SYOK

DEFINISI SYOK 
SINDROM KLINIS AKIBAT KEGAGALAN SISTEM SIRKULASI UNTUK MENCUKUPI :

lNUTRISI   ==>     PASOKAN ==> METABOLISME
lOKSIGEN  ==>     UTILISASI ==> JARINGAN TUBUH
==>DEFISIENSI O2 SELULER
*FASE: KOMPENSASI
  DEKOMPENSASI
  IREVERSIBEL

Etiologi Syok
 Type                        Primary Insult                                Common Cause
 Hypovolemic           Decreased circulating                     Dehydration,hemorrhage,
                                 blood vol                                        capilarry leaks
 Distributive              Vasodilation -> venous                   Sepsis, anaphylaxis,
                                 pooling -> decreased preload          drug intoxication,
                                                                                         spinal cord injury
 Obstructive               Obstruction of cardiac Cardiac       tamponade, tension
                                  filling/out flow                               pneumothoracx, pulmonary
                                                                                         embolus
 Cardiogenic              Decreased contractility                   Congenital heart disease,
                                                                                         myocarditis, dysritmia
 Dissociative              O2 not released from                       CO poisoning,
                                  hemoglobin                                     methemoglobinemia

Syok akibat Perdarahan
*Clinical Signs      Compensated      Uncompensated      Irreversible
*Blood loss (%)        Up to 25               25 - 40                    > 40
  
*Heart rate             Tachycardia +     Tachycardia ++       Tachy/bradycardia
*Systolic BP                  N                 N or falling             Plummeting
*Pulse volume         N/ Turun            Turun +                  Turun ++
*Capillary refill       N/ Naik              Naik +                     Naik ++
*Skin                       Cool, pale          Cold, mottled         Cold, deathly pale
*Respiratory rate     Tachypnoea +     Tachypnoea ++      Sighing rsp.
*Mental state           Mild agitation     Lethargic               Reacts only to pain
                                                           Uncooperative       or unresponsive

SYOK ANAFILAKSIS
ETIOLOGI
    l. Injection of drugs
    l. Blood products
    l. Plasma substitutes
    l. Contrast media
    l. Ingestion of food or food additives
    l. Insect stings

SYOK ANAFILAKSIS
PATOFISIOLOGI
Antigen ==> HOST ==> Antibody (IgE) ==>sel Basofit, Sel Mast
Histamin (arteriolar dilatation)
Serotonin (venular constriction)
SRS-A (bronchial constriction)
Bradikinin (permiabilitas kapiler meningkat)

MANIFESTASI KLINIS
Kontak/masuknya substansi ==>Gejala Klinis (< 30 menit)
 l. Sistim Sirkulasi
     l. Pucat, palpitasi, kolaps
 l. Sistim Kulit
     l. Urtikaria, edema, pruritus
 l. Sistim respiratorik
     l. Dispnea, wheezing, sianosis
 l. Sistim Gastrointestinal
    l. Mual-mual, nyeri perut, diare

Sign of Shock
             Early                                                        Late
Narrowed pulse pressure           Decreased systolic pressure
Delayed capillary filling            Decreased diastolic pressure
Tachycardia                               Cold, pale skin
Hyperventilation                       Altered mental status
                                                 Confusion & lethargy
                                                 Decrease urine out put

PENATALAKSANAAN
l. Ketenangan
l. Hilangkan substansi (Ag)
l. Perbaiki perfusi jaringan
l. Oksigenasi
l. Adrenalin 1:1000 dalam aqua 0,01 mg/kgbb/x (IM) (dapat diulang 5 menit)
l. Koreksi hipovolemi : kristaloid/koloid
l. Aminofilin 5 mg/kgBB/IV è pelan-pelan (Spasme bronkhus)