it 8_syl initial evaluation of shock in children.pptx

8/20/2019 IT 8_SYL Initial Evaluation of Shock In Children.pptx

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Initial evaluation ofshock

in children

Silvia triratnaDivisi pediatri gawat daruratBagian Ilmu Kesehatan Anak FK UNSRI RSU!"oh #oesin !alem$ang

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Shock

• a d&namic and unsta$lepathoph&siologic state

• characteri'ed $& inade(uatetissue perfusion)

*


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• Inade(uate peripheral perfusionwhere o+&gen deliver& does notmeet meta$olic demand

Initiall&,the e-ects of inade(uateperfusion are reversi$le

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prolonged o+&gen deprivation

• generali'ed cellular h&po+ia

• disruption of critical $iochemical

processes

• cell mem$rane ion pump d&sfunction

• intracellular edema,• inade(uate regulation of intracellular p#,

• cell death)

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• Aggressive treatment within

the 0rst few hours afterpresentation ma& prevent theinvaria$le progression and poor ofshock

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2hildren can e-ectivel& compensatefor circulator& d&sfunction

• heart rate, ↑

• s&stemic vascular

resistance, ↗• and venous tone, ↗

maintainingnormal $lood

pressuresdespite

hypotension is avery late

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what should the cliniciando 44

• Although the cause of shockma& not $e initiall& apparent,

treatment must $eginimmediatel&

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• 6he clinician should $e a$le torecogni'e recogni'e children inshock earl& $efore the& develop

h&potension,

• when the& are more likel& to respondfavora$l& to treatment

• 6he K78 is79A:UA6I;N

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= 6he goals of the initial evaluationof shock in children include

• Immediate identi0cation of life?threatening conditions

• Rapid recognition of circulator&compromise

• 7arl& classi0cation of the t&pe andcause of shock

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A s&stematic approach to the evaluation of children with

evidence of poor perfusion

• Identi0es features of the histor&,• !h&sical e+amination,

• Ancillar& studies that suggest theetiolog& of the underl&ing condition

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Etiology

• Decreased intravascular

volume,• A$normal distri$ution of

intravascular volume• andor impairedcardiovascular function)

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2:ASSIFI2A6I;N

• is $ased on the ph&siologicmechanisms that result in decreasedtissue perfusion

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Shock

CardiogenicHypovolaemic

Anaphylactic Septic

Distributive

Neurogenic

Classification of Shock


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STAGES OF SHOCK

Compensated shock

Heart rate is initially increased. Ssigns of peripheral vasoconstriction s!ch as cool skin" decreased

peripheral p!lses" and olig!ria#

$ormal %lood press!e

&ecompensated shock '

Signs and symptoms of organ dysf!nction s!ch as altered mental

stat!s as the res!lt of poor (rain perf!sion# appear.

Systolic (lood press!re falls"

)rreversi(le shock ' &!ring this stage" progressive end*organ

dysf!nction leads to irreversi(le organ damage and death. The

process is often irreversi(le" despite res!scitative efforts

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S6A7S ;F S#;2K

2ompensated shock#eart rate is initiall& increased)

signs of peripheral vasoconstriction Csuch as cool skin, decreasedperipheral pulses, and oliguria

Normal Blood pressue

Decompensated shock =Signs and s&mptoms of organ d&sfunction Csuch as altered mental statusas the result of poor $rain perfusion appear)

S&stolic $lood pressure falls,

Irreversi$le shock =• progressive end?organ d&sfunction leads to irreversi$le organ damage

and death)

• 6he process is often irreversi$le, despite resuscitative e-orts

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2hildren with life?

threatening conditions,h&potension, andcompensated shock Ceg,

poor perfusion with a normal$lood pressure

should $e recogni'ed froman initial rapid assessment

of appearance, $reathing,


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18

MENENTUKAN

ANAK SAKIT GAWAT

PAT

"7:I#A6 K7ADAAN ANAK 7N7RA: ASS7SS"7N6

PENILAIAN ABCDE

INI6IA: ASS7SS"7N6


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P E N A M P I L A N

U P A Y A

N A F A S

SIRKULASI KULIT

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T = Tonus

I =Interactiveness

C = Consolability L = Look/Gaze S = Speech/Cry

Suara nafasabnormal

Posisi abnormal Retraksi apas cupin!

hi"un!

