bls yogya 2012

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Basic Life SupportUKK Pediatri Gawat Darurat

Penatalaksanaan syok hipovolemik pada anakTujuan :Mengetahui definisi syokMengenal tanda-tanda syokMemahami penatalaksanaan syok hipovolemik pada anak2Pendahuluan

Syok hipovolemik penyebab tersering pada anak (45,9%) Stadium syok tersering pada syok hipovolemik adalah fase kompensasi (88,9%)

Singh D, Chopra A, Pooni PA and Bhatia RC. Indian Pediatri. 2006;43:619-23.

Kehilangan cairanMaldistribusi cairan Gagal sirkulasiGagal napasDistress pernapasan Depresi pernapasanHENTI JANTUNGGAGAL SIRKULASICardiac outputHeart rateStroke VolumePreloadafterloadKontraktilitas miokardiumResistensi vaskuler sistemikTekanan darahFungsi sistem sirkulasiDefinisiSyok adalah sindroma akut akibat ketidakmampuan sistem sirkulasi menyediakan kecukupan oksigen dan nutrien untuk memenuhi kebutuhan metabolik organ vital.

Baru :Syok adalah disbalance antara oksigen delivery (DO2) dan komsumsi oksigen (VO2)

VO2DO2

VO2 DO2 SYOK Demam Aktifitas otot Stress, systemic inflammatory respons syndrome6 langkah perjalanan oksigen dari udara ke selOxygenationHaemoglobinCardiac OutputUptake in the LungCarrying capacityDeliveryDO2 PaO2 SaO2 Flow rateCaO2 OXYGEN DELIVERY(DO2)Cardiac Output(CO)(SaO2 or SpO2)Hemoglobin(Hgb)Heart Rate(HR)Stroke Volume(SV)PreloadAfterloadContractilityXXXPRELOADCardiac Output x SVR 3.Pipe = Vascular2.Pump =Heart1.Volume =BloodHypovolemic ShockCardiogenic Shock/Acute Heart FailureDistributive/ Septic ShockInotropes (Dob,Dop,Adr,Amr)Vasopressor ( NE,PE,ADR,Dop)FluidsObstructive ShockRelease tamponade,etcBlood Pressure/MAPHYPOTENSI/Cardiac OutputPRELOADCONTRACTILITYPRELOADCONTRACTILITYWhat is hemodynamic?healthy peoplecritically illHYPOTENSI/ Cardiac OutputHYPOTENSI/Cardiac OutputSYSTEMIC VASCULAR RESISTANCESYSTEMIC VASCULAR RESISTANCEKehilangan cairanAsupan kurangPenurunan volume intravaskulerPenurunan Perfusi jaringanSyok hipovolemikPenyebab syok hipovolemik :

Hemorragik Non hemorragik :diare muntah pergeseran cairan plasma ( mis. DSS)

12MANIFESTASI KLINIS

COMPENSATEDUN-COMPENSATEDEffort :

Takikardiatakipneu ringan vasokonstriksi perifertekanan darah masih normal tekanan nadi menyempit

Efek :

Kulit : motled, pucat, ekstremitas dinginCRT >> melambat, hipotensiGinjal : oliguria. TGI : iskemia, motilitas 1 ml/kg/jamPerfusi hangat, CRT < 2 detikTanda kelebihan cairan :

RonkiHepatomegaliIrama gallopPeningkatan usaha napas

Evaluasi DENGUE SHOCK SYNDROMEProblem in IndonesiaMore than 35% of the countrys population lives in urban areas

150.000 cases were reported in 2007 (the highest on record) with over 25.000 cases reported from jakarta and west java

Case fatality rate was appoximatelly 1%

WHO Guideline 2009

DEMAM BERDARAH DENGUE (WHO,1997): Kriteria Klinis :Demam mendadak tinggi 2-7 hariManifestasi perdarahanPembesaran hatiGangguan sirkulasi/syok

Kriteria laboratorium :-Trombosit < 100.000/ml-Hemokonsentrasi ( > 20 % )

Definisis kasus :Dua kriteria klinis dan dua kriteria labDemam mendadak tinggi 2-7 hariManifestasi perdarahanTrombosit < 100.000/mlHemokonsentrasi ( > 20 % )

Tanda kebocoran plasma : efusi pleura ascites penurunan serumSeverity of DHFDHF grades IDHF grades IIDHF grades III DHF grades IVDSSDefinition of DSS ?Dengue Shock SyndromeA syndrome due to the dengue virus that tends to affect children under 10, causing abdominal pain, hemorrhage (bleeding) and circulatory collapse (shock)Pathogenesis Shock in DHFPathogenesis

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2009

ShockClinical syndrome failure of circulatory systemOxygen supply Nutrien need Tissue and cell hypoxiaCirculatory system

Hipovolemik CardiogenicAll in septic shockShock in DSSHypovolemia shockCardiogenic shockSeptic shockManagement Syok hipovolemikAirway dan pernapasan adekuatOksigen 100%Akses IV/IO : cairan 20 cc/kg 10 menitCairan 20 cc/kg (sp 60 cc/kg)Evaluasi syok Evaluasi -+Observasi PICU-+42Evaluasi +Pikirkan :

Kehilangan cairan masih berlangsung/estimasi kurangPenyebab lain : hipoglikemiaHb < 10 g/dl ; darah, NaClHb> 10 g/dl : NaCl ; 5% albumin

OxygenasiFluid : kristaloid/koloidRecovery +Recovery -Perfusi jaringanHb,Ht, trombositPEIRL 60-100 ml/kgBB (12 jam)(5-8 ml/kgBB/jamRL turunkan bertahap 24 jamCairan maintenanceHemodinamik stabilStop IVFD (48 jam)Prolonged shok10-30 menitPICUALGORITME DSSTERIMAKASIHTERIMA KASIH