Fluid Management in Traumatic Shock

7/25/2019 Fluid Management in Traumatic Shock

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ISF

9L9L

ISFISF IVFIVF ICFICF

3L3L 24 L24 L220,#220,# /0 ,#/0 ,#

A(&!'g1A(&!'g1

RL1-C#RL1-C#

3L3L

Phy!"#"g!$ &!'$!#(Phy!"#"g!$ &!'$!#(

") )#*!+ ,-'-g(,('.") )#*!+ ,-'-g(,('.

Hasanul, 2002Hasanul, 2002



ISF

9L9L


3L3L 24 L24 LLL

A#5%A#5%

L L

Phy!"#"g!$ &!'$!#(Phy!"#"g!$ &!'$!#(

") )#*!+ ,-'-g(,('.") )#*!+ ,-'-g(,('.




ISF

9L9L


3L3L 24 L24 LLL

HES56%HES56%LL

Phy!"#"g!$ &!'$!#(Phy!"#"g!$ &!'$!#(

") )#*!+ ,-'-g(,('.") )#*!+ ,-'-g(,('.






ISFISFISF IVFIVF ICFICF

3L3L 24 L24 L600,#600,#

D(.&-'5D(.&-'54040

LL

Phy!"#"g!$ &!'$!#(Phy!"#"g!$ &!'$!#(

") )#*!+ ,-'-g(,('.") )#*!+ ,-'-g(,('.


9L9L260 ml260 ml

340ml340ml



ISFISFISF IVFIVF ICFICF

3L3L 24 L24 L300,#300,#

D(.&-'5D(.&-'5/0/0

LL

Phy!"#"g!$ &!'$!#(Phy!"#"g!$ &!'$!#(

") )#*!+ ,-'-g(,('.") )#*!+ ,-'-g(,('.

9L9L

130 ml130 ml170ml170ml





Th( T&!,"+-# D!.&!*.!"' ")Th( T&!,"+-# D!.&!*.!"' ")

T&-*,-.!$ D!(-(T&-*,-.!$ D!(-(

IMMEDIATE : CNS injury or Heart and great vessel injuryIMMEDIATE : CNS injury or Heart and great vessel injury

EARLY : Major e!orrageEARLY : Major e!orrage

LATE : In"e#tion and Multi $rgan "ailureLATE : In"e#tion and Multi $rgan "ailure

% e r # e n t o " t r

a u ! a d e a t s &'

('

)'

*'

+'

'

Time after injuryTime after injury ' + * ) (,rs

--

+.* &./ 0ee1s




Traumatic ShockTraumatic Shock

PerdarahanPerdarahan


PneumothoraxPneumothorax

HematothoraxHematothorax

Cardiac TamponadeCardiac Tamponade

Spinal Shock Spinal Shock

MyocardialMyocardial

ContussionContussion



Th( G"#+(' H"*& Th( G"#+(' H"*&

is te time in !i" resus"itation of se#erelyis te time in !i" resus"itation of se#erely

injured $atients must %egin to a"ie#einjured $atients must %egin to a"ie#e

ma&imal sur#i#ema&imal sur#i#e

R. Adams Cowley, MD

The lethal factor in shock is inadequate cellular The lethal factor in shock is inadequate cellular

oy!en deli"ery, leads to irre"ersi#le anoicoy!en deli"ery, leads to irre"ersi#le anoic

cellullar in$ury that kills a critical mass of cellscellullar in$ury that kills a critical mass of cells




+''

2'

/'

('

*'

' )' /' 3'

THE GOLDE HO7RTHE GOLDE HO7RProbability of SurvivalProbability of Survival

Survival is related to severitySurvival is related to severity

and durationand duration

minutes

%sur"i"al

R. Adams Cowley, MD




OXYGEN TRANSPORTOXYGEN TRANSPORT




PRE5LOADPRE5LOAD COTRACTILITYCOTRACTILITY AFTER5LOADAFTER5LOAD

STRO8E VOL7ESTRO8E VOL7E HEART5RATEHEART5RATE

CARDIAC O7TP7TCARDIAC O7TP7T TOTALTOTAL

PERIPHERALPERIPHERAL

RESISTACERESISTACE

BLOODBLOOD

PRESS7REPRESS7REHasanul, 2002Hasanul, 2002



PERDARAHANPERDARAHAN

HILANG VOLUMEHILANG VOLUME

HILANG ERITROSITHILANG ERITROSIT




B1B1,, nafas sesak RR cu!in" hi#un"nafas sesak RR cu!in" hi#un"

B$B$,, HR na#i ha%us ce!at T&' N(HR na#i ha%us ce!at T&' N(

P*#(5&( 1 (&)*! +!'g!'1 *$-.1 --h1P*#(5&( 1 (&)*! +!'g!'1 *$-.1 --h1

$-!##&()!## ; 2 +(.1 #-$.!$5-$!+$-!##&()!## ; 2 +(.1 #-$.!$5-$!+

= B3B311

= B4B411

-'!"*1 $"')*(+1 #(.h-&gy-'!"*1 $"')*(+1 #(.h-&gy

*&!'( "*.5*. 1 <0 ,#=kg=>-,1 (k-.*&!'( "*.5*. 1 <0 ,#=kg=>-,1 (k-.


