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Shock Shock
Hemorrhagic Shock Pathophysiology Hemorrhagic (Classic) shock Pathophysiology
Stage 1: Compensated Stage Stage 2: Progressive Stage
Sympathetic Nervous System is stimulated releasing Epinephrine and Increased hypo-perfusion causes increase in metabolic acid build up
Norepinehrine to stimulate Alpha and Beta Receptors
Shock Shock
Hemorrhagic (Classic) shock Pathophysiology The Course of Hypovolaemic Shock in Absence of Therapy
Stage 3: Irreversible Stage Blood Pressure Heart Rate
Blood Pressure (mm Hg)
Heart rate (min)
Mechanism: Compensatory mechanisms fail
150 Bleeding
50
Cell damage, organ failure and death occur
0 (Time)
Compensation Decompensation Irreversibility
Shock Phases
1
9/24/15
Shock
The Influence of Volume Replacement on Tissue Perfusion and Organ Function
Cellular Response to Shock
Cerebral Function
Tissue
(Body Control)
Perfusion
Pulmonary Function Blood Inadequat
(O2 Supply) Acidosis
Loss e
Perfusion
Cellular
Cellular
Edema
Hypoxia
Volume Replacement
Liver Lactic
Function Aerobic
Heart (metabolism) Acid Anaerobic
Function Metabolism
(cardiac output) Renal Function Metabolism
(Diuresis)
Summary in Preeclampsia
Hypertriglyceridemia Insulin resistance
Hyperinsulinemia
sfu ine
Reduced HDL
ion
Ab
Dy ndocr
n Hypertriglyceridemia
nct
tab al L
cholesterol oli ipi
sm d
n
tio
ma
Ox
ida
am
Infl
tiv
eS
tr e
ss
2
9/24/15
ATLS Classification of
Hemorrhagic Shock
CLASS I CLASS II CLASS III CLASS IV
3
9/24/15
Ligasi a hipogastrika
Histerektomi subtotal
Kristaloid vs Koloid
Fluid Management
Estimasi BB : ... 60 kg
Kristaloid Koloid
Estimasi Blood Volume : ... 70 ml/kg x 60 = 4200 ml
Estimasi Blood Loss : .... % EBV = ..... ml Merembes ke komponen
ekstraselular
Tetap berada di komponen
Tsyst 120 100 < 90 < 60-70 Mengurangi peningkatan
Nadi 80 > 120 > 140 -
intravaskular
100 cairan paru
Perf hangat pucat dingin ttb volume yang diperlukan lebih
basah Meningkatkan fungsi organ
Manfaat sedikit
setelah operasi
Meningkatkan transpor oksigen
-- 15%
-- 30% Reaksi anafilaktik minimal
NORMO -- 50% ke jaringan, kontraktilitas
EBV EBV Kemungkinan dapat
VOLEMIA
EBV
jantung dan keluarannya
mengurangi angka kematian
Lebih murah
4
9/24/15
Kristaloid vs Koloid
Transfusion Reactions
Immediate Delayed
Terima Kasih