Diskusi Syok
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SYOKTopic Discussion with dr.Nata, Sp.PD
By Edwin H. / 071 20110101
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Outin!
D!"nisi # Prinsip dasar
Tip!P!nd!$atan %inisTataa$sana
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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
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Tipe-Tipe
Bisa Overlapping %ardio!ni$ syo$
t!radi pada s!&ua
tahap a$hir syo$
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P!nd!$atan %inis Concurrent Diagnostic & Therapeutic Eforts !! B3s onitor $ardior!spi
Pus! O2 Sup!&!n O2 45 acc!ss )D, a* %at!t!r urin TT5 ++' ss!ss&!nt c!pat, &urah, dan s!d!rhana
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Dianosa na&n!sa P6 TT5, 85P, Th, *d dan P!r(usi p!ri(!r9
Su&*!r 4n(!$si :a*s; 3B3 %i&ia darah
= 39 :a$tat D+di&!r %utur darah
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E?auasi :*h :anut
3T
:P %utur :u$a ++'
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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
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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$
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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
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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
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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
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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!
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irway
P!rti&*an$an 4ntu*asi TP4; (-sa&pin intu*asi ++' H4POTENS4 S!dati( BP
PP5 Pr!oad
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Br!athin 3ontro
Otot na(as ua &!n$onsu&si O2
Ta$ipn!u ++' %!ra otot na(as ++' sidosis:a$tat
5!ntiasi G S!dasi
*!*an $!ra otot na(as
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Opti&a$an 3ircuation
%ristaoid isotoni$
Tar!t ; 35P J+12 && H Bia dipasan9
0 &/hr9
H
Bisa &!ncapai +K :
%ooid ++' +9 Outco&! *!n!"t
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## 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
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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
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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
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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 $!p!ruanJANGAN ' 0
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Pasti$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
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3apaiah End Points o(
!suscitation
)oa;
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Hipot!nsi P!rsist!n 5o. !susitasi cu$up
Pn!u&othora-
3ardiac ta&ponad! Occut B!!din
dr!na insuci!ncy
!ri O*at
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Pra$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!
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Pus2 ;p
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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
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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!
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!(!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.
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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