Etiologi : Syok Kardiogenik Syok Obstrutif ( temponade perikardium, koartasio aorta, emboli paru, HT pulmoner primer ) Syok Oligemik / Hipovolumik Syok Distributif ( Septik, anafilaktik, neurogenik )
SYOK SEPTIK# SIRS /systemic inflamatory respon syndroma : ( 2 atau lebih ) Suhu > 38 C atau < 36 C Nadi > 90 x/mnt Respirasi > 20 x/mnt atau PaCO2 < 32 mm/Hg lekosit > 12000 / < 4000
# SEPSIS SIRS + sumber infeksi dan / penurunan kesadaran # SYOK SEPTIK sepsis + gangguan perfusi / hipotensi # Sepsis Syok septik GMO /MODS
Pathophysiology -Renal failure - Hepatic failure -Metabolic Systemic failure
Pathogenetic inflammatory Local Systemic response Cardiovascular -Respiratory
microorganism inflam. inflam. plus evidence insuficiency insuficiency- death Death
response response of inadequate organ -Gastrointestinal
perfusion failure - Immune system failure - Central
nervous system
failure - Hematologic failure
Clinical entity Local Sepsis Sepsis Septic infection syndrome shock Multiorgan
failure
# Penatalaksanaan : Suport respirasi, sirkulasi & hemodinamik Masukan kalori yg cukup Antibiotik : empiris / sesuai kultur Vasopressor Tx penyakit dasar Tx sumber infeksi
Principal Therapeutic Concepts
Infection
Toxines
Mediatores
SIRS septic shock MODS
AntibioticsNeutralisation :immunoglobulinesAntagonisation :TNF, interleukines
Elimination :hemofiltration
Supportive therapy
Definisi reaksi sestimik tipe segera yg dimediasi alergen + IgE terikat pd permukaan sel mast / basofil pelepasan mediator manifestasi klinik
Reaksi alergi :
# Tipe I alergen + IgE mast cell histamin + mediator inflamasi # Tipe II IgM / IgG hapten + komplemen reaksi sitotoksik # Tipe III alergen + Ab aktivasi komplemen + inflamasi # Tipe IV / tipe lambat limfosit pelepasan sitokin + mediator inflamasi
Manifestasi Klinik* Kulit urtikaria, angioedema, kemerahan kulit wajah, pruritus* Pernapasan takipnea, suara parau, edema laring, bronkospasme* Kardiovaskuler takikardi, hipotensi, angina, aritmia* Gastrointestinal disfagia, diare, mual, muntah
Penatalaksanaan
Epinefrin 1 : 1000 0,3 cc sc/im Hentikan penyebab sebisa mungkin Infus cairan kritaloid ( PZ/RL ) Dipenhidramin : 50 mg iv Oksigen : 3-5 L/mnt Kortikosteroid : dexa 5 mg / metilpred 125 mg
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