Patofisiologi syok.pptx

7/26/2019 Patofisiologi syok.pptx

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Pathophyfsiologyo Shock

Emmy Pranggono

Internal Medicine

Padjadjaran University Hasan Sadikin Hospital

Bandung


2/22

Delivery O2 Requirement O2

hipoperfusion

cellular dysfuntion

production and release mediator

microvaculature changed


3/22

P!H"#E$ESIS $% "$&ESP"$SE

'Microcirculation

'(ellular responses

' $euroendocrine responses'(ardiovascular responses

' Pulmonary responses

'&enal responses'Meta)olic derangement

'In*ammatory &esponses


4/22

(lassifcation o shock

(+P ("P S+&

Hypovolemic

!raumatic

(ardiogenic

Septic

Hyperdynamic

Hypodynamic

$eurogenic


5/22

Etiology Sign

1. Cardiogenic Cardiology Pump failure

2. Hypovolumic Bleeding, Vomits,

diarrhea, polyuria

Turgor

3. istri!utive "eptic, anaphylactic,

adrenal crisis,

neurogenic

sign and symptom of

#nfection

$. %!structive cardiac temponade

tension pneumothora&

'assive pulmonaryem!olism

Pulsus parado&us

(systolic ) 1*

mmHg in inspiration+,

dyspneu, tachycardia


6/22

PH!"#E$ESIS and "$ &ESP"$SE

U!"&E#U-!I"$

("P S+& to maintain MP

sustaining )rain and coronaryperusion

.high meta)olic rates high/ lo0stores o energy1

e2pense o other tissue 3 skin/muscle/ #I!


7/22

M-%IS!&IBU!I"$ "6 B-""% 6-"7

HypotensionHypoperusion

8 MP 9 45 mmHg "rgandisungsi organ

or8 Systolic : ;5 mmHg 8

a0areness8 oliguria

8lactic acidosis


8/22

' %etermined )y luminal%IME!E&oarterioles

' rteriole smooth muscle= > adrenergic receptor 8

vasoconstriction

=

? adrenergic receptor 8vasodilatation

M"S! 6U$%ME$!- &ESP"$SE&educe Blood Pressure

e@erent symphatetic nerve 8 release


9/22

"ther vasoconstrictor su)stance'angiotensin II

'vasopressin

'endothelin'A

' throm)o2an ?

(irculating vasodilators during shock'prostacyclin .P#I>1

'nitric o2ide .$"1

' adenosine .meta)olic product1

Perusion

+asoconstrictor


10/22

!ransport to the cell

Microsirculary *o0

capillary permea)ility di@usion o "?/ ("?/nutrients/products ometa)olism

e2changes o the productacross cell mem)rane

(entral o pathophysiologicresponse o shock

derangement o cellular meta)olism


11/22

Mild and Moderate Hypovolumia

&estitution intravascular volume)y3A= rteriol vasoconstriction 8 hydrostatic pressure

C= (hanges in cellular meta)olicunction Dhyperglicemia

Dglycolysis

E2tracellular osmolarityDlypolisis

Dproteolysis

volume interstitiel


12/22

(E--U-& &ESP"$SES

Impaired transport o interstitialnutrient

Mitochondrial transmem)rane

dysunction potential

!P intracell $a and0ater anaero)ic

meta)olites

. lactate1 8 vasodilator (ells0elling


13/22

$EU&"E$%"(&I$E &ESP"$SES

H


14/22

NEUROENDOCRINE RESONSES

SE+E&E PI$SE+E&E S!&ESS

HypothalamusPancreatic

(!H 8 (ortisol #lucagon peripheral glucosa / gluconeogenesis

aminoacid uptakelipolysis/ gluconeogenesis

Blood glucose


15/22

(&%I"-"


16/22

PU-M"$&< &ESP"$SES

SH"(K

P+&!achypnea Pain

=

!+

&6( = +d/ +ttelectasis

= &esp alkalosis

Undernon ventilated alveoli/

interstalveoli edema


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&E$- &ESP"$SES

SH"(K and H


18/22

ME!B"-I( %E&$#EME$!

Hypo2ia 8 SH"K

L Hepatic gluconeogenesis

L -actate production L Hepatic lypolisis

L Protein cata)olism 8

= negative protein )alance= severe muscle 0asting

" S " S S


19/22

I$6-MM!"&< &ESP"$SES

'Proin*ammatory mediator (Ja/(a/ ('N

'ctivation o coagulation cascade

microvascular throm)osis

microvascular injury

' !hrom)o2ane C 8 potentvasoconstrictor

'Platelet'activating 6actor Pulmonary vasoconstrition/)ronchoconstriction

systemic vasodilation



20/22


drenergic discharge

&enin angiotensi I

angiotensi II.potent vasoconstrictor1

adrenal corte2 posterior

pituitary

aldosterone vasopressin

tu)ular rea)sorption $avasoconstriction

0ater rea)sor tion

Hi l i h k


21/22

Hipovolumic shock

Mild Moderate Severe

!"2#$ %lood vol& !2#'(#$& )(#$

Cool e*tremities Same+plus Same+plus,

Capillary re-ll time .achycardia/emodynamic

.achypneu insta0ility

Diaphoresis Oliguria 1ared

tachycCollaps vein ostural changes 1entalstatus

tederioration

3n*iety


22/22

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Patofisiologi syok.pptx

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