Pemicu 1

LO 1 : Shock
 Syok Kardiogenik
• Definisi :
“Hipoksia jaringan secara sistemik oleh karena
penurunan curah jantung sistemik pada keadaan
volume intravaskular yang cukup”
 Syok Kardiogenik
• Syarat :
– TD <90 mmHg  > 1 jam
– Pemberian cairan  tidak berespons
– Ada tanda hipoperfusi
• indeks kardiak < 2,2l/menit per m2
• Tekanan baji kapiler paru > 18mmHg
– Sekunder terhadap disfungsi jantung
 Syok Kardiogenik
• Tanda dan Gejala
– Hipotensi (< 90 mmHg dalam > 1 jam)
– Hipoperfusi
– Penurunan status mental
– Akral dingin
– Oliguria
 Etiologi
• Infark miokard akut

• Ruptur septal ventrikel

• Ruptur atau disfungsi otot papilaris

• Ruptur miokard

• Infark ventrikel kanan tanpa disertai infark atau disfungsi

ventrikel kiri
SIKLUS SYOK KARDIOGENIK
Infark
miokard
Disfungsi
miokard

Hipotensi

Asidosis Aliran darah

metabolik koroner ↓

Hipoksia
miokard

Aritmia
Harrison’s Principles of Internal Medicine.
19th Edition.
Harrison’s Principles of Internal Medicine. 19th Edition.
 Diagnosis
• Anamnesis :
– Didahului palpitasi dan angina pektoris
– Memiliki riwayat penyakit jantung koroner

• Pemeriksaan fisik :
– TD < 90mmHg
– Pemeriksaan dada  suara gallop (disfungsi
ventrikel kiri)
– Akral teraba dingin
• Pemeriksaan penunjang :
– EKG :
• Gambaran miokard infark (ST elevation) atau
gambaran lainnya (fibrilasi , takikardia ,
bradikardia)
• Lead menunjukan letak kelainan
• Pemeriksaan penunjang :
– Rontgen dada
• Disfungsi ventrikel kiri  kardiomegali dan edema paru
• Defek septal / regurgitasi mitral  edema paru tanpa
kardiomegali
– Hemodinamik
• Teknanan baji pembuluh kapiler paru > 18mmHg
Harrison’s Principles of Internal
Medicine. 19th Edition.
 Komplikasi Syok Kardiogenik
1. Cardiopulmonary arrest
2. Disritmia
3. Gagal multisistem organ
4. Stroke
5. Tromboemboli
 Appendicitis

Marx, John A (2014). Rosen’s Emergency Medicine (8th ed)

Peritonitis
 Definition
• Peritonitis is an inflammation of the
peritoneum, the thin membrane that lines the
abdominal wall and covers the organs inside.
 Etiology
• Primary Peritonitis
• Secondary peritonitis
• Tertiary peritonitis
• Chemical peritonitis
• Peritoneal abscess
Peritonitis Etiologic Organisms Antibiotic Therapy
(Type) (Suggested)
Class Type of Organism
Primary Gram-Negative • E coli (40%) Third-generation
• K pneumoniae (7%) cephalosporin
• Pseudomonas species (5%)
• Proteus species (5%)
• Streptococcus species (15%)
• Staphylococcus species (3%)
• Anaerobic species (< 5%)

Secondory Gram-negative • E coli • Second-generation

• Enterobacter species
• Klebsiella species
• Proteus species
Gram-positive
Anaerobic
Tertiary Gram-negative • Enterobacter species
• Pseudomonas species
• Enterococcus species
Gram-positive Staphylococcus species
Fungal Candida species
http://emedicine.medscape.com/article/180234-overview#a5
cephalosporin
• Third-generation
cephalosporin
• Penicillins with anaerobic
activity
• Quinolones with
anaerobic activity
• Quinolone and
metronidazole
• Aminoglycoside and
metronidazole
• Second-generation
cephalosporin
• Third-generation
cephalosporin
• Penicillins with anaerobic
activity
• Quinolones with anaerobic
activity
 Hernia Incarcerata
Characteristics of asymptomatic hernias are as follows:
• Swelling or fullness at the hernia site
• Aching sensation (radiates into the area of the hernia)
• No true pain or tenderness upon examination
• Enlarges with increasing intra-abdominal pressure and/or
standing

Characteristics of incarcerated hernias are as follows:

• Painful enlargement of a previous hernia or defect
• Cannot be manipulated (either spontaneously or manually)
through the fascial defect
• Nausea, vomiting, and symptoms of bowel obstruction
(possible)
Diarrhea
Managment