Ganong WF. Cardiovascular homeostasis in health and disease. In: Review of Medical Physiology. 22nd Edition.

London: McGraw-Hill;
2005:p.630-46.
*
Clear consciousness
Brisk capillary refill time (<2 sec)
Warm and pink extremities
Good volume peripheral pulses
Normal heart rate for age
Normal pulse pressure for age
Normal respiratory rate for age
Normal urine output
Clear consc-shock can be missed
if we dont touch the patient
Capillary refill time ( >2 sec)
Cool extremities
Weak peripheral pulses
Tachycardia
Normal syst pressure , raised
diastolic; postural hypotension
Narrowing pulse pressure
Tachypnea
Reduced l urine output
Restless or lethargy
Mottled skin, Cap refill time
Cold,clammy extremities
Feeble or absent peripheral pulses
Severe tachycardia; bradycardia in
late shock
Narrowed pulse pressure(<20)
Hyperpnoea/Kussmaul
Oliguria/Anuria
Maintenance solution:
20 drops/min or 3 ml/kg/hr
Replacement solution:
5-10 ml/kg/hr
Replacement solution:
Bolus 20 ml/kg (15 min) or colloid
TATALAKSANA CAIRAN PADA DEMAM BERDARAH DENGUE
www. moh.gov.my : Management of Dengue Infection in Adults.2 edition 2008.
DENGUE GUIDELINES FOR DIAGNOSIS,TREATMENT, PREVENTION AND CONTROL. New Edition 2009
Yip WCL. Dengue Haemorrhagic Fever: Current Approaches to Management.Medical Progress October 1980
WARNING SIGNS
Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation (pleural effusion, ascites)
Mucosal bleed
Restlessness or lethargy
Liver enlargement > 2 cm
Laboratory : Increase in HCT concurrent with rapid
decrease in platelet
COMPENSATED SHOCK ISOTONIC CRYS 10 ml/kg/hr
Capillary refill > 2 sec
Narrowing pulse pressure
Tachycardia
Tachypnoea
Cold extremities
Maintenance ONLY ISOTONIC INFUSION
COMPENSATED SHOCK
Kristaloid (Asering/RL/NS) atau koloid 20 ml/kg selama 15 menit
Usahakan periksa Ht sebelum resusitasi
Ya
Perbaikan
Tidak
Turunkan jadi 5-7 ml/kg/jam
untuk 1-2 jam,kmd:
Turunkan jadi 3-5 ml/kg/jam selama 2-4 jam;
Turunkan jadi 2-3 ml/kg/jam selama 2-4 jam.
Jika terus membaik, cairan bisa dikurangi lagi
Pantau hematokrit ( Ht) setiap 6-8 jam.
Jika pasien tidak stabil, lihat kadar Ht:
Jika Ht naik, beri bolus cairan atau tambah
Jika Ht turun pertimbangkan transfusi fresh
whole blood
Hentikan infus setelah 48 jam
Periksa Hematokrit (Ht)
Ht atau tinggi Ht
Berikan bolus cairan kedua
10 - 20 ml/kg/jam selama 1 jam
Transfusi
fresh whole
blood
Perbaikan
Ya
Tidak
Jika membaik, turunkan menjadi
7 - 10 ml/kg/jam selama 1 -2 jam
DECOMPENSATED/
HYPOTENSIVE SHOCK
Kristaloid (Asering/RL/NS) 5 - 10 ml/kg selama 1 jam
Perbaikan
Ya Tidak
Kristaloid atau koloid 10 ml/kg/jam selama 1 jam,
lalu teruskan dengan:
Kristaloid 5-7 ml/kg/jam selama 1-2 jam;
turunkan jadi 3-5 ml/kg/jam selama 2-4 jam;
turunkan jadi 2-3 ml/kg/jam selama 2-4 jam.
Pantau hematokrit ( Ht) setiap 6 jam.
Jika pasien tidak stabil, lihat kadar Ht:
Jika Ht naik, beri bolus cairan atau tambah
Jika Ht turun pertimbangkan transfusi fresh
whole blood
Hentikan infus setelah 48 jam
Tinjau Ht pertama
Ht
Ht atau tinggi
Berikan bolus cairan kedua (koloid)
10 - 20 ml/kg/jam selama 1 jam
Perbaikan
Ya Tidak
Transfusi
fresh whole
blood
Ulang Ht kedua
Ht atau tinggi Ht
Berikan bolus cairan ketiga (koloid)
10 - 20 ml/kg/jam selama 1 jam
Perbaikan
Ulang Ht ketiga
Ya Tidak
Referensi:
DENGUE:GUIDELINES FOR DIAGNOSIS,TREATMENT, PREVENTION AND CONTROL
New edition 2009. A joint publication of the World Health Organization (WHO) and
the Special Programme for Research and Training in Tropical Diseases (TDR)