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Exogenous blood,
Hypovolemic Volume loss plasma, fluid or
electrolyte loss
Myocardial infarction,
Cardiogenic Pump failure cardiac arrhythmias,
heart failure
Increased venous
Septic shock, spinal
capacitance or
Distributive shock, autonomic
arteriovenous
blockade, drug
shunting
overdose
Vena caval
Extra-cardiac obstruction, cardiac
Obstructive obstruction of blood tamponade,
flow pulmonary embolism,
aortic compression or
dissection
*MORE THAN ONE TYPE MAY BE PRESENT
1. HYPOVOLEMIC SHOCK
DECREASE IN INTRAVASCULAR
BLOOD VOLUME
Hemorrhage
Vomiting
Diarrhea
Fluid sequestration
Intraluminal – bowel
obstruction
Intraperitoneal – pancreatitis
Interstitial - burns
DECREASE IN CARDIAC
OUTPUT AND TISSUE
PERFUSION
HYPOVOLEMIC SHOCK
1. DECREASE IN
INTRAVASCULAR BLOOD
VOLUME
3. BLOOD DIVERTED
PREFERENTIALLY TO HEART AND
BRAIN
Thirst, oliguria
Tachycardia
Labile blood pressure
HYPOVOLEMIC SHOCK
4. DECREASED BLOOD FLOW TO
BRAIN AND HEART
5. END-STAGE SHOCK
Bradycardia
Arrythmias
Death
2. CARDIOGENIC SHOCK
DECREASED CARDIAC FUNCTION
Decreased ventricular function
MI
Pericaridal tamponade
Tension pneumothorax
CLINICAL FINDINGS
Hypotension
Tachycardia
Tachypnea
Oliguria
**distended neck veins**
3. SEPTIC SHOCK
SEVERE INFECTION W RELEASE
OF MICROBIAL PRODUCTS
Release of vasoactive mediators
HYPERDYNAMIC STATE
Peripheral vasodilation
Increased cardiac output
CLINICAL FINDINGS
Bradycardia
Mild hypotension
Flat neck veins
anamnesis
• Riwayat kehilangan cairan tubuh
• Riwayat sakit jantung
• Riwayat sakit panas
• Riwayat trauma
• Riwayat pengobatan
• Lamanya kejadian
• Lamanya tanda-tanda syok
Pemeriksaan fisik
• Kesadaran : compos mentis ---- sopor
• Tensi : hipotensi / normotensi
• Nadi : takikardi, bradikardi, isi dan tegangan,
reguler/ireguler
• Suhu : hipotermi, hipertermi
• Frekwensi nafas : cepat/lambat,
dalam/dangkal
• Kulit : turgor, hangat, dingin
Pem. Fisik ( lanjutan)
• Leher : tegangan vena jugular
• Jantung : irama, frekwensi, bising
• Paru : ronki, wheezing
• Abdomen :hepar, asites, defence musc
• Extremitas : akral hangat, dingin
PATHOGENESIS OF SHOCK
Cardiogenic Distributive
Shock Shock
Inotropes
Vasopressor ( NE,PE,ADR,Dop)
(Dob,Dop,Adr,Amr
)
Release Pump = Pipe = Vascular Blood Pressure
tamponade,e
tc Heart
Hypovolemic
Fluids
Shock
PRINSIP RESUSITASI
Mempertahankan ventilasi
Meningkatkan perfusi
Terapi penyebab
MAINTAIN
VENTILATION
Increased
Especially in: oxygen demand
Sepsis
Hypovolemia
Trauma Hyperventilation
Decreased CO
DO2 = CO x CaO2
Cardiac Arterial
output O2
content
Inotropes Partially
Fluids Transfus dependent
e on FIO2 and
pulmonary
status
THERAPI CAIRAN
Body fluid composition
• Total body water is 60% of total body weight
• = distributed into 3 main compartment