival compared with
monotherapy in septic shock: a propensity-matched analysis. Crit Care Med 38: 1773-1785.

17. Goldberg RJ, Gore JM, Alpert JS, Osganian V, de Groot J, et al. (1991) Cardiogenic shock after acute myocardial infarction. Incidence and mortality
from a community-wide perspective, 1975 to 1988. N Engl J Med 325: 1117-1122.

18. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, et al. (2010) Comparison of dopamine and norepinephrine in the treatment of shock. N
TERIMA KASIH