#ottle" Pucat Sianosi

s

SEITIA PENILAIAN PE!IATRIK CP$%I&TRIC &SS$SS#$T TRI&GL$ = P&T'


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A b

n o r m

a l

A p p e a r a n

c e

Poor Circulation to Skin

MEANS SHOC

N o r m a l

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• After completing the 6riangle,$egin a more complete

• pediatric primary survey (

A!"#A$

%"EA&H!N'

C!"C()A&!ON

D!SA%!)!&$

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**


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Respiratory Effects

• Remember that the cardiovascular and

respiratory systems ork to!ether"

• #achypnoea is one of the first si!ns that

reflects reduced blood flo and o$y!en

transport%

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2IR2U:A6I;N

• !oor perfusion can often $eidenti0ed rapidl&, $efore a $lood

pressure measurement is taken)• Features of circulation that should$e (uickl& evaluated i

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Eualit& of central and

peripheral pulses

Decreased intensit& of distal pulses

in comparison to central pulsessuggests peripheral vasoconstrictionand compensated shock)

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Skin temperature

• Skin ma& $e cool in children withcompensated shock, $ut this 0nding

can also $e inuenced $&environmental temperature)

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2apillar& re0ll

• 2apillar& re0ll greater than twoseconds suggests shock)

• Flash capillar& re0ll suggest septicshock

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#eart rate ?

• 6ach&cardia signs of compansated shock• A normal heart rate with signs of

compensated shock can occur

spinal cord inGur&)#&po+ia and$eta $lockers and calcium channel$lockers can cause $rad&cardia

• Brad&cardia can also $e an agonal eventfor patients with shock from an& cause)

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'1

"ir"#lation


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S$in Signs• Feel for

temperatureand

moisture

• 7stimate

capillar&re0ll)

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.1


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Blood pressure

• ? 2hildren with shock ma& havenormal $lood pressures)

• #&potension must $e rapidl&identi0ed, $ecause those with low$lood pressures t&picall& deterioraterapidl& to cardiovascular collapseand cardiopulmonar& arrest

• For children with normal s&stolic$lood pressures, the classi0cation of

shock ma& $e suggested $&.3


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• Narrow pulse pressure occurs when

diastolic $lood pressure is increasedas the result of a compensator&increase in s&stemic vascular

resistance Csuch as withh&povolemic and cardiogenicshock)

• idening of pulse pressure can $eseen when diastolic $lood pressureis decreased as the result ofdecreased s&stemic vascular

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&EANAN S!S&O)! M!N!MA)

%& ' ( ) * #+#r ,tah#n- .

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Nor+al /oo0 Press#re

1or "hil0renAge S&stolic B!

J *< da&F6

H 3

% J %* mo H 5

% J % & 5 * + age in &H % & H @

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6emperature

Fever Cor h&pothermia in&oung infants is often

consistent with septic shock)

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A

ALERT

V

RESPONS TO VOICE

P

RESPONS TO PAIN

U

UN RESPONSIVE

A V P U

CARA CEPAT ENILAI KESADARAN

/*


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"ANA7"7N6

• supportive care

• resuscitation,

• monitoring• septic shock $road spectrum

initial antimicro$ial therap&

• "eto$olic

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• !A:S septic shock algorithm

//

!A:S


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!A:Ssepti

cshoc

kalgorithm

/1


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TINDAKAN LANJUT

• MENERUSKAN RESUSITASI

• PEMERIKSAAN /PEMANTAUAN

LEBIH LANJUT

•

MERUJUK

PAT

ABCD

/3


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)ey *ssues *n Shock

• Reco!nise and treat early +durin! compensatory phase,*ncreased resp% rate-

Restlessness- Early

An$iety- signs of

Ar!umentative shock• .allin! /P 0 )ate sign of shock

• Pallor- tachycardia and slo capillary refill 0 Shock untilproven otherise

&allmark symptoms are

2ecreased /P

*ncreased &R


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it 8_syl initial evaluation of shock in children.pptx

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