shock

Hemorrhagic shock and septic
Hemorrhagic shock
Classification of hemorrhagic shock
1. Lightweight, jka bleeding <20% blood vol
2. Medium, already arise oliguria and decreased organ perfusion to the liver, intestine and kidney
3. Weight, no palpable pulse and a decrease in consciousness

Pathophysiology of hemorrhagic shock

• On a mild decrease organ perfusion to reply durable against ischemia such as skin, normal arterial pH 
• Shock is a decline in organ perfusike yg pd ischemia lasting a short time, there was metabolic acidosis
• Shock weight, decreased perfusion to vital organs, there was a severe metabolic acidosis and acidosis respitarorik

Clinical symptoms of hemorrhagic shock

• Shock ringan.takikardi minimal, less hypotension, vasoconstriction edge light: skin cold, pale, wet. Urine normal / slightly berkurang.keluhan feel cold 
• Shock sedang.takikardi 100-120/m.hipotensi: 90-100 mmHg systolic, oliguria / anuria.keluhan has
• Shock berat.takikardi <120/m.hipotensi systolic <60 mmHg.Pucat once, anuria, agitation, decreased consciousness

Septic shock

• Stadium early, increased cardiac output, heart rate faster and mean arterial pressure menrun.Kemudian progressive journey with decreased cardiac output, marked with a decrease in central venous pressure 
• Pulmonary hypertension due to increased vascular resistance due to blockage of leucocytes in the pulmonary capillaries, marked with pulmonary failure, arterial pO2 down, hyperventilation, dispneu, cough, acidosis
• DIC because of damage to capillary endothelial

Clinical symptoms of septic shock

1. High fever> 38.9 C, often begins with chills, then the temperature dropped within a few hours
2. Tachycardia
3. Hypotension systolic <90 mmHg
4. Ptekia, leukocytosis or leukopenia who shifted to the left, thrombocytopenia
5. Hyperventilation with hypocapnia
6. Local symptoms such as abdominal tenderness, perirektal

Handling shock• Resuscitation of hemorrhagic shock

   1. Overcome tissue perfusion
   2. Lay on your back with legs elevated
   3. Exempt airway
   4. Give O2 5-10 l / m

Fluid resuscitation

1. Put abocath No. 16 G and take blood samples and pairs of central venous catheters
2. Give RL or Nacl physiological as much as 2-3 x blood which came out with a quick drop for 20-30 minutes
3. Maintain a central venous pressure 3-8 cmH2O
4. In severe hemorrhagic shock can diberika colloidal fluids such as dextran as much as 10-20 ml / kg

Giving medicines

• Sodium bicarbonate, when the arterial pH <7.2, is given with the formula base excess x BB x 1 / 3, half given iv bolus, the rest by infusion 
• vasoconstrictor, eg dopamine, are supplied liquid diberikanresusitasi
• Corticosteroids
• Antibiotics, high dose and combination eg clindamisin 600 mg/6jam and garamisin 2mg/kg bw / 8 hours
• Heparin in case of DIC

The success of shock therapy 
• Pressure CVP 3-8 cm H2O 
• Production of urine 0.5 ml / kg bw / hour 
• improved awareness• increased tissue perfusion 
• an increase in heart Rainfall> 3.5 L / m