16. shock (perioperative course 2015)edited
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SHOCK
PERIOPERATIVE COURSE FOR THE RESIDENTS
TIM PERIOPERATIF
DEPARTEMEN OBSTETRI-GINEKOLOGIFAKULTAS KEDOKTERAN UNIVERSITAS INDONESIA
2015
SYOK
George. ICU without walls, 2014
Category of shock
George. ICU without walls, 2014
Cardiac output
Cardiac physiology
George. ICU without walls, 2014
George. ICU without walls, 2014
Card
iac
cycl
e
George. ICU without walls, 2014
Cardiac outputMeasured to assess the cardiac performance
George. ICU without walls, 2014
Cardiac output
George. ICU without walls, 2014
Cardiac output
George. ICU without walls, 2014
Cardiac output
DIASTOLIC SISTOLIC
George. ICU without walls, 2014
George. ICU without walls, 2014
Systemic Vascular Resistance (SVR)
George. ICU without walls, 2014
Can’t use BP as an indicator of shock
Oxygen delivery
Oxygen delivery (DO2)
George. ICU without walls, 2014
DO2 / VO2
George. ICU without walls, 2014
Oxygen consumption
George. ICU without walls, 2014
Oxygen consumption
George. ICU without walls, 2014
Compensatory mechanism
Glikogen
Glukosa
2 Pyruvate 2 Laktat + 2 ATP
Siklus Kreb
(Mitochondria)
36 ATP
Pembersihan oleh hati, ginjal, GIT, otot
Glikogen hatiEpinephrine
AnoxiaEndotoxinThiamine deficiency
+
_
Alkalosis
+
Pyruvate dehydrogenase
Membran sel
8
6
4
2
0Seru
m la
ctat
e (m
mol
/L)
0 40 80 120 160Time (min)
Endotoxin infusion
Dichloroacetate
FiO2 12%
Pembersihan terlambat karena hipoperfusi, disfungsi hepar & renal
_
Pembentukan laktat
Plasma lactate level
Aduen, et al. JAMA 1994;272:1678-85
Category of shock
George. ICU without walls, 2014
George. ICU without walls, 2014
George. ICU without walls, 2014
Management strategy
George. ICU without walls, 2014
OXYGEN DEMAND
George. ICU without walls, 2014
Management strategy
George. ICU without walls, 2014
Norepinephrine
KESIMPULAN
DEFINISI SYOK
George. ICU without walls, 2014
HIPOTENSI ADALAH LATE MARKER DARI HIPOPERFUSI
George. ICU without walls, 2014
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