Anaphylactic shock.ppt

8/13/2019 Anaphylactic shock.ppt

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Macam danpathofisiologi shock

Drg Yayun Siti Rochmah SpBM



C (Circulation)

Assessment of organ perfusion

- Level of conciousness

- Skin color and temperature

- Pulse rate and character

- Urinary output



SHOCK

An abnormality of the circulatory system

that result in inadequate organ perfusion

and tissue oxygenation



DEFINITION SHOCK:- It is generalized

inadequency of blood flow throughout

the body to the extent that the body

tissue are damaged because of too

little flow, especially too little delivery ofoxygen and other nutrients to tissue cell.



Batasan shock

GANGGUAN SIRKULASI

DISERTAI MENURUNNYAPERFUSI JARINGAN



Shock indeks

NADI

TENSI(SISTOLE) = 0,5

SHOCK INDEKS = 1,0 BAHAYA

SHOCK INDEKS = 1,5 MANIFEST



TYPES:-

SHOCK

HYPOVOLMIC CARDIOGENIC

ANAPHYLACTIC SEPTICEMIC NEUROGENIC

DISTRIBUTIVE



CLASSIFICATION OF SHOCK

Trauma : - Haemorrhagic

- Non haemorrhagicCardiogenicTension pneumothoraxNeurogenic

Septic



….. Classification of shock

Hypovolemic : - Haemorrhage- Diarrhoea

- Burn

Distributive

- Septic- Anaphylaxsis- Spinal cord injury



….. Classification of shock

Cardiogenik :

- Arrytmias- Heart failure- Myocardial contusion / infarction

Obstructive- Tension pneumothorax

- Cardiac tamponade- Haemopneumothorax

Disscociative

- Profound anemia

- Co poisoning



ETIOLOGY: 1)HYPOVOLMIC:>

>HAEMORRHAGE

>TRAUMA

>BURNS

>DEHYDRATION 2)SEPTIC:>

>Gm +ve SEPTICEMIA

>Gm -ve SEPTICEMIA

3)CARDIOGENIC:>

>DEFICIENCY OF EMPTYING

>DEFICIENCY OF FILLING

>OUTFLOW OBSTRUCTION



Jenis shock

Shock dengan tahanan vaskuler

sistemik tinggi : syok kardiogenik,

syok hipovolemik

Shock dengan tahanan vaskular

sistemik rendah : syok septik, syok

anafilaktik



CO = SV X F

preload C after loadEDV SVRVR

BP = CO X SVR



FISIOLOGI SHOCK

CARDIAC

OUTPUTMENINGKAT

Mengurangi stimulasi baroreseptorA. Carotis dan arcus aorta :

kenaikan output sistem sarafsimpatis

1. Vena besar berkontraksi, vol.Darah sirkulasi meningkat,

cardiac output naik (Hk.Starling)

2. Takhikardia3. Vasokonstriksi arteriol, tahanan

perifer meningkat Tahanan sistemikvaskular meningkat



PATOFISIOLOGI SHOCK

VOLUME DARAHBERKURANG

Kegiatan simpatis

meningkat

Iskemik splanknikIskemik renal

Depresi RES

ENZIM2 LISOSOMDILEPAS (PROTEOLITIK)

Toksin vasoaktifdilepas

Asidosis metabolik

Kontraksi arteri >>

Iskemia jaringan

Reaksi kardiogenikFaal renal, serebralberkurang, respirasi

menurun, faal kontraksi jantung<<

Kerusakan endotel,cairan hilang,

kelainan metabolik

Shock Syndrome



PATHOGENESIS

HYPOVOLUMIC & SEPTIC

DECREASED EFFECIENCY CIRCULATING VOLUME

DECREASED VENUS RETURN TO HEART

DECREASED CARDIAC OUTPUT

DECREASED BLOOD FLOW

DECREASED SUPPLY OF OXYGEN

ANOROXIA

SHOCK



CARDIOGENIC

CARDIAC OUTPUT

DECREASED BLOOD FLOW

DECREASED SUPPLY OF OXYGEN

ANOROXIA

SHOCK



SHOCK RECOGNITION AND MANAGEMENT

• Recognize signs of inadequate perfusion

and oxygenation

• Identify probable cause• Restore perfusion

• Re-evaluate patient response

• Immediate involvement by specialists



CLINICAL FEATURES:-

>RAPID PULSE (TAKHIKARDIA)

>PULSE MAY BE WEAK (INDEKS !)

>RAPID BREATHING(TAKHIPNEU)

>ANXIETY>COOL,CALMMY SKIN (CLAMMY)



>WEAKNESS

>PALE SKIN COLOR(PALLOR)

>SWEATING,MOIST SKIN

>DECREASED OR NO URINE

OUTPUT

>LOW BLOOD PRESSURE

>CONFUSION>UNCONCIOUSNESS



CLINICAL SIGNS

1231. Tachycardia

2. Vasoconstriction

3. cardiac output

4. Narrow pulse pressure

5. MAP

6. blood flow

Remember :

Compensatory mechanisms



Akibat shock pada tubuh

Asidosis laktat dan gangguan pernafasan

karena kompensasinya

Adanya PH rendah menekan kontraktilitasmiokard, tensi turun

Vasodilatasi sebagai akibat akhir : hipotensi

Gagal organ spesifik otak : kesadaran turun

Gangguan perfusi ginjal : GGA Perfusi usus menurun, basorbsi toksin bakteri

usus : hipotensi, sepsis, “shock splanknik”



Shock anaphylactic

Terjadi karena pelepasan histamin

Berakibat edema paru akut,

bronkospasme dan edeme mukosasehingga menyebabkan obstruksi jalannafas akut



terapi

Oksigen

Infus

Adrenalin

Kortikosteroid

Intubasi dan ventilasi



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Anaphylactic shock.ppt