Shock and the handling

Shock is a state of metabolic and hemodynamic disturbances are very heavy yan marked by the failure of the circulatory system to maintain adequate organ perfusion. This condition can be caused by a blood volume inadequate (hypovolaemic shock), inadequate cardiac function (cardiogenic shock) or inadequate vasomotor tone (neurogenic shock and septic).
Causes of shock include:
• The inability of the heart to pump enough blood to the organs.
• lost a lot of blood: So the amount of blood flow is not sufficient.
• dilatation (development) excessive blood vessels.
In a state of shock organs will be starved of oxygen. Organ oxygen deficiency will not give symptoms and signs as follows:
• Thirst
• Weak
• Dizziness spin
• Nervous, scared
• Pernapafasan rapid and shallow (the lungs)
• Rapid and weak Nadi (heart)
• Skin is pale, cold and damp (skin)
• Front looked pale and bluish on the lips, tongue and ear as well (skin).
• Pupil dilation / widening (eye).
• Nausea vomiting.
Based etiloginya the shock of some kind are classified as follows: Hypovolaemic Shock, Cardiogenic Shock, and Shock Distributive
Hypovolaemic shock
Definition
Hypovolaemic shock is the type most common shock characterized by decrease in intravascular volume. Body fluids contained in the intracellular and extracellular compartments. Intracellular fluid occupies nearly 2 / 3 of total body water and the extracellular body fluids found in one intavaskular and interstitial compartment. Interstitial fluid volume is approximately 3-4x of intravascular fluid. Hypovolaemic shock occurs when decline in volume intavaskuler 15% to 25%. This will describe the loss of 750 ml to 1300 ml in men with body weight 70 kg.
Aetiology
The conditions that put patients at risk of hypovolaemic shock are (1) loss of external fluids such as: trauma, surgery, vomiting, diarrhea, diuresis, (2) displacement of internal fluids such as: internal and hemoragi burns
Management
The main goal in dealing with hypovolaemic shock is (1) restore intravascular volume to reverse the order of events that do not lead to tissue perfusion is not adequate. (2) redistribute the volume of liquid, and (3) fix the underlying causes of fluid loss as soon as possible.
ü Treatment of underlying causes.
If the patient is experiencing hemoragi, attempts were made to stop the bleeding. Includes installation of pressure on the bleeding or may need surgery to stop internal bleeding.
ü Replacement Fluids and Blood
Installation of two intra-venous lines with large kjarum installed to make access to intra-venous fluids. Meaning allow for simultaneous fluid therapy and blood components if necessary.
For example: Ringer's lactate and 0.9% Sodium clorida, Colloid (albumin and dextran 6%).
ü redistribution of fluid
Giving the modified trendelenberg position by elevating the legs of patients, about 20 degrees, knees aligned, trunchus horizontal and head slightly raised. The goal, to increase the flow through the veins that are influenced by gayagravitasi.
ü medication therapy
Medication will be prescribed to overcome dehidarasi if the underlying cause is dehydration. For example, insulin will be given to patients with dehydration secondary to hyperglycemia, desmopresin (DDVP) for diabetes insipidus, anti-diarrhea preparations for diarrhea and anti-emetic to vomit.
ü Military syoc anti trousersn (MAST)
Pkain go round that is designed to correct internal bleeding and hypovolaemia by providing back pressure around the legs and abdomen. This tool creates artificial peripheral resistance and helps keep perfusion Coroner.
SYOK cardiogenic
Definition
Cardiogenic shock caused by the failure of heart pump function leading to cardiac output is reduced or stopped altogether.
Aetiology
Causes of cardiogenic shock has the aetiology of coronary and non coronary. Coronary, myocardium caused by infarction, while non-coronary cardiomyopathy caused by, valve damage, cardiac tamponade, and dysrhythmias.
Management
Destination management of patients with cardiogenic shock are:
1. Limiting further damage miocardium
2. Miocardium recuperate
3. Improving the ability of the heart to pump effectively.
The main management of cardiogenic shock include:
a. Additional supply of oxygen
In the early stages of shock, supplemental oxygen is given through a nasal cannula 3 to 5 Liter / min.
b. Controlling heartburn
If the patient menglami chest pain, morphine sulfate given intravenously to relieve the pain. Providing semi-Fowler position, can help to provide a comfortable position and improve lung expansion.
c. Provision of drugs vasoaktif
Vasoaktif drug therapy consisting of multiple pharmacological strategies to restore and maintain adequate cardiac output. In cardiogenic shock, coronary, diujukan drug therapy to improve cardiac contractility, reduced preload and afterload, or stabilize the heart frequency. For example, Dopamine and nitroglycerin.
d. Support a particular liquid
