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American College of Surgeons Committee on Trauma. Advanced trauma life supports for doctors,
student course manual Ed. 8th.Chicago: American College of Surgeons Committee on Trauma, 2008.
DEFINISI SYOK
Gangguan sirkulasi yang ditandai dengan
kolapsnya hemodinamik tubuh berupa perfusi
yang tidak adekuat pada kulit, ginjal dan
sistem saraf pusat.
American College of Surgeons Committee on Trauma. Advanced trauma life supports for doctors,
student course manual Ed. 8th.Chicago: American College of Surgeons Committee on Trauma, 2008.
KLASIFIKASI SYOK
Syok
Syok hipovolemik
Kehilangan volume intravaskular yang bersirkulasi dan
penurunan cardiac preload
Loss of blood Loss of Fluid and
(hemorrhagic shock) electrolyte
External hemorrhage
Trauma - External
Gastrointestinal tract Vomiting
bleeding Diarrhea
American College of Surgeons Committee on Trauma. Advanced trauma life supports for doctors,
student course manual Ed. 8th.Chicago: American College of Surgeons Committee on Trauma, 2008.
PENILAIAN AWAL PASIEN
Denyut
American College of Surgeons Committee on Trauma. Advanced trauma life supports for doctors,
student course manual Ed. 8th.Chicago: American College of Surgeons Committee on Trauma, 2008.
Pathophysiology of Shock
Hypovolemi
Volume loss
Autonomic tone Fluid shifts from extracellular to
Catecholamine release intravascular
Maintenance of perfusion
Survival / delayed
morbidity / mortality
ATP production / lactic
acidosis
Continued volume
loss
Membrane
porosity
Lysozymal
Movement of leakage
fluid from Cellular
intravascular autodigestion
to interstitial
Irreversibl spaces
e shock
intervention
No. intervention
DEATH 5/23/17 8
The Golden Hour
is the time in which resuscitation of severely
injured patients must begin to achieve
maximal survive
R. Adams Cowley, MD
Hasanul, 2009
THE GOLDEN HOUR
Probability of R. Adams Cowley, MD
Survival
100
80
%
survival
60
40
20
0 minutes
30 60 90
Survival is related to severity and
duration
Hasanul, 2009
SYOK HEMORAGIK
Perdarahan adalah kehilangan volume darah
sirkulasi secara akut.
Estimated Blood Volume (EBV):
Dewasa: 65-70 ml/kg BB
Anak: 80-90 ml/kg BB
Kehilangan darah yang mencapai 25% EBV akan
menyebabkan pasien jatuh dalam syok.
DERAJAT SYOK PERDARAHAN
Sign & Class I Class II Class III Class IV
symptom
Blood loss Up to 750 750-1500 1500-2000 >2000
(mL)
%Blood Up to 15 15-30 30-40 >40
volume
Pulse rate <100 >100 >120 >140
Blood N N
pressure
Capillary refill N
RR N 20-30 30-40 >35
Urinary >30 20-30 5-15 Negligible
output (ml/hr)
Mental status Mild anxiety Anxiety Confused Lethargic
Fluid Crystalloid Crystalloid Crystalloid + Crystalloid +
replacement blood blood
American College of Surgeons Committee on Trauma. Advanced trauma life supports for doctors, student course manual Ed. 8 th.Chicago: American College of Surgeons
Committee on Trauma, 2008.
Perubahan Dalam Systemic Oxygen Delivery
Akibat Syok Perdarahan
PENATALAKSANAAN SYOK HEMORAGIK
INTRAVASCULAR VOLUME
HEMODYNAMIC MECHANISM
PRE-LOAD CONTRACTILITY AFTER-LOAD
SYSTEMIC VASCULAR
CARDIAC OUTPUT RESISTANCE
Hasanul, 2006
Kristalloid 3:1
Koloid, HES 1:1
Gelatin 1.5 : 1
Darah 1:1
PENGGANTIAN DARAH
Mengembalikan kapasitas angkut oksigen di
dalam volume intravaskuler.
Whole Blood = 6 x BB x Hb
Whole Blood = 6 x BB x Hb
American Soc of Anesthesiologists 1996
Hb 7-15
End-1
Pola kerja penanganan shock
perdarahan
Penderita datang
dengan perdarahan
RAPID TRANSIENT NO
RESPONSE RESPONSE RESPONSE
Vital Sign Return to Transient Remain
Normal improvement, abnormal
recurrent of
BP and HR
Estimated Minimal (10%- Moderate and Severe (>40%)
blood loss 20%) ongoing (20%-
40%)
Need for more Low High High
crystalloid
Need for blood Low Moderate to Immediate
high
Blood Type and cross Type-specific Emergency
preparation match blood release
Need for Possibly Likely Highly likely
operative
TANDA HEMODINAMIK MEMBAIK
Perfusi membaik (akral teraba hangat)
Nadi <100 x/menit
MAP > 65 - 95
Produksi urine 0,5 1 cc/kgBB/jam
SYOK DEHIDRASI
ETIOLOGI
Gastrointestinal losses
Vomiting
Diarrhea
Urinary losses
Diabetic ketoacidosis
Diabetes insipidus
Adrenal insufficiency
Diuretic usage
Decreased intake
Stomatitis, pharyngitis
Anorexia, fluid deprivation
Moderate 5- Severe
Mild < 5%
10% >10%
Pulse rate N
Blood N N
pressure
Respiratory N N Rapid
rate
Capillary <2 seconds 3-4 seconds >5 seconds
return
Urine Output N Negligible/abs
ent
5%Mucous Moist
dehydration = loss Dry
of 5 ml of fluid per 100 g bodyParched
weight or 50 ml
membran
per kg
PRODUKSI URIN
Pemantau aliran darah ginjal
Anak
27
Estimasi Cairan
Rumatan/Maintenance
Weight Rate
Pemberian
Cairan Dibagi rata Tahap I (rehidrasi cepat) :
Defisit dalam 24 jam 20-40 cc/KgBB/1-2 jam
Tahap II :
sisa defisit 6 jam
sisanya 16-17 jam
MONITOR
PERUBAHAN :
-Gx Klinis
-Hematokrit
-Plasma elektrolit
-CVP
+ Maintenance
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