SHO!

HO!



'lass ('lass ( 'lass (('lass (( 'lass ((('lass ((( 'lass ()'lass ()Blood*+ossml-Blood*+ossml- *./0*./0 /0*100/0*100 100*2000100*2000 .2000.2000

Blood*loss B)-Blood*loss B)- *.1*.1 1*301*30 30*4030*40 .40.40

5ulse*Rate &6min7-5ulse*Rate &6min7- 81008100 .100.100 .120.120 .140.140

Blood*5ressureBlood*5ressure 9ormal9ormal 9ormal9ormal :e"reased:e"reased :e"reased:e"reased

5ulse*5ressure5ulse*5ressure 9 or9 or

in"reasedin"reased:e"reased:e"reased :e"reased:e"reased :e"reased:e"reased

Res$iratory RateRes$iratory Rate 14*2014*20 20*3020*30 30*330*3 .3.3

Urine out*$ut ml6our-Urine out*$ut ml6our- .30.30 20*3020*30 *1*1 9egligi%le9egligi%le

Mental status6'9SMental status6'9S SligtlySligtly

an&iousan&iousMidlyMidly

an&iousan&iousAn&ious andAn&ious and

"onfused"onfused'onfused and'onfused and

letargi"letargi"

E.!,-.(+ F#*!+ -'+ B#""+ L"(E.!,-.(+ F#*!+ -'+ B#""+ L"(

B-(+ "' P-.!('.? I'!.!-# P&(('.-.!"'B-(+ "' P-.!('.? I'!.!-# P&(('.-.!"'

>6 4 ?' !l-1g>6 4 ?' !l-1g




"#$D REP"AEMENT

"#$D REP"AEMENT

3 : 1 Rule3 : 1 Rule'lass ('lass ( 'rystalloid'rystalloid

'lass (('lass (( 'rystalloid'rystalloid ;; 'olloid <'olloid <

'lass ((('lass ((( 'rystalloid'rystalloid

;;'olloid'olloid, Blood, Blood'lass ()'lass () 'rystalloid'rystalloid

;;'olloid'olloid, Blood, Blood




P"#- k(&>- ('-'g-'-'P"#- k(&>- ('-'g-'-'

h"$k (&+-&-h-'h"$k (&+-&-h-'

5enderita datang5enderita datang

dengan $erdaraandengan $erdaraan

5asang5asang 22 infus jaruminfus jarumkali%er %esar =1>?,1@?kali%er %esar =1>?,1@?

am%il sam$le daraam%il sam$le dara

Ukur tekanan dara,Ukur tekanan dara,

itung nadi, nilai $erfusi,itung nadi, nilai $erfusi,

$roduksi urine$roduksi urine

Tentukan estimasiTentukan estimasi

jumla $erdaraan, jumla $erdaraan,minta daraminta dara

?uyur "e$at?uyur "e$at Ringer AsetatRinger Asetat =Asering=Asering Ringer +aktat atau 9a'lRinger +aktat atau 9a'l

0707 angat, 3angat, 300''-- 3& $rakiraan3& $rakiraan

lost*#olume 1*2 liter-lost*#olume 1*2 liter- EvaluaEvalua




Management

anagement

%elan&utn'aelan&utn'a

Ra$id res$onse,Ra$id res$onse,$erdaraan 820$erdaraan 820

Transient res$onse,Transient res$onse,

$erdaraan 20*40 B)$erdaraan 20*40 B)

ongoing lossongoing lossresusitasi tdk adek!atresusitasi tdk adek!at

AseringAsering, R+, 9a'l 07,, R+, 9a'l 07, KolloidKolloid,,

:ara<:ara<

Minimal, no res$onseMinimal, no res$onseTindakan %eda segeraTindakan %eda segera

Transfusi daraTransfusi dara



E)(k @"#*,( !')* L $-!&-' 8"##"!+ -+-E)(k @"#*,( !')* L $-!&-' 8"##"!+ -+-

k",-&.(,('. .**h BB1/0kgk",-&.(,('. .**h BB1/0kg

L - & * . - 'L - & * . - ' V"# #-,-V"# #-,- V"# !'.(&.!.!-#V"# !'.(&.!.!-# V"#!'.&-(#V"#!'.&-(#

Al9u!in.&@ Al9u!in.&@ +'''+''' .. ..

%%F 7%las!a %rotein%%F 7%las!a %roteinFra#tion.&@8Fra#tion.&@8 +'''+''' .. ..

ela"undinela"undin +'''+''' .. ..

