MEKANISME SHOCK

Stages of Shock
A progressive process: Intervene early
Compensated Shock: Cardiac output
(HR x SV) and systemic vascular resistance (peripheral
vasoconstriction) work to keep BP within normal.
On exam: Tachycardia; decreased pulses & cool extremities in
cold shock; flushing and bounding pulses in warm shock;
oliguria; labs may show mild lactic acidosis
Hypotensive (Uncompensated) Shock: Compensatory
mechanisms are overwhelmed.
On exam: As above, plus hypotension, altered mental status;
labs may show increased lactic acidosis
Generally quick progression to cardiac arrest.
Irreversible Shock: Irreversible organ damage, cardiac
arrest, death occur.
Classifications of Shock
Hypovolemic Shock
Decreased preload due to internal or external losses.
Distributive Shock
Decrease in SVR, with abnormal distribution of blood
flow functional hypovolemia, decreased preload.
Typically, CO.
Cardiogenic Shock
Pump failure. CO, systolic function.
Obstructive Shock
Outflow from left or right side of heart physically
obstructed.
Type of Shock Preload
(PCWP)

Cardiac
Output
Afterload
(SVR)

Tissue
Perfusion

Hypovolemic
Shock










Distributive
Shock

Or = or =






Cardiogenic
Shock










Obstructive
Shock








Syok Kardiogenik
Terjadi karena kegagalan sistim pompa jantung/
kontraktilitas miokard
Gangguan miokard terjadi karena :
- Myocardial depressant factor
- Kelainan metabolisme
- Insuffisiensi coroner blood flow
Sebab- sebab syok kardiogenik :
- gangguan irama jantung
- miokarditis
- asidemia, kel. elektrolit
- kel. Metabolik
- Congenital heart disease
Obstructive shock
Syok obstruktif terjadi akibat aliran darah dari
ventrikel mengalami hambatan secara
mekanik, diakibatkan oleh gangguan pengisian
pada ventrikel kanan maupun kiri yang dalam
keadaan berat bisa menyebabkan penurunan
Cardiaac Output. Hal ini biasa terjadi pada
obstruksi vena cava, emboli pulmonal,
pneumotoraks, gangguan pada pericardium
(misalnya : tamponade jantung) .
The Academic Pediatric Asossiation
The Open Pediatric Medicine Journal, 2013, 7,
(Suppl 1: M2) 2-9 1Division of Critical Care
Medicine, Cincinnati Childrens Hospital Medical
Center, USA. Department of Pediatrics, University
of Cincinnati College of Medicine, USA
SIGNA VITAE 2008; 3(1): 13 23. Pediatric Shock.
Istanbul
National Pediatric Nighttime Curriculum.Written
by Julia M. Gabhart, M.D. Lucile Packard
Childrens Hospital at Stanford.