PEDIATRIC SHOCK

BY :
ARGIA ANJANI
1102013041

ADVISOR:
DR. PULUNG M. SILALAHI, SP.A

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
RUMAH SAKIT BHAYANGKARA TK. I RADEN SAID SUKANTO
DEFINITION

Shock is a state of acute energy

failure in which there is not enough
adenosine triphosphate (ATP)
production to support systemic
cellular function.
CLASSIFICATION

TYPE PRIMARY INSULT COMMON CAUSES

HYPOVOLEMIC Decreased circulating Dehydration,

blood volume hemorrhage, capillary
leaks
DISTRIBUTION Vasodilatation – venous Sepsis, anaphylactic
pooling – decreased drug intoxication,
preload spinal cord injury
OBSTRUCTIVE Obstruction of cardiac Cardiac tamponade,
filling/outflow tension pneumothorax
CARDIOGENIC Decreased contractility Congenital heart
disease, myocarditis
Hypovolemic shock
 Result of inadequate circulating blood volume, caused
by sudden blood loss, severe dehydration, or injuries
that cause significant fluid shifts from the intravascular
space to the interstitial space (e.g., burns)
DISTRIBUTIVE SHOCK
Cardiogenic shock
 Cardiogenic shock is recognized as a low-cardiac-output
state secondary to extensive left ventricular (LV)
infarction, development of a mechanical defect (e.g.,
ventricular septal defect or papillary muscle rupture),
or right ventricular (RV) infarction.
Obstructive shock
Obstructive shock is a form of shock associated with
physical obstruction of the great vessels or the heart
itself. Pulmonary embolism and cardiac tamponade are
considered forms of obstructive shock.
Stages of shock
Stage 1. The body activates compensatory mechanisms in
an effort to maintain circulatory volume, blood pressure,
and cardiac output.
 Normal vital signs and cerebral perfusion, and the shock
state often goes unrecognized.

Stage 2. Compensatory mechanisms begin to fail,

metabolic and circulatory derangements become more
pronounced, and the inflammatory and immune responses
may become fully activated.
 Signs of dysfunction in one or more organs may become
apparent.
(cont’d)
Stage 3. In the final, irreversible stage, cellular and tissue
injury are so severe that the patient’s life is not
sustainable even if metabolic, circulatory, and
inflammatory derangements are corrected.
 Full-blown multisystem organ dysfunction syndrome (MODS)
may become evident.
Diagnosing shock
 Anamnesis

 Physical Examination

 Laboratory Findings
Anamnesis
 Lack of fluids intake and/or profuse fluids loss

 Any kinds of cardiac diseases

 Any kinds of severe illness (Sepsis, anaphylactic

reaction, injury of back bone etc.)

 Any kinds of trauma or patalogic process on chest/lung

Physical examination
 Decrease of mental status, & other signs of organ
hypoperfusion e.g. decreased urine output, elevated
LFTs, bilirubin

 Hypotension

 Tachycardia, or arrythmia, or bradycardia (depend on

the causa & stadium of shock)

 Cold acral
Laboratory findings
 Metabolic asidosis for all kinds of shock

 Hemoconcentration for hypovolemic shock

 Bacteriemia for septic shock

 Tension (pneumothorax with lung collaps and

mediastinum shift on chest x-ray) for obstructive shock

 Cardiomegali or abnormality of cardiac appearance in

chest x-ray and ECG for cardiac shock
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No.: 004/Rek/PP IDAI/III/2014
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No.: 004/Rek/PP IDAI/III/2014
Tata Laksana Syok