Ns. Defi Efendi, Sp. Kep.

An
RSUI - FIK UI 18-19 Juni 2022
Riwayat Pekerjaan
§ Clinical Care Manager NICU RSUI [2018 – sekarang]
§ Staf pengajar Dep. Kep. Anak FIKUI [2016 – sekarang]
§ Perawat pelaksana NICU RSCM [2017 – 2018]
§ Perawat pelaksana RS Binasehat [2012]

Riwayaat Organisasi
§ Kaderisasi PP IPANI [2016– 2022]
§ Pokja Kep. Neonatus dan Diklat PP IPANI [2017– Sekarang]
§ DPK PPNI RSUI [2018 – Sekarang]

Riwayaat Pendidikan
§ Magister dan Spesialis Kep. Anak - Universitas Indonesia [2013– 2016]
§ Sarjana dan Ners – Universitas Muhammadiyah Jember [2006– 2012]

Interest/Minat: Interest/Minat:
§ Neontaus risiko tinggi § Perawatan kulit dan pencegahan cidera
§ Developmental care
§ Perawatan ventilasi mekanik § Uji klinis acak terkontrol (RCT)
§ Akses vaskular § Telaah sistematis (Systematic review)
• Definisi
• Tingkatan syok
• Manifestasi klinis syok
• Pengkajian fisik syok
• Jenis-jenis syok
• Manajemen syok pada anak
 Shock didefinisikan dengan variatif, diantaranya:

Shock merupakan kondisi kegagalan suplay energi akut berupa

produksi ATP untuk mendukung fungsi seluler sistemik (Carcilo,
J.A. et Al, 2007)

Clinical Pediatric Emergency Medicine, Vol.8 (2007) doi:10.1016/j.cpem.2007.07.002

Shock umumnya
dimanifestasikan dengan
hipotensi, namun pasien
dengan tensi normal
dapat mengalami syok..
 Shock
Cellular demands (VO2) > Oxygen delivery (DO2)

SHOCK.! NORMAL
 Shock
Cellular demands (VO2) > Oxygen delivery (DO2)

Cellular demands (VO2) > CO X CaO2

Cellular demands (VO2) > [HR x SV] X [ 1.34 x Hgb x SaO2 + 0.003 x PaO2 ]
The oxygen carried by haemoglobin The amount of oxygen dissolved in plasma

• CO: Cardiac output

• CaO2 : The content of oxygen in arterial blood
• SV : Stroke volume
 Shock
- Chronotropy
- Dromotropy
- Arrythmias pRBC

Cellular demands (VO2) > [HR x SV] X [ 1.34 x Hgb x SaO2 + 0.003 x PaO2 ]
The oxygen carried by haemoglobin The amount of oxygen dissolved in plasma

Konsumsi O2 Afterload Contractility

Preload
- Agitasi (ESV) - Hypothermia
(EDV) - PAO2 – PaO2
- Nyeri - Systemic - Acidotic pH
- Venous - Shunt
- Menggil vascular - Abnormal
tone electrolytes - Hgb O2 offloading
- WoB resistance
- Venous
- Aritmia - Toxic
volume
- Demam ingestion

• CO: Cardiac output

• CaO2 : The content of oxygen in arterial blood
• SV : Stroke volume
• Chronotopy : SA node firing rate
• Dromotropy: Kecepatan impulse system konduksi
 Penyebab Shock
Shock

Kekurangan Suplay Kekurangan Suplay Disfungsi Mitokondria

Oksigen Glukosa (glycopenia)

• Anemia • Level glukosa • Hipoglikemia

• Hipoksia • Aliran darah • Resistensi
• Iskemia insulin
• Insulin ekstrim

Clinical Pediatric Emergency Medicine, Vol.8 (2007) doi:10.1016/j.cpem.2007.07.002

Klasifikasi Shock
Dan Subklasifikasi

Hector Wong. 2016. Circulatory Failure/Shock . Pediatric Critical Care Study Guide: Text and Review. Chapter 26. SpringerLink
Klasifikasi Shock

Cool
Dan Temuan klinis

Cool

Warm

Cool

Note: PCWP (Pulmonary capillary wedge pressure); SVR (Systemic vascular resistance)
Pengkajian
• RPD
• Penyakit jantung
• Pembedahan
• Trauma
• Masalah medis terkait
• RPS
• Pajanan
• Berapa lama
Pengkajian

Horezcko et al. 2013. The Pediatric Assessment Triangle: Accuracy of Its Application by
Nurses in the Triage of Children. J Emerg Nurs. 2013 March ; 39(2): 182–189.
doi:10.1016/j.jen.2011.12.020
Management - Umum

Airway Breathing Circulation

• Pastikan jalan • Mulai dengan • Pasang akses

napas bersih Oksigen 100% segera
• Intubasi jika • Pasang monitor • Monitor status
kepatenan jalan kardiorespirator
napas tidak
terjaga
Management
spesifik
Algoritma

Pediatric Bradichardia
Algoritma

Pediatric Tachycardia
Algoritma

Pediatric Septic Shock

 Shock
- Chronotropy
- Dromotropy
- Arrythmias pRBC

Cellular demands (VO2) > [HR x SV] X [ 1.34 x Hgb x SaO2 + 0.003 x PaO2 ]
The oxygen carried by haemoglobin The amount of oxygen dissolved in plasma

Konsumsi O2 Afterload Contractility

Preload
- Agitasi (ESV) - Hypothermia
(EDV) - PAO2 – PaO2
- Nyeri - Systemic - Acidotic pH
- Venous - Shunt
- Menggil vascular - Abnormal
tone electrolytes - Hgb O2 offloading
- WoB resistance
- Venous
- Aritmia - Toxic
volume
- Demam ingestion