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The principals ofshock 

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SHOCK 

 

GANGGUAN PERFUSI JARINGAN YG MENYEBABKAN

INSUFISIENSI KADAR OKSIGEN DAN NUTRIEN SEHINGGA

TERJADI KEGAGALAN METABOLISME SELULER

 PENYEBAB UTAMA :

1. ANUAN PE!"US# $A!#NAN  (proses masuk!a "ara# ke "a$am %ar&'a se$)

DIPERBERAT OLEH *

%. pen&r&nan ka'ar oksi(en 'ala)  'arah ar*eriel

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SHOCK 

  The ESSENTIAL signs ofshock :

  tachycardia

 /tachypnoe(compensatory mechanisms),

  hypotension  poor end-organ perfusion (such

as low urine output)confusion or loss of

consciousness

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SHOCK 

  ENE!A+ S#NS  A rapid, weak, thready pulse due to

decreased blood ow combined withtachycardia and arrythmia

 Rapid and shallow respirations dueto sympathetic nervous systemstimulation and acidosis

 ypotension due to decrease incirculatory volume

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SHOCK ......... ENE!A+S#NS

 !ool, clammy skin due tovasoconstriction 

 Thirst and dry mouth, due to uiddepletion ypothermia due to decreased

perfusion and evaporation of sweat

 !old and mottled skin (cutis marmorata), especially e"tremities, due toinsu#cient perfusion of the skin

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SHOCK.......ENE!A+S#NS

 An"iety, restlessness,altered mental state due to

decreased cerebral perfusion andsubse$uent hypo"ia

%atigue due to inade$uateo"ygenation

 &istracted look in the eyes orstaring into space, often with pupilsdilated (midriasis)

 In septic shock hyperpire!ia

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Si(ns of se,eri*-

'RA&   *p to about + loss of e-ective

blood volume (./+0ml ) tachycardia1tachypnoe sign of ischae)ic hear* 'isease'RA& 2 3etween +450 loss of blood

volume (/+04+00ml) slight to moderate hypotension

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Si(ns of se,eri*-

'rade 5

At 50 4 60 loss of e-ective bloodvolume (+00 4 2000 ml)

7atient8 pale and becomeunconcious

 small arterial pulse9ore tachycardia  )o'era*e *o se,ere h-po*ension

 low urine output (0;+ml1kg1hr in

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Si(ns of se,eri*-

 'RA& 6At 604+0 loss of blood volume

(2000 42+00 ml)profound hypotension will more

severe and prolonged7recomateous patient=o urine outputwill cause end4organ damage and

death;

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Hinsha an' Co/ classi0ca*ionof shock 

 H-po,ole)ic shock Car'io(enic shock   is*ri2&*i,e shock : insu#cient

intravascular volume of blood;  >eptic shock   Anaphylactic shock  : !aused by a severe anaphylactic reaction to an

allergen, antigen, drug or foreign proteincausing the release of histamine which causeswidespread vasodilation, leading to hypotensionand increased capillary permeability;

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Hinsha an' Co/ classi0ca*ionof shock 

 =eurogenic shock  : rarest cases  caused by trauma to the

spinal cord  resulting in the suddenloss of autonomic and motor ree"esbelow the in?ury level

 O2s*r&c*i,e shock :  !ardiac tamponade  Tension pneumothora"   9assive pulmonary embolism 

 Aortic stenosis 

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Hinsha an' Co/ classi0ca*ionof shock 

 En'ocrine shock : 2ase' onen'ocrine

'is*&r2ance ypothyroidism  Thyroto"icosis  (

!ardiogenic shock )

  Acute adrenal insu#ciency (

&istributive shock)

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Shock :.........Pa*hoph-siolo(-

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Shock.........2asic principal*rea*)en*.............

 >hock re$uires immediate interventions topreserve life;;;;;;; ;R>*>!@TAT@= ( !7!R )

 Therefore, the early recognition and

treatment is essential even before a speciBcdiagnosis is made ;

intravenous uids and or transfusion through  restoring and maintaining the blood

circulating volume ensuring o"ygenation and blood pressure are

ade$uat preventing complications

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Shock.........2asic principal*rea*)en*.............

 patient with di#culty of respirationmust be

take a tracheal intubation andused mechanical ventilation in so many cases must be used

!=TRACD=*> 7R>>*R (cvp) canule,

to gavean ade$uat uids1blood therapy

 another drugs should be give as

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SHOCK............Pro(nosis

 The prognosis of shock depends on theunderlying cause

ypovolemic, anaphylactic and neurogenicshock are readily treatable and respond wellto medical therapy;

>eptic shock however, is a grave condition

and with a mortality rate between 50 and+0;

 The prognosis of cardiogenic shock is evenworse;

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SHOCK............Pro(nosis

&eath is due to hemorrhagic necrosis   ) this is not seen and cessation of

bleeding and restoration of bloodvolume is usually very e-ective

  2) prolonged hypovolemia andhypotension does carry a risk of

respiratory and then cardiac arrest;   5) 7erfusion of the brain may be the

greatest danger during shock; Thereforeurgent treatment must be correctly

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 TA=E F*;;;;