Giving fluids should be carefully monitored by nurses to detect signs of fluid excess. Bolus intravenous fluid that continues to be given diingkatkan with great care starts with the number of 50 ml to determine the optimal filling pressure to improve cardiac output.
SYOK distributive
Definition
Distributive shock or vasogenik occurs when abnormal blood volume in the move vaskulatur as blood in the peripheral blood vessels.
Aetiology
Distributive shock can be caused either by loss of sympathetic tone or by the release of chemical mediators into the cells. Kondosi-conditions that put patients at risk of distributive shock (1) neurogenic shock, such as spinal cord injury, spinal anesthesia, (2) shock sensitivity anafilaktik such as penicillin, transfusion reactions, bee sting allergy (3) septic shock such as immunosuppressive, age extremes of> 1 yr and> 65 years, malnutrition
Various mechanisms that lead to the beginning of shock vasodiltasi further distributive shock classification divides this into 3 types:
1. Shock Neorugenik
In neurogenic shock, vasodilatation occurs as a result of loss of sympathetic tone. This condition can be caused by spinal cord injury, spinal anesthesia, and damage to the nervous system. This shock can also occur as a result of work depressant drugs or the lack of glucose (eg, insulin reaction or shock). Spinal neurogenic shock is marked by dry skin, warm and not cold, damp as happened in hypovolaemic shock. Another sign is bradikardi.
Management:
- Neurogenic shock Specific treatment depends on the cause. If the cause Hypoglycemia (insulin shock) is giving quickly glucose.
- Neurogenic shock can be prevented in patients who mendapakan spinal or epidural anesthesia by elevating the head of the bed 15 to 20 degrees to prevent the spread of anastetik to the spinal cord.
- On Suspicion spinal cord, neurogenic shock can be prevented by immobilization of the patient carefully to prevent damage to the spinal cord further.
- Elastic stockings and elevate the foot of the bed can minimize the collection of blood in the legs. The collection of blood in lower limb placing patients at increased risk of thrombus formation.
- Provision of heparin, compression stockings and pneumatic compression of the legs can prevent the formation of thrombus.
2. Shock Anafilaktik
Anafilaktik shock caused by an allergic reaction when a patient who previously had formed an anti body against foreign substances (anti-gene) experienced a reaction of anti-gene antibody systemic.
Management:
- Provision of drugs that will restore vascular tone, and support emergency basic life functions. Example: epinephrine, aminophylline. Epinephrine given intravenously to vasokonstriktifnya effects menaptkan. Difenhidramin given intavena to fight the effects of histamine thus reducing the effects of capillary permeability. Aminophylline given intravenously to counteract histamine bronkospasme result.
- If there is a threat or has cardiac arrest and stopped breathing, is cardiac pulmonary resuscitation (CPR)
3. Septic shock
Septic shock is the most common form of shock caused by distributuf and widespread infection. Septic shock incidence can be reduced with infection control practice, doing a careful aseptic technique, perform debriden wound to remove necrotic tissue, maintenance and cleaning equipment properly and wash hands thoroughly
Aetiology
Microorganisms causing septic shock is gram-negative bacteria. When microorganisms attack the body's tissues, the patient will show an immune response. Generate an immune response is the activation of chemical mediators that have various effects that lead to shock. Increased capillary permeability, which engarah the permeation liquid from the capillary and vasodilatation are two such effects.
Management:
- The collection of specimens of urine, blood, sputum and wound drainage performed with aseptic technique.
- Giving high nutritional supplementation aggressively proteins made during the 4 days of awitan shock.
- Providing intravenous fluids and medications are prescribed, including antibiotics and drugs to restore vasoaktif vascular volume
First aid on the patient in shock






- Enable SPGDT (called an ambulance).
- Check the ABC, and if necessary to do artificial breathing and CPR
- Wlaupun person is able to breathe alone, keep check breathing every 5 minutes until help arrived
- If the person is conscious and has no injuries to the head, legs, neck or spine, place in a shock position of the person put in place a flat and moved out about 12 inches. Do not lift his head. And if her feet would cause membahyakan something, then let the person is lying on his back.
- Give appropriate first aid for the closure of the wound or injury.
- Keep warm and comfortable and loosen tight clothing.

The most important
- Do not give anything into the mouth of the victim, including eating and drinking
- Do not move the affected victims of spinal sedera
- Do not let the mild symptoms became worse until help has arrived.


by Mochamad Faisal Adam

http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm

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