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PENILAIAN TANDA SYOK

Esdras Ardi Pramudita

Fakultas KedokteranUniversitas Kristen Duta wacana

2014

Definisi Syok

Tidak adekuatnya perfusi dan oksigenasi pada sel yang dapat memacu disfungsi

dan kematian jaringan atau organ

Tipe Syok

Kardiogenik

Obstruktif

Hipovolemik

Distributif

Patofisiologi: Overview

Tissue perfusion ditentukan olehMean Arterial Pressure (MAP)

MAP = CO x SVR

Heart rate Stroke Volume

Preload afterload kontraksi pembuluh

Kardiogenik

Penurunan kontraktilitas jantung (Miokardial Infark, miokarditis, cardiomiopati, Post resuscitation syndrome following cardiac arrest)

Disfungsi mekanik (Papillary muscle rupture post-MI, Severe Aortic Stenosis, rupture of ventricular aneurysms etc)

Aritmia (Heart block, ventricular tachycardia, SVT, atrial fibrillation etc.)

Kardiotoksisitas (Overdosis B blocker and Calcium Channel Blocker)

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Obstruktif

Jantung bekerja dengan baik, tetapi ada hambatan utk aliran darah Massive pulmonary embolism Aortic dissection Cardiac tamponade Tension pneumothorax

Obstruks aliran balik ke jantung Vena cava syndrome - eg. neoplasms, granulomatous

disease Sickle cell splenic sequestration

Hipovolemik

Penurunanvolume intravaskuler (Preload) penurunan stroke volume

Hemoragik - trauma, GI bleed, kehamilan ektopik

Hipovolemik Luka bakar, GI losses, dehidrasi, third spacing (e.g. pancreatitis, bowel obstruction), Diabetic Ketoacidosis

Distributif

Tonus pembuluh darah menurun Inflamasi

Sepsis and Toxic Shock Syndrome

Anafilaksis

Penurunan fungsi saraf simpatik Neurogenic - C spine or upper thoracic cord injuries

Keracunan Due to cellular poisons -Carbon monoxide,

methemoglobinemia, cyanide

Drug overdose (a1 antagonists)

Type of Shock Insult Physiologic Effect

Cardiogenic Heart fails to pump blood out CO

Obstructive Heart pumps well, but the outflow

is obstructed

CO

Hemorrhagic Heart pumps well, but not enough

blood volume to pump

CO

Distributive Heart pumps well, but there is

peripheral vasodilation

SVR

Tanda dan Gejala Syok

Tingkat Kesadaran Anxietas

Agitasi

Konfusi and Delirium

Obtundation and Coma

Tanda dan Gejala Syok

Nadi

Takikardia HR > 100

Rapid, weak, thready distal pulses

Respirasi

Takipnea

Shallow, irregular, labored

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Tekanan darah Bisa normal atau hipotensi

Definisi hipotensi

Sistolik < 90 mmHg

MAP < 65 mmHg

40 mmHg drop systolic BP from from baseline

Tanda dan Gejala Syok Tanda dan Gejala Syok

Kulit Cold, clammy (Cardiogenic, Obstructive,

Hemorrhagic)

Warm (Distributive shock)

Mottled appearance in children

Look for petechia

Mukosa kering

urine output rendah,

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