Escolar Documentos
Profissional Documentos
Cultura Documentos
Hipoperfusi
Otak : Penurunan kesadaran
Kulit : Akral Dingin
Ginjal : Urine Output berkurang
Myocardial infarction,
Cardiogenic Pump failure cardiac arrhythmias,
heart failure
HEMORRHAGIC
NON - HEMORRHAGIC
HEMORRHAGIC
Trauma
Vascular
Gastrointestinal
Retro peritoneal
Karakteristik hemodinamik
curah jantung
tek pengisian vent kiri
tahanan pemb darah sistemik
CARDIOGENIC SHOCK
Tujuan Utama Terapi: Memperbaiki fungsi
miokard
Antiaritmi
Inotropik : Dobutamin (ß1,ß2) - kontraksi
Vasopresor : Norepinephrin (a1,a2) – me
diastolik pressure untuk perfusi koroner
Kombinasi NE dan dopamin dosis tinggi jika
TD < 80 mmHg, tambahan dobutamin jika
TD sudah mulai stabil untuk mengganti
vasopresor
CARDIOGENIC SHOCK
DECREASED CARDIAC FUNCTION
Decreased ventricular function
MI
Pericaridal tamponade
Tension pneumothorax
CLINICAL FINDINGS
Hypotension
Tachycardia
Tachypnea
Oliguria
**distended neck veins**
TENSION
PNEUMOTHORAX
DISTRIBUTIVE SHOCK
Sebab :
Tersering septik syok, anafilaksis,
neurogenik, obat vasodilator dan
insufisiensi adrenal akut.
Gambaran hemodinamik :
curah jantung normal / meningkat,
tahanan pemb.drh sistemik
rendah, tekanan pengisian
ventrikel kiri rendah/normal
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
CLINICAL FINDINGS
Bradycardia
Mild hypotension
Flat neck veins
HEMODYNAMIC
Lung
Pulmonal
vein
Left atrium
SVR =
Systemic
Blood Pressure
Vascular
Right
Left Resistance
Atrium
ventricle
Right
ventricle
organ
PATHOGENESIS OF
SHOCK
Cardiogenic Distributive
Shock Shock
Inotropes
Vasopressor ( NE,PE,ADR,Dop)
(Dob,Dop,Adr,Amr)
Hypovolemic
Fluids
Shock
DIAGNOSIS STATUS SHOCK
BERDASARKAN PARAMETER
HEMODYNAMIK
Cardiac
TYPE CVP or PCWP Output SVR
A. > 1200
B. 1020
C. 920
D. < 800
1
A. Hipovolemik
B. Kardiogenik
C. Distributif (Septik)
Kasus 2
A. > 1200
B. 1020
C. 920
D. < 800
2
A. Hipovolemik
B. Kardiogenik
C. Distributif (Septik)
Kasus 3
A. > 1200
B. 1000
C. 920
D. < 800
3
A. Hipovolemik
B. Kardiogenik
C. Distributif (Septik)
TREATMENT CONCEPT OF SHOCK
DO2 = CO x CaO2
Cardiac Arterial
output O2 content