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SYOK

Dr H Bambang Eko S, M.Sc, Sp.An


NPA IDI 0604. 48565
Definisi

Kondisi klinis dg gejala & tanda karakteristik yg


terjadi akibat ketidakseimbangan antara suplai O2
dengan kebutuhan O2 hipoksia jaringan. (McLukie,
2003)
Kondisi dimana sangat berkurangnya effective tissue
perfusion, menyebabkan pertama reversibel dan
bila berlanjut menjadi irreversibel cellular injury
(Anand, 2008).
Syok adalah sindroma klinis akibat kegagalan
sirkulasi dlm mencukupi kebutuhan O2 jaringa ( Ery
Leksana, 2006).
Cardiogenic Shock Distributive Shock

Inotropes
Vasopressor

Release Pipe = Vascular Arterial pressure


tamponade,etc

Obstructive Cardiac Output x SVR


Shock

Volume =
Blood

Hypovolemic Shock
Fluids
Gambaran klinis

Gangguan perfusi organ dan oksigenasi


jaringan :
kulit dingin
urin berkurang
kesadaran menurun
tekanan darah turun, nadi meningkat
takipnea
Vasopresor/Inotropik
KLASIFIKASI SYOK

6
Therapeutic Goals in Shock

Control of bleeding
Establish adequate ventilation and oxygenation
Restoration blood volume
Increase O2 delivery
Optimize O2 content of blood
Improve cardiac output and
blood pressure
Match systemic O2 needs with O2 delivery
Reverse/prevent organ hypoperfusion
The History of Transfusion
Triggers
1980 the 10/30 rule
The American Society of Anesthesiology. 6-
10, g/dl
The American College of Physician. 8, g/dl
The National Institute of Health. 7, g/dl
The Transfusion Requirements in Critical
Care. 7-9, g/dl
Postoperative Outcomes of
Anemic Jehovahs Witnesses

Preoperative Hemoglobin Mortality


Level
<6 g/dl 61.5 %
6.1 to 8 g/dl 33 %
8.1 to 10 g/dl 0%
>10 g/dl 7.1 %

Addison K M et al. Rational use of blood production in : Lanten PN ed the intensive care unit manual
2001. P181-92
Hemodynamic of Anemia
DO2 = Oxygen Delivery
DO2 = CO x CaO2 CO = Cardiac Output
CaO2 = Content of Arterial Oxygen

M.A.P = Mean Arterial Pressure


M.A.P
T.P.R = Total Peripheral Resistance
CO = = HR x SV
HR = Heart Rate
T.P.R
SV = Stroke Volume

Hb = Haemoglobin
CaO2 = Hb X Sa02 X 1.39
SaO2 = Oxygen Saturation
Oxygen Delivery = CO x CaO2 (Hb x SpO2 x 1,39 + 0,003xPaO2)
O2content, O2 extracting Ratio, O2 Consumption

Important determinant to tissue


oxygenation
Component : Cardiac Output, Hb,
SpO2 arterial & venous blood
PENTING !
VOLUME INTRA-VASKULAR
O2 TRANSPORT ( ERITROSIT )

JUMLAH OKSIGEN YANG TERSEDIA UNTUK JARINGAN :

CO X (SAT.O2 X Hb X 1.39 + PO2 X 0.03)

= 5 l/m X 20 l/m O2/100 ml


= 1 liter O2/m

KEBUTUHAN = 25 % = 250 ml
O2/m
TREATMENT CONCEPT OF SHOCK
ENHANCING PERFUSION / OXYGEN DELIVERY

DO2 = CO x CaO2

Cardiac Arterial O2
output content

Oxygen delivery/DO2 = HR X SV X Hb X S02 X 1.39 + 0.03 X PaO2

Inotropes : Transfuse Partially


Dopamin Fluids dependent on
Dobutamin
Norepinephrin
FIO2 and
Epinephrin pulmonary
status
Syok hipovolemia
Indikasi masuk ICU

Critical Ill dan Potensi critical Ill yg reversibel:


- Gagal nafas/impending dgn kriteria klinis
- Shock semua penyebab
- Sepsis/awal sepsis
- Post operasi besar/berat/lama
- Post resusitasi jantung paru
- Kardiovaskuler-respirasi tidak stabil (dekompensasi
jantung dg gagal nafas
- Critical Ill dg prognosis reversibel
Syok septik
DIAGNOSING THE SHOCK TYPE
CaO2 = Cardiac
DO2 =Hypoxemia,
Arterial OxygenHemorrhagic
Content
x Output
poisoning shock

SaO2 x 1.34 x Hb SV x HR

1. Quantitative Shock volume Afterload Contract


1. Decreased CaO2
2. Decreased Flow Cytophatic Cardiogenic
Hypovolemic
shockhypoxia shock
2. Distributive Shock

O2ER
Capillary Flow
recruitment redistribution
Key steps in oxygen cascade
Uptake in the Lung Oxygenation P aO 2
CaO2
Haemoglobin Carrying capacity SaO 2 DO2

Delivery Cardiac Output Flow rate

CaO2 = Cardiac
DO2 = Arterial Oxygen Content
x Output
SaO2 x 1.34 x Hb
Arterial oxygen content SV x HR

Global Flow
Preload Afterload Contract
/ Perfusion
Key steps in O
oxygen cascade
2
Uptake in the Lung Oxygenation P aO 2
CaO2
Haemoglobin Carrying capacity SaO 2 DO2

Delivery Cardiac Output Flow rate

Organ distribution Autoregulation Nervous Syst


Humoral
Local Control
Diffusion Distance

Cellular use Mitochondria VO2

Contraction