MA TA KU L IA H :

SHOCK,
ELECTROLYTE
, AND FLUID
Dibawakan oleh
 Tranexamic Acid

TXA, sebuah obat antibrinolitik, dikenal efektif dalam mengurangi

perdarahan berlebihan, digunakan dalam prosedur bedah besar, dan
bahkan direkomendasikan dalam kasus perdarahan intrakranial spontan
pasca trauma. Meskipun memiliki hasil positif pada penelitian seperti
CRASH-2, beberapa penelitian retrospektif menunjukkan hasil yang
bertentangan. TXA menarik perhatian sebagai obat murah dengan efek
samping minimal."

03
Darah mengantarkan oksigen melalui sel darah
merah, yang mengandung hemoglobin.
Perhitungan sederhana pengiriman oksigen
(DO2) adalah curah jantung (CO) dikalikan
dengan kandungan oksigen yang dibawa oleh
volume darah (CaO2)
Dalam keadaan normal, pengiriman oksigen kira-kira 1000 mL/menit O2. Konsumsi oksigen
dalam keadaan normal adalah 25% dari pengiriman dan kira-kira 250 mL/menit. Pada
pengiriman oksigen yang sangat rendah, diyakini bahwa konsumsi bergantung pada pengiriman
dan terjadi dalam keadaan syok. Terdapat hutang oksigen selama syok dan selama pemulihan,
dan terdapat tahap hiperdinamik dimana sistem peredaran darahmembayar kembali hutang
oksigennya
 OPTIMAZATION

Peningkatan konsumsi oksigen dianggap sebagai proses

pembayaran kembali hutang oksigen yang terjadi selama
iskemia di seluruh tubuh. Pasien syok ditemukan memiliki
tahap hiperdinamik, dimana peningkatan pengiriman
oksigen mengakibatkan peningkatan konsumsi. Asumsinya
adalah bahwa peningkatan konsumsi berarti mengisi
kembali hutang oksigen yang telah dikeluarkan tubuh.
 Proses optimasi ini melibatkan pemberian bolus
cairan dengan cepat dan memastikan bahwa
haltersebut meningkatkan tekanan baji. Karena
respon terhadap infus cairan bersifat dinamis, maka
proses infus harus dilakukan dalam waktu singkat,
misalnya 20 menit.

jika respons tidak diukur segera setelah infus, efek

infus diketahui akan menurun dengan cepat saat
cairan keluar dari ruang pembuluh darah. Tekanan
baji dan curah jantung harus diukur beberapa menit
sebelum infus cairan untuk menentukan apakah
tindakan tersebut efektif.
The recommended agent at that time was dobutamine. The dose was
increased, and its effect on cardiac output was documented. With each
maneuver, oxygen consumption was measured and cardiac output was
"optimized" to meet consumption needs. is optimizing the oxygen
delivery process to the maximum to ensure that all tissues are adequately
nourished.

when the heart is pushed through the supernormalization process,

the heart's metabolism increases to such an extent that the heart
becomes the main organ that seems to consume all the excess
oxygen being delivered. The harder the heart works to deliver oxygen,
the more oxygen it has to use. The normal cardiac output of the
average man is about 5 liters/minute, but patients often reach a
cardiac output of 15 liters/minute or more.

07
During hemorrhage or hypovolemia, blood is diverted to
organs such as the brain, liver, and kidneys-at the expense
of tissues such as skin, muscle, and intestines. our search
was on to determine the consequences of this shunting
process. the gastrointestinal (GI) tract became the focus of
much of this research. Two main methods were
developed, gastric tonometry and near-infrared (NIR)
technology.
NIR technology may be able to show when the patient is in
shock or even when the patient is fine. Hidden
hypoperfusion can be detected or even ruled out with NIR.
In trauma situations, non-invasive methods that can
continuously detect trends in parameters such as regional
oxygenation status, base deficit or blood pressure will
definitely play a role.
Untuk menguji kegunaan perangkat pemantauan yang ideal ini, studi prospektif
multisenter dilakukan untuk menentukan apakah teknologi NIR dapat mendeteksi pasien
yang berisiko mengalami syok hemoragik dan gejala sisa. Dilakukan di tujuh pusat trauma
tingkat I, penelitian ini melibatkan 383 pasien yang mengalami syok traumatis berat
disertai hipotensi dan memerlukan transfusi darah.
Mortality after traumatic injury is described as trimodal. Some patients die a short time after
injury, some die in hospital within hours, and many die late in hospital. However, a study on
trauma patients showed that death occurs in a logarithmic decay manner and follows the rules
of biology; no grouping of deaths can be seen, unless the data is represented or combined into
immediate, early, or late data. The only reason for the early trimodal distribution is because
patients who died after 24 hours were labeled as late deaths.
Activated intravascular neutrophils will adhere and roll until a series of other mechanisms
cause strong adherence, and transendothelial migration out of the vascular system occurs.
This transmigration process is believed to injure the endothelium, releasing oxygen free
radicals. This can result in fluid leakage out of the vascular system. ICAM, intercellular
adhesion molecule; PECAM, platelet-endothelial cell adhesion molecule.
EVOLUTION OF MODERN
RESUSCITATION
Neutrophil activation in whole pig blood was
measured by flow cytometry. The highest
neutrophil activation occurred after
hemorrhagic shock and resuscitation using
LR. Similar neutrophil activation occurred
when the animal was not resuscitated but
infused with LR. No activation occurred when
shocked animals were resuscitated with
whole blood or 7.5% HTS.
 EVOLUTION OF MODERN
RESUSCITATION
When blood is diluted with various resuscitation fluids, the inflammatory changes depend on
the fluid used; although the physiological outcomes are similar in vivo, the immunological
outcomes are different. These responses are ubiquitous throughout the inflammatory
response system, including at the DNA and RNA expression levels. Ultimately, it is recognized
that the inflammatory response is caused by various resuscitation fluids. The type and amount
of fluid directly causes inflammation. All artificial fluids used to increase blood pressure can
cause the inflammatory sequelae of shock. The type of fluid and the amount are responsible
for the inflammatory response.
New recommendations for fluid resuscitation from the US military by the Tactical Combat
Casualty Care Committee.