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FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN INDONESIA
Jl. Mayjen Sutoyo No. 2 Cawang Jakarta 13650
Telp. (021) 95380533
Disusun oleh :
Hypoxia
Anaerobic metabolism
Lactic acidosis
Cell wall damage
Sodium and calcium enter the cell
Potassium leaks out of the cell
Causes hyperkalaemia, hyponatraemia and hypocalcaemia
Intracellular lysosomes break down releasing powerful enzymes
which destroy own cell
General criteria of shock
a. Systolic arterial BP < 80 mmHg or a
reduction > 40 mmHg
b. Oliguria
c. Metabolic acidosis
d. Poor tissue perfusion
Vomiting/diarrhoea
HAEMORRHAGE VOLUME EFFECTS
120
100
80
Loss 10%: no effect 60
40
Loss 25%: hypovolaemic symptoms 36hrs 20
0
Loss 50%: coma. death. Normal 10% 25% 50%
BLOOD LOSS
17
Dehidrasi
Terapi syok hipovolemik bertujuan untuk restorasi volume
intravaskuler, dengan target utama mengembalikan tekanan darah, nadi,
dan perfusi organ secara optimal. Bila kondisi hipovolemia telah teratasi
dengan baik, selanjutnya pasien dapat diberi agen vasoaktif, seperti
dopamine, dobutamine.
Dobutamine
Is a adrenergic agonist
Doses of 5-20 /kg/BB/mt is a potent inotropes increase CO
Norepinephrine (NE)
Is a potent adrenergic vasopressor agent.
Also has adrenergic, inotropic, and chronotropic effects.
Dose ranges start at 0,05 g/kgBB/mt titrated to desired
effects
Epinephrine (E)
Has both and adrenergic effects
Potent inotrope and chronotrope
Increase in myocrdial oxygen consumption
Dose ranges start at 0,1 g/kgBB/mt titrated to desired
effects
SYOK SEPTIK
Syok septik adalah sepsis yang disertai
hipotensi (tekanan sistolik <90 mmHg) dan
tanda-tanda hipoperfusi meskipun telah
dilakukan resusitasi cairan secara adekuat. Syok
septik merupakan salah satu penyebab kematian
utama pada unit perawatan intensif.
Patofisiologi: Vasodilatasi akibat
menurunnya SVR Kebocoran kapiler difus
disebabkan peningkatan permeabilitas
endotelial vaskuler yang menyebabkan
penurunan preload bermakna, sehingga berdampak
perburukan perfusi jaringan
Systemic inflamatory response syndrome (SIRS)
The SIR to a variety of severe clinical insults.
The respon in manifested by two or more of the following
conditions :
- Temperature > 38o C or < 36o C
- Heart rate > 90 x/mt
- RR > 20 x/mt or PaO2 < 4,3 kPa (< 3,2 Torr)
-White blood cell count > 12.000 cells/mm3, or >10 %
immature (band) forms
Sepsis
Defined as SIRS as a result of infection.
Severe Sepsis
Sepsis that is associated with organ dysfunction,
hypoperfusion, or hypotension.
Septic Shock
Sepsis with hypotension, despite adequate fluid resuscitation,
a long with the presence of perfusion abnormalities.
35
ANAPHYLACTIC SHOCK:
MECHANISM
36
ANAPHYLACTIC SHOCK: MECHANISM
37
ANAPHYLACTIC SHOCK:
TREATMENT
38
TERIMAKASIH