8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 1/25

Macam danpathofisiologi shock

Drg Yayun Siti Rochmah SpBM

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 2/25

C (Circulation)

Assessment of organ perfusion

- Level of conciousness

- Skin color and temperature

- Pulse rate and character

- Urinary output

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 3/25

 SHOCK

 An abnormality of the circulatory system

that result in inadequate organ perfusion

and tissue oxygenation

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 4/25

DEFINITION SHOCK:- It is generalized

inadequency of blood flow throughout

the body to the extent that the body

tissue are damaged because of too

little flow, especially too little delivery ofoxygen and other nutrients to tissue cell.

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 5/25

Batasan shock

GANGGUAN SIRKULASI

DISERTAI MENURUNNYAPERFUSI JARINGAN

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 6/25

Shock indeks

NADI

TENSI(SISTOLE) = 0,5

SHOCK INDEKS = 1,0 BAHAYA

SHOCK INDEKS = 1,5 MANIFEST

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 7/25

  TYPES:-

SHOCK

HYPOVOLMIC CARDIOGENIC

 ANAPHYLACTIC SEPTICEMIC NEUROGENIC

DISTRIBUTIVE

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 8/25

CLASSIFICATION OF SHOCK

Trauma : - Haemorrhagic

- Non haemorrhagicCardiogenicTension pneumothoraxNeurogenic

Septic

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 9/25

….. Classification of shock  

Hypovolemic : - Haemorrhage- Diarrhoea

- Burn

Distributive

- Septic- Anaphylaxsis- Spinal cord injury

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 10/25

….. Classification of shock  

Cardiogenik :

- Arrytmias- Heart failure- Myocardial contusion / infarction

Obstructive- Tension pneumothorax

- Cardiac tamponade- Haemopneumothorax

Disscociative

- Profound anemia

- Co poisoning

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 11/25

ETIOLOGY: 1)HYPOVOLMIC:>

>HAEMORRHAGE

>TRAUMA

>BURNS

>DEHYDRATION 2)SEPTIC:>

>Gm +ve SEPTICEMIA

>Gm -ve SEPTICEMIA

3)CARDIOGENIC:>

>DEFICIENCY OF EMPTYING

>DEFICIENCY OF FILLING

>OUTFLOW OBSTRUCTION 

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 12/25

Jenis shock

Shock dengan tahanan vaskuler

sistemik tinggi : syok kardiogenik,

syok hipovolemik

Shock dengan tahanan vaskular

sistemik rendah : syok septik, syok

anafilaktik

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 13/25

CO = SV X F

preload C after loadEDV SVRVR

BP = CO X SVR

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 14/25

FISIOLOGI SHOCK

CARDIAC

OUTPUTMENINGKAT

Mengurangi stimulasi baroreseptorA. Carotis dan arcus aorta :

kenaikan output sistem sarafsimpatis

1. Vena besar berkontraksi, vol.Darah sirkulasi meningkat,

cardiac output naik (Hk.Starling)

2. Takhikardia3. Vasokonstriksi arteriol, tahanan

perifer meningkat Tahanan sistemikvaskular meningkat

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 15/25

  PATOFISIOLOGI SHOCK

VOLUME DARAHBERKURANG

Kegiatan simpatis

meningkat

Iskemik splanknikIskemik renal

Depresi RES

ENZIM2 LISOSOMDILEPAS (PROTEOLITIK)

Toksin vasoaktifdilepas

Asidosis metabolik

Kontraksi arteri >>

Iskemia jaringan

Reaksi kardiogenikFaal renal, serebralberkurang, respirasi

menurun, faal kontraksi jantung<<

Kerusakan endotel,cairan hilang,

kelainan metabolik

Shock Syndrome

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 16/25

  PATHOGENESIS 

HYPOVOLUMIC & SEPTIC

DECREASED EFFECIENCY CIRCULATING VOLUME 

DECREASED VENUS RETURN TO HEART

DECREASED CARDIAC OUTPUT  

DECREASED BLOOD FLOW

DECREASED SUPPLY OF OXYGEN

ANOROXIA

SHOCK

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 17/25

 

CARDIOGENIC

CARDIAC OUTPUT  

DECREASED BLOOD FLOW

DECREASED SUPPLY OF OXYGEN

ANOROXIA

SHOCK

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 18/25

SHOCK RECOGNITION AND MANAGEMENT

• Recognize signs of inadequate perfusion

and oxygenation

• Identify probable cause• Restore perfusion

• Re-evaluate patient response

• Immediate involvement by specialists

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 19/25

 

CLINICAL FEATURES:-

>RAPID PULSE (TAKHIKARDIA)

>PULSE MAY BE WEAK (INDEKS !)

>RAPID BREATHING(TAKHIPNEU)

>ANXIETY>COOL,CALMMY SKIN (CLAMMY)

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 20/25

  >WEAKNESS

>PALE SKIN COLOR(PALLOR)

>SWEATING,MOIST SKIN

>DECREASED OR NO URINE

OUTPUT

>LOW BLOOD PRESSURE

>CONFUSION>UNCONCIOUSNESS

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 21/25

CLINICAL SIGNS

1231. Tachycardia

2. Vasoconstriction

3.  cardiac output

4. Narrow pulse pressure

5.   MAP

6.   blood flow

Remember :

Compensatory mechanisms

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 22/25

Akibat shock pada tubuh

Asidosis laktat dan gangguan pernafasan

karena kompensasinya

Adanya PH rendah menekan kontraktilitasmiokard, tensi turun

Vasodilatasi sebagai akibat akhir : hipotensi

Gagal organ spesifik otak : kesadaran turun

Gangguan perfusi ginjal : GGA Perfusi usus menurun, basorbsi toksin bakteri

usus : hipotensi, sepsis, “shock splanknik” 

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 23/25

Shock anaphylactic

Terjadi karena pelepasan histamin

Berakibat edema paru akut,

bronkospasme dan edeme mukosasehingga menyebabkan obstruksi jalannafas akut

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 24/25

terapi

Oksigen

Infus

Adrenalin

Kortikosteroid

Intubasi dan ventilasi

8/13/2019 Anaphylactic shock.ppt

http://slidepdf.com/reader/full/anaphylactic-shockppt 25/25