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Manifestasi Klinis:
a.Akral Dingin, Pucat basah
b.Nadi >100 x/ menit
c.TD <90 mmHg
JENIS SHOCK
Hipovolemic Shock
Cardiogenic Shock
Neurogenic Shock
Septic Shock
Sirkulasi / hemodinamik
normal
4800 = 60 x 80 cc
Perfusion
VR setara CO
CO = frek x Stroke Volume
Shock hypovolemic =
masalah pada volume darah
Perfusion
4800 = 60 x 80 cc
VR turun, CO turun
CO = frek naik x Stroke Volume turun
perdarahan
4800 = 120 x 40 cc
Shock obstructive =
masalah pada aliran darah
Perfusion
Perfusion
Criteria
Parasite
Virus
Severe
Infection Sepsis SIRS
Sepsis
Fungus
shock Severe
SIRS Trauma
Bacteria
BSI
Burns
Other
Lung 8%
47%
Culture
Negative
20%
Criteria
MANAJEMENT
EARLY GOAL DIRECTED THERAPY
INTERNATIONAL MANAGEMENT
RECOMENDATIONS
NOREPINEFRINE (NE)
Mekanisme : NE disintesin dari Dopamin oleh enzim b- hidroksilase, bersifat agonis
pada reseptor alfa-1.
Sifat : Vasopressor , Inotropik Negatif
Efek Samping : Bradikardia, Aritmia, Iskemik,
Dosis : 0.05 µg/kg , dosis dititrai dinaikan perlahan
DOPAMINE
DOBUTAMINE
INOTROPIC / VASOPRESSOR AGENTS
Dopamine
Low dose (2-3 g/kg/min) – mild inotrope
plus renal effect
Intermediate dose (4-10 g/kg/min) –
inotropic effect
High dose ( >10 g/kg/min) – vasoconstriction
Chronotropic effect
SHK 26
®
INOTROPIC AGENTS
Dobutamine
5-20 g/kg/min
Inotropic and variable chronotropic effects
Decrease in systemic vascular resistance
SHK 27
®
INOTROPIC / VASOPRESSOR AGENTS
Epinephrine
Both and actions for inotropic and
vasopressor effects
0.1 g/kg/min and titrate
Increases myocardial O2 consumption
SHK 28
®
DAFTAR PUSTAKA