Hae!a#elHae!a#el ?''?'' .)''.)'' ..

De5tran.('De5tran.(' +/''+/'' .*/'.*/' .)('.)('

De5tran.?'De5tran.?' +)''+)'' .+)'.+)' .+?'.+?'

E5Ba"usinE5Ba"usin +'''+''' .. ..

Haes.steril./@Haes.steril./@ +'''+''' .. ..

Haes.steril.+'@Haes.steril.+'@ +(&'+(&' .(&'.(&' ..




Transient resBonse;Transient resBonse;

dara 9elu! datangdara 9elu! datang,,)er#arahan masih)er#arahan masih

*er%an"sun"*er%an"sun"

+on"oin" %oss,+on"oin" %oss,

8"##"!+8"##"!+

::



Tran%(u%i

ran%(u%i

)

Target H* + g,Target H* + g,

R*#( ") 5R*#( ") 5 55!l ole.>lood 4 & 5 delta H9 5 >>!l ole.>lood 4 & 5 delta H9 5 >>

contoh&contoh&

BB 50 kg, Hb 6g%, WB yang dibutuhkan = 5 x 3 x 50BB 50 kg, Hb 6g%, WB yang dibutuhkan = 5 x 3 x 50

= 750 ml= 750 ml

= 3 bag [unit]= 3 bag [unit]




TR!S"#S$TR!S"#S$

'dema (al(e#ra)'dema (al(e#ra)

". *u!ularis eterna non$ol)". *u!ularis eterna non$ol)

+luid o"erload )+luid o"erload )

R%R% +urosemide+urosemide



Dopamine,Dopamine,

200 mg Doamin! "ai#kan m!n$adi 50 ml200 mg Doamin! "ai#kan m!n$adi 50 ml

d!ngan a&l 0'(%'d!ngan a&l 0'(%'

)alankan d!ngan *y#ing! um')alankan d!ngan *y#ing! um'

Do*i* + ugkgm!nitDo*i* + ugkgm!nit

-umu* +-umu* +

ml$amml$am ==ug x BB x 60ug x BB x 60

.000.000



Dobutamine,Dobutamine,

250 mg Dobutamin! "ai#kan m!n$adi 50 ml250 mg Dobutamin! "ai#kan m!n$adi 50 ml

d!ngan a&l 0'(%'d!ngan a&l 0'(%'

)alankan d!ngan *y#ing! um')alankan d!ngan *y#ing! um'

Do*i* + ugkgm!nitDo*i* + ugkgm!nit

-umu* +-umu* +

ml$amml$am ==ug x BB x 60ug x BB x 60

50005000



Th( &(*,( ") .&-.(g!$Th( &(*,( ") .&-.(g!$

'rystalloid 2 +'rystalloid 2 +

'olloid'olloid

5R'5R'

'rystalloid 2+'rystalloid 2+

'rystalloid'rystalloid

Cole BloodCole Blood

D 'rystalloid 2+'rystalloid 2+

D 'rystalloid6'olloid'rystalloid6'olloidD Cole BloodCole Blood

D FurosemideFurosemide




Terima -asih .Terima -asih .





Aserin!Aserin!

- le#ih ce(at diru#ah men$adi le#ih ce(at diru#ah men$adi

#ikar#onat di#andin! Rin!er laktat#ikar#onat di#andin! Rin!er laktat

- Meta#olisme diototMeta#olisme diotot

- (roses kimiawi asetat men$adi(roses kimiawi asetat men$adi

#ikar#onat le#ih sedikit mem#utuhkan /2#ikar#onat le#ih sedikit mem#utuhkan /2

dan le#ih sedikit men!hasilkan C/2dan le#ih sedikit men!hasilkan C/2

di#andin!kan den!an (eru#ahan laktatdi#andin!kan den!an (eru#ahan laktat

men$adi #ikar#onatmen$adi #ikar#onatHasanul, 2002Hasanul, 2002



olume& 10 mlk!hari

'lektrolit &

3a4 & 25 m'qk!hari64& 752 m'qk!hari

6alori &1005800 k.cal

3utrient lain9minimal:



HEMOD!"M# ST"$% $"# HEMOD!"M# ST"$% $"#

PE&'(S )PE&'(S )

O#S*E!"SO#S*E!"S

C"&"!C"&"!

&(M"T"!&(M"T"! +O%(ME+O%(ME

E%E#T&O%TE%E#T&O%T

#"%O&#"%O&

!(T&E!T %"!!(T&E!T %"!



6a'3M;< 4 =anAmin;6a'3M;< 4 =anAmin;

olume & 2 literolume & 2 liter

3=C & 800 kcal3=C & 800 kcal

Asam amino & 2>.2 !rAsam amino & 2>.2 !r

3a3a44 10, 6 10, 6 4420, Cl20, Cl5510, ?actate2010, ?actate20

6a'3M;<6a'3M;<

Panmin&'

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Fluid Management in Traumatic Shock