SHOCK AND TREATMENT

Dr Samsirun Halim SpPD KIC

Unit Perawatan Intensif
RSD Raden Mattaher Jambi

DEFINISI
Gangguan dari perfusi jaringan yang terjadi akibat
adanya ketidakseimbangan antara suplai oksigen ke
sel dengan kebutuhan oksigen dari sel tersebut.
Semua jenis shock mengakibatkan gangguan pada
perfusi jaringan yang selanjutnya berkembang
menjadi gagal sirkulasi akut atau disebut juga
sindrom shock

IT IS NOT LOW BLOOD PRESSURE

!!!
IT IS HYPOPERFUSION..

TIPE2 SHOCK*
Type

of Shock

Clinical

causes

Hypovolemic

Volume loss

Cardiogenic
Pump failure

Distributive

Obstructive

Increased venous
capacitance or
arteriovenous
shunting
Extra-cardiac
obstruction of
blood flow

Primary

mechanism
Exogenous blood,

plasma, fluid or
electrolyte loss
Myocardial
infarction, cardiac
arrhythmias, heart
failure
Septic shock,
spinal shock,
autonomic
blockade, drug
overdose
Vena caval
obstruction,
cardiac tamponade,
pulmonary
embolism, aortic
compression or
dissection

*MORE THAN ONE TYPE MAY BE PRESENT

1. HYPOVOLEMIC SHOCK
DECREASE IN INTRAVASCULAR
BLOOD VOLUME
Hemorrhage
Vomiting
Diarrhea
Fluid sequestration
Intraluminal bowel
obstruction
Intraperitoneal pancreatitis
Interstitial - burns

DECREASE IN CARDIAC
OUTPUT AND TISSUE
PERFUSION

HYPOVOLEMIC SHOCK
1. DECREASE IN
INTRAVASCULAR BLOOD
VOLUME

2. BLOOD DIVERTED FROM SKIN

TO MAINTAIN ORGAN PERFUSION
Pale and cool skin
Postural hypotension and tachycardia

3. BLOOD DIVERTED
PREFERENTIALLY TO HEART AND
BRAIN
Thirst, oliguria
Tachycardia
Labile blood pressure

HYPOVOLEMIC SHOCK
4. DECREASED BLOOD FLOW TO
BRAIN AND HEART
Restless, agitated, confused
Hypotension
Tachycardia
Tachypnea

5. END-STAGE SHOCK
Bradycardia
Arrythmias
Death

2. CARDIOGENIC SHOCK
DECREASED CARDIAC FUNCTION
Decreased ventricular function
MI
Pericaridal tamponade
Tension pneumothorax
Infective cardiac contraction
Arrhythmias

CLINICAL FINDINGS
Hypotension
Tachycardia
Tachypnea
Oliguria
**distended neck veins**

3. SEPTIC SHOCK
SEVERE INFECTION W RELEASE
OF MICROBIAL PRODUCTS
Release of vasoactive mediators

HYPERDYNAMIC STATE
Peripheral vasodilation
Increased cardiac output
Fever, tachycardia, tachypnea, warm skin

MAINTENANCE OF
INTRAVASCULAR VOLUME

FAILURE TO MAINTAIN
INTRAVASCULAR VOLUME

Hyperdynamic shock

Hypodynamic shock
Cool skin, tachycardia,
hypotension, oliguria

4. NEUROGENIC SHOCK
REDUCED VASOMOTOR TONE
FROM LOSS OF SYMPTATHETIC
INNERVATION
Spinal cord trauma
Spinal anesthesia
Acute gastric dilatation

CLINICAL FINDINGS
Bradycardia
Mild hypotension
Flat neck veins

anamnesis

Riwayat kehilangan cairan tubuh

Riwayat sakit jantung
Riwayat sakit panas
Riwayat trauma
Riwayat pengobatan
Lamanya kejadian
Lamanya tanda-tanda syok

Pemeriksaan fisik
Kesadaran : compos mentis ---- sopor
Tensi : hipotensi / normotensi
Nadi : takikardi, bradikardi, isi dan
tegangan, reguler/ireguler
Suhu : hipotermi, hipertermi
Frekwensi nafas : cepat/lambat,
dalam/dangkal
Kulit : turgor, hangat, dingin

Pem. Fisik ( lanjutan)

Leher : tegangan vena jugular

Jantung : irama, frekwensi, bising
Paru : ronki, wheezing
Abdomen :hepar, asites, defence
musc
Extremitas : akral hangat, dingin

PATHOGENESIS OF
SHOCK

Cardiogenic
Shock

Distributive
Shock

Inotropes
(Dob,Dop,Adr,Amr
)
Release
tamponade,e
tc

Vasopressor ( NE,PE,ADR,Dop)

Pump = Pipe = Vascular

Heart

Blood Pressure

Cardiac Output x SVR

Obstructive
Shock
Volume =
Blood

Fluids

Hypovolemic
Shock

PRINSIP RESUSITASI

Mempertahankan ventilasi
Meningkatkan perfusi
Terapi penyebab

Especially in:

MAINTAIN
Increased
VENTILATION
oxygen demand

Sepsis
Hypovolemia
Trauma

Hyperventilation

Respiratory
fatigue
Respiratory failure
Respiratory acidosis, lethargy-coma,
hypoxia

Diversi blood flow

from vital organ

Organ injury

TREATMENT OF RESPIRATORY
FAILURE
Hypovolemia (blood
loss)

Decreased CO

Decreased oxygen delivery,

increased oxygen requirement

Metabolic acidosis, hypoxemia

tachypnea

TREATMENT:

Primary resuscitation
Oxygen
Mechanical ventilation if needed

TREATMENT CONCEPT OF SHOCK

ENHANCING PERFUSION / OXYGEN DELIVERY

DO2 = CO x CaO2
Cardiac
output

Arterial
O2
content

Oxygen delivery/DO2 = HR X SV X Hb X S02 X 1.34 + Hb X paO2

Inotropes

Fluids Transfus
e

Partially
dependent
on FIO2 and
pulmonary
status

THERAPI CAIRAN

Body fluid composition

Total body water is 60% of total body
weight
= distributed into 3 main compartment
INTRA CELULLAR (ICF)
INTERSTITIAL (ICS)
PLASMA VOLUME (IVF)

40%
15%
5%

Jenis cairan intravena

cairan desktrose
Cairan kristaloid
Cairan koloid
Darah atau komponen darah

Efek pemberian cairan

terhadap komposisi cairan
tubuh