diskusi syok

7/24/2019 Diskusi Syok

1/30

SYOKTopic Discussion with dr.Nata, Sp.PD

By Edwin H. / 071 20110101


2/30

Outin!

D!"nisi # Prinsip dasar

Tip!P!nd!$atan %inisTataa$sana


3/30

D!"nisi O2D!&and ''' Suppy

Hipop!r(usi )o*a ++' - na!ro*++' sidosis !ta*oi$

Hipo$sia *!r$!pananan ++' )aaoran &utip! ++' Fin

syo$ *isa t!radi d!nan BP DBN,s!dan$an p- d hipot!nsi *!u&t!ntu syo$

D!&an

d

Suppy


4/30

Tipe-Tipe

Bisa Overlapping %ardio!ni$ syo$

t!radi pada s!&ua

tahap a$hir syo$


5/30


6/30

P!nd!$atan %inis Concurrent Diagnostic & Therapeutic Eforts !! B3s onitor $ardior!spi

Pus! O2 Sup!&!n O2 45 acc!ss )D, a* %at!t!r urin TT5 ++' ss!ss&!nt c!pat, &urah, dan s!d!rhana


7/30

Dianosa na&n!sa P6 TT5, 85P, Th, *d dan P!r(usi p!ri(!r9

Su&*!r 4n(!$si :a*s; 3B3 %i&ia darah

= 39 :a$tat D+di&!r %utur darah


8/30

E?auasi :*h :anut

3T

:P %utur :u$a ++'


9/30

P!nd!$atan %inis ## Hipo?o!&i$ P!ndarahan &!!na, h!&oroid,

&!norrhaia9, d!hidrasi &untah, diar!,inta$! 9

Tanda2 curah antun t!$anan nadi@20 &&H, a$ra dinin, 3T @2 dt9

P!&!ri$saan a* an!&ia, %49


10/30

P!nd!$atan %inis S!pti$ D!&a&

Tanda+tanda in(!$si pada saah satu sist!& oran

s!sa$ na(as/*atu$, ny!ri *!r$!&ih, d9 Port d! !ntrA! pada $uit *iasa pada indi?idu d

i&un 9

%rit!ria S4S #9

%ardio!ni$ iw. )n t s!*!u&nya p- &aupun $!uara9

S> aop, 85P , Ta$i$ardi$

Bisa t!radi p!r*ai$an *ia di*!ri *ous cairan pd Thawa ++' 8N)N dianap syo$ hipo?o!&i$


11/30

P!nd!$atan %inis O*stru$ti( Pn!u&otora$s, %ardia$

ta&ponad!, PE9

iw. Trau&a )a&*aran $inis dari &asin+&asin

$!ainan ts*. %!cuai %ardia$ ta&ponad! B!c$Cs Triad

Hipot!nsi, 85P , Bunyi 8antun 9


12/30

Prinsip Syo$3ari tanda anuan p!r(usi ;

Ta$i$ardi +++' a*nor&aitas y pain awa&uncu

BPo Textbook PresentationBP sistoi$ @ 0 &&H

o BP *isa nor&a pada syo$ HT9 ++' '0 &&Hdari BP awa

o


13/30

Prinsip Syo$ ++' %uss&au ++' sidosis ++'

pH art!ri

P!ru*ahan status &!ntais/$!sadaran++' late sign

S4 F /SBP N F 0.I+0.79 +++' Severity

syo$ S4 F /P '1.>9 +++' ortality


14/30

Tuuan T!rapi B3DE Airway

Br!athin 3ontro

Opti&aisasi Circuation

Pasti$an D!i?!ry O2 !(!$ti(

3apaiah End points o( r!suscitation

T!&u$an # S!!sai$an oot o( th!3aus!


15/30

irway

P!rti&*an$an 4ntu*asi TP4; (-sa&pin intu*asi ++' H4POTENS4 S!dati( BP

PP5 Pr!oad


16/30

Br!athin 3ontro

Otot na(as ua &!n$onsu&si O2

Ta$ipn!u ++' %!ra otot na(as ++' sidosis:a$tat

5!ntiasi G S!dasi

*!*an $!ra otot na(as


17/30

Opti&a$an 3ircuation

%ristaoid isotoni$

Tar!t ; 35P J+12 && H Bia dipasan9

0 &/hr9

H

Bisa &!ncapai +K :

%ooid ++' +9 Outco&! *!n!"t


18/30

## 3ircuation )aa &!&*ai$

Dopa&in! &c/$/&in9 1+I; urin! G r!na *ood Low I+1I ; r!na *ood Low , 3O, H,

cardiac contractiity 20+I0 ; BP G ?asoconstriction, ris$ o(

tachyarrit&ia, +9 *!n!"t to BPStrongB!ta+1 sti&uator, Dos!+d!p!nd!nt

pha+1 G Dopa&in!ric !M!cts


19/30

Binun H!h! dr!n!ri$ ;

