Patofisiologi syok.pptx
-
Upload
mohamad-rizki-dwikane -
Category
Documents
-
view
241 -
download
6
Transcript of Patofisiologi syok.pptx
-
7/26/2019 Patofisiologi syok.pptx
1/22
Pathophyfsiologyo Shock
Emmy Pranggono
Internal Medicine
Padjadjaran University Hasan Sadikin Hospital
Bandung
-
7/26/2019 Patofisiologi syok.pptx
2/22
Delivery O2 Requirement O2
hipoperfusion
cellular dysfuntion
production and release mediator
microvaculature changed
-
7/26/2019 Patofisiologi syok.pptx
3/22
P!H"#E$ESIS $% "$&ESP"$SE
'Microcirculation
'(ellular responses
' $euroendocrine responses'(ardiovascular responses
' Pulmonary responses
'&enal responses'Meta)olic derangement
'In*ammatory &esponses
-
7/26/2019 Patofisiologi syok.pptx
4/22
(lassifcation o shock
(+P ("P S+&
Hypovolemic
!raumatic
(ardiogenic
Septic
Hyperdynamic
Hypodynamic
$eurogenic
-
7/26/2019 Patofisiologi syok.pptx
5/22
Etiology Sign
1. Cardiogenic Cardiology Pump failure
2. Hypovolumic Bleeding, Vomits,
diarrhea, polyuria
Turgor
3. istri!utive "eptic, anaphylactic,
adrenal crisis,
neurogenic
sign and symptom of
#nfection
$. %!structive cardiac temponade
tension pneumothora&
'assive pulmonaryem!olism
Pulsus parado&us
(systolic ) 1*
mmHg in inspiration+,
dyspneu, tachycardia
-
7/26/2019 Patofisiologi syok.pptx
6/22
PH!"#E$ESIS and "$ &ESP"$SE
U!"&E#U-!I"$
("P S+& to maintain MP
sustaining )rain and coronaryperusion
.high meta)olic rates high/ lo0stores o energy1
e2pense o other tissue 3 skin/muscle/ #I!
-
7/26/2019 Patofisiologi syok.pptx
7/22
M-%IS!&IBU!I"$ "6 B-""% 6-"7
HypotensionHypoperusion
8 MP 9 45 mmHg "rgandisungsi organ
or8 Systolic : ;5 mmHg 8
a0areness8 oliguria
8lactic acidosis
-
7/26/2019 Patofisiologi syok.pptx
8/22
' %etermined )y luminal%IME!E&oarterioles
' rteriole smooth muscle= > adrenergic receptor 8
vasoconstriction
=
? adrenergic receptor 8vasodilatation
M"S! 6U$%ME$!- &ESP"$SE&educe Blood Pressure
e@erent symphatetic nerve 8 release
-
7/26/2019 Patofisiologi syok.pptx
9/22
"ther vasoconstrictor su)stance'angiotensin II
'vasopressin
'endothelin'A
' throm)o2an ?
(irculating vasodilators during shock'prostacyclin .P#I>1
'nitric o2ide .$"1
' adenosine .meta)olic product1
Perusion
+asoconstrictor
-
7/26/2019 Patofisiologi syok.pptx
10/22
!ransport to the cell
Microsirculary *o0
capillary permea)ility di@usion o "?/ ("?/nutrients/products ometa)olism
e2changes o the productacross cell mem)rane
(entral o pathophysiologicresponse o shock
derangement o cellular meta)olism
-
7/26/2019 Patofisiologi syok.pptx
11/22
Mild and Moderate Hypovolumia
&estitution intravascular volume)y3A= rteriol vasoconstriction 8 hydrostatic pressure
C= (hanges in cellular meta)olicunction Dhyperglicemia
Dglycolysis
E2tracellular osmolarityDlypolisis
Dproteolysis
volume interstitiel
-
7/26/2019 Patofisiologi syok.pptx
12/22
(E--U-& &ESP"$SES
Impaired transport o interstitialnutrient
Mitochondrial transmem)rane
dysunction potential
!P intracell $a and0ater anaero)ic
meta)olites
. lactate1 8 vasodilator (ells0elling
-
7/26/2019 Patofisiologi syok.pptx
13/22
$EU&"E$%"(&I$E &ESP"$SES
H
-
7/26/2019 Patofisiologi syok.pptx
14/22
NEUROENDOCRINE RESONSES
SE+E&E PI$SE+E&E S!&ESS
HypothalamusPancreatic
(!H 8 (ortisol #lucagon peripheral glucosa / gluconeogenesis
aminoacid uptakelipolysis/ gluconeogenesis
Blood glucose
-
7/26/2019 Patofisiologi syok.pptx
15/22
(&%I"-"
-
7/26/2019 Patofisiologi syok.pptx
16/22
PU-M"$&< &ESP"$SES
SH"(K
P+&!achypnea Pain
=
!+
&6( = +d/ +ttelectasis
= &esp alkalosis
Undernon ventilated alveoli/
interstalveoli edema
-
7/26/2019 Patofisiologi syok.pptx
17/22
&E$- &ESP"$SES
SH"(K and H
-
7/26/2019 Patofisiologi syok.pptx
18/22
ME!B"-I( %E&$#EME$!
Hypo2ia 8 SH"K
L Hepatic gluconeogenesis
L -actate production L Hepatic lypolisis
L Protein cata)olism 8
= negative protein )alance= severe muscle 0asting
" S " S S
-
7/26/2019 Patofisiologi syok.pptx
19/22
I$6-MM!"&< &ESP"$SES
'Proin*ammatory mediator (Ja/(a/ ('N
'ctivation o coagulation cascade
microvascular throm)osis
microvascular injury
' !hrom)o2ane C 8 potentvasoconstrictor
'Platelet'activating 6actor Pulmonary vasoconstrition/)ronchoconstriction
systemic vasodilation
NEUROENDOCRINE RESONSES
-
7/26/2019 Patofisiologi syok.pptx
20/22
NEUROENDOCRINE RESONSES
drenergic discharge
&enin angiotensi I
angiotensi II.potent vasoconstrictor1
adrenal corte2 posterior
pituitary
aldosterone vasopressin
tu)ular rea)sorption $avasoconstriction
0ater rea)sor tion
Hi l i h k
-
7/26/2019 Patofisiologi syok.pptx
21/22
Hipovolumic shock
Mild Moderate Severe
!"2#$ %lood vol& !2#'(#$& )(#$
Cool e*tremities Same+plus Same+plus,
Capillary re-ll time .achycardia/emodynamic
.achypneu insta0ility
Diaphoresis Oliguria 1ared
tachycCollaps vein ostural changes 1entalstatus
tederioration
3n*iety
-
7/26/2019 Patofisiologi syok.pptx
22/22
Terima kasih