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PEDIATRIC SHOCK

Pembimbing :
Dr. Pulung M. Silalahi Sp.A
RS POLRI Said Sukanto
Kramat Jati
2015

Defenition
Shock is emergency acute syndrome due to insufficiency
perfution in fulfilling the body needs .This caused by an
increase in needs metabolic (the need for oxygen) or decrease
in supply metabolic.
If the oxygen perfution to tissue continue to decline so
response of the
endocrine system, blood vessels ,
inflammatory , metabolism , cellular and systemic will appear
and resulting in the patient becomes unstable .
Shock is a progressive process, where when no body capable
of tolerate so it can result in damage irreversible on an organ
vital and can lead to death

Epidemilogy
The shock for children and adolescence about 2% in hospitals
in the united states. Where the death toll about 20-50% case .
Almost all patients are not died in phase hypotension but
because the result of one or more complications brought on by
the shock. Dysfunction multiple organ increase the risk of
death (one organ 25% death, two organs 60% death, three
organ or more 85%). The death toll was shocked to the decline
in proportion to the extent good education, where a
preliminary introduction shock and management good and fast
contributing more .

Classification

Hypovolemic shock
Hypovolemic shock happened due to lack of volume blood intravascular in
large quantities. This is a major cause child mortality in the united states
and throughout the world, although a causal agent Hypovolemic shock
may be different around the world.Children with acute diarrheal may have
lost 10-25 % of the volume of circulating them in 1-2 hours. Rehidrasi often
is hampered by vomiting usually occurred the same by diarrhea, and
decrease in the amount of intravasculer fluid on child usually occurring in a
short time

Sign and Symptom


o Anxiety, weakness, mental disorder, because the perfution to brain is low
o pale, cold extremity and moist
o Hipotention, decrease of circulation volume
o Fast but weak pulse, decrease of bloodflow
o oligouria, Vasoconstriction of arteri renalis
o Rapid and deep breath, stimulation of symphatic nerve and asidosis
o hypotermi, because hypoperfution
o thirsty and dry mouth, lack of fluid
o Weak and fatigue, inadequate oxygenation

Distributive Shock
Distributive shock is shock occurring due to lack of volume blood is
relatively , in the sense of the amount of blood in enough blood vessels but
happened dilatation of the veins and if volume blood in blood vessels
diminished ( hipovolemia relative ) even if a patient is just lost track of
bodily fluids . But, physiological disturbance common that affects DO2 in all
its forms shock distributive is a reduction preload that is the result of
volume

intravascular

vasodilation

effective

inadequate

as

result

of

massive

Distributive Shock
Divided by 3 form

Septic Shock : Caused by infection that causes vasodilation blood vessels.

Anaphylactic Shock : Because reaction to anfilaktic allergen, antigens ,


drug , foreign matter causing the release of histamine that causes
vasodilation.

Neurogenik Shock : caused by trauma to the medulla spinal cord , sudden


loss occurs in reflexes autonomous and motor under lesions .Without any
stimulation sympathetic , the walls of the veins vasodilation who are out of
control , the results the decline in resistance of peripheral blood vessels so
as to cause vasodilation and hypotension

Sign and Symptom


SEPTIC SHOCK

Anaphylactic Shock

Same sign as hypovolemic


shock but it start with

Skin Eruption

High fever or low body


temperature cause by the
bacteria

Local edema (especially on


face)

Vasodilatation and
escalating cardiac output

Fast pulse but weak


cough and short of breath

Neurogenic Shock
Same sign as hypovolemic
shock

Cardiogenic Shock
Decrease

of

heart

contractility

is

base

that

cause

cardiogenic

shock.Decrease of heart muscles contractility will resulting decrease stroke


volume (SV) dan cardiac output (CO),which DO2.
Etiology

Congestive heart failure

Ischemic heart disease

Congenital heart disease

Myocarditis

Cardiomyopathi

Heart tamponade

Cardiogenic Shock

Obstructive Shock
Terdapat penyumbatan pada jantung (penyakit jantung obstruktif)
yang menyebabkan aliran darah terganggu, pada beberapa
kondisi hal ini bisa menyebabkan timbulnya syok.
Contoh syok obtruktif
Cardiac tamponade
Tension pneumothoraks
Pulmo massive emboli
Stenosis aorta
Tanda dan gejala sama dengan syok hipovolemik tapi ditambah
dengan peningkatan JVP

Monitoring
The monitoring conducted by in shock covering monitoring hemodynamics
respiration and metabolic. Do monitoring against:
1) Conciusness
2) Respiratory rate and type of breath
3) Cardiovascular parametric :
Body temp and skin
Pulse and pulse volume
Blood Pressure
Capillary refill time
Central venous pressure
4) Urine productionnormal in adult 0,5 cc/kg/hour , child1-2 cc/kg/hour
5) Oxymetrix pulse Oxygenation of tissue set by perfution, the hb and
saturation oxygen that could be monitors with oxymetric pulse, used routinely
to judge shock.

Treatment
1. General treatment
Patient should be kept in cold
Raising foot end of the patient bed by 6 to 12 inch
2. Airway and breathing
Clear the Airway and give 100% of oxygen to relieve the
hypoxia
3. Cardiac output and Blood Volume at the circulation
Vasoactive drugs
Resucitation

Treatment
1. pertahankan jalan nafas berikan oksigen ( FIO2 100%) bila perberikan
tunjangan ventilator
2. Pasang akses vaskular secepatnya ( 60-90 detik), berikan cairan
cristaloid 20ml/kgbb dalam waktu 10 menit
d

In shock hipovolemik any cause, resuscitation a liquid started with a liquid crystalloids ( rl
or salt physiological ) as many as 20 ml per kilogram for from ten minutes.If not look
improvement and alleged still happens hipovolemia is given similar liquid as many as 20 ml
per kilogram and patients evaluated back.
In shock septic , resuscitation liquid useful to restore volume intravaskular .A kind of liquid
still konroversial , a liquid crystalloids can cause pulmonary edema resulting from
decreased pressure onkotik intravaskular and heavier leak capillary .While liquid colloidal ,
although it can maintain pressure onkotik will eventually seeping into the resulting from the
loss of integrity interstitial vascular .Resuscitation in shock septic need a combination of
liquid crystalloids and colloid to restore perfusi that adekuat .
In shock distributive, the provision of liquid crystalloids rapid has been proven save a life.

Vasoactive drug

There are several a drug


that can used a supporting
in
handling
shock
if
resuscitation a liquid not
enough to stabilize system
cardiovascular

Ada beberapa obat yang dapat digunakan mendukung


dalam menangani kejutan jika resusitasi cairan tidak
cukup untuk menstabilkan sistem kardiovaskular