Alpha 1++' 5aso$onstri$si ++' pr!oad ND

a(t!road 2++' 6!!d*ac$ &!ch

Beta

1++' 8antun $rono, ino, dro&o9,

!nin 2++' 5asodiasi PD 8antun dan otot

s$!!ta P59


20/30

Bac$ to Topic

Dopa&in! &c/$/&in9

StrongB!ta+1 sti&uator, Dos!+d!p!nd!ntpha+1 G Dopa&in!ric !M!cts 1+I; urin! G r!na *ood Low I+1I ; r!na *ood Low , 3O, H, cardiac

contractiity 20+I0 ; BP G ?asoconstriction, ris$ o(

tachyarrit&ia, +9 *!n!"t to BP

Dopa&in!ric !M!cts; 0.I+2 ++' 5asodiasi !na GSpan$ni$

B!ta+1 !M!cts ; 2+10

pha !M!cts ; '10


21/30

Sti ## 3ircuation Do*uta&in! &c/$/&in9

StrongB!ta+1,WeakB!ta+2 G pha

!M!cts 3ardiac D!co&

0.I+1 initiay, th!n 2+20

JANGAN ' 0 :ow 3O

2+20 au titrasi s!suai $!p!ruanJANGAN ' 0


22/30

Pasti$an D!i?!ry O2 E(!$ti( Supp!&!ntasi O2

O2 d!

na!si$ # n-ioyti$ p.r.n9 ++' t!nan$anp-

8aa H* ' +10 /d:

S!ria :a$tat atau Sat. O2 5!na S!ntra+++' Niai E$stra$si O2 pd ? arinan


23/30

3apaiah End Points o(

!suscitation

)oa;


24/30

Hipot!nsi P!rsist!n 5o. !susitasi cu$up

Pn!u&othora-

3ardiac ta&ponad! Occut B!!din

dr!na insuci!ncy

!ri O*at


25/30

Pra$tisnya Pantau T!rus p- s!p!rti ini

TT5 *!r$aa; ssess $!*!rhasian t!rapi

Tanda+tanda awa Syo$ d!$o&

%!rasa&a d p!rawat, s!sa&a $oas GO ; pasti$an s!&ua piha$ t!rin(o p-

ini 8E:E% H!h!h!


26/30

Pus2 ;p


27/30

S!psis Two or &or! o( S4S crit!ria T!&p ' >J or @ >K 3

H ' 0 ' 20 QB3 ' 12,000 or @ ,000

Pus th! pr!su&!d !-ist!nc! o( in(!ction

Bood pr!ssur! can *! nor&a


28/30

S!ptic syo$ S!psis r!&!&*!r d!"nition9

Pus r!(ractory hypot!nsion (t!r *ous o( 20+0 &:/% pati!nt sti has

on! o( th! (oowin;

SBP @ 0 && H

P @ KI && H

D!cr!as! o( 0 && H (ro&*as!in!


29/30

!(!r!nc!s Sh!r&an S, Q!*!r 8, Schind*!c$ , Patwari

. 3inica !&!r!ncy &!dicin!.

i?!rs !t a. Eary )oa+Dir!ct!d Th!rapy inth! Tr!at&!nt o( S!?!r! S!psis and S!pticsyo$. NE8 2001 >I19;1>KJ.

B!r!r T, )r!!n 8, Hor!c$o T, Haar , )arN, Suar! !t a. syo$ 4nd!- and Eary

!conition o( S!psis in th! E&!r!ncyD!part&!nt; Piot Study. Q!st!rn 8ourna o(E&!r!ncy !dicin!. 201>129;1KJ+17.


30/30

B!r!r T, )r!!n 8, Hor!c$o T, Haar , )ar N, Suar! !t a. syo$ 4nd!- and Eary !conition o( S!psis inth! E&!r!ncy D!part&!nt; Piot Study. Q!st!rn 8ournao( E&!r!ncy !dicin!. 201>129;1KJ+17.

:iu . odi"!d syo$ ind!- and &ortaity rat! o(!&!r!ncy pati!nts. Qord 8 E&!r !d. 2012>29;11.

utsch!r , Ni!na*!r pati!nts d!ri?!d (ro& th!

Trau&a!ist!r D)179;172.

Qira 3, 6rancis , Bhat S, Ehr&an , 3onn!r D, Si!!. Th! syo$ 4nd!- as a Pr!dictor o( 5asopr!ssor

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