The Principal of Shock
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Transcript of The Principal of Shock
7/21/2019 The Principal of Shock
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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*;;;;