Syok Hipovolemik

HYPOVOLEMIC SHOCK

Authors:

Mahda Rizki Iliana

Irfandy C.S Lubis

Supervisor:

dr. Yusmalinda,Sp.An

INTRODUCTION

Bleeding

Loss of fluid in the intravascular space

Failure compensation

Multiorgan failure

Hypovolemic shock

Frequent in indonesia Need to study

DISCUSSION

BASIC CONCEPT OF FLUIID AND ELECTROLYTE

Fluid is the most part of the human body and its percentage is depends on gender, age, and degree of obesity.

Age KgBW (%)

premature infants 80

3 months 70

6 months 60

1-2 years 59

11-16 years 58

Adults 58-60

Adult (obese) 40-50

Adult (thin) 70-75

Total Body Fluid Change by Age

BASIC CONCEPT OF FLUIID AND ELECTROLYTE

BASIC CONCEPT OF FLUIID AND ELECTROLYTE

Electrolytes are substances that dissociate in the liquid and conduct electricity.

Electrolytes

Cations Anions

Extracellular: Na

Intracellular: KExtracellular:

Cl & HCOIntracellular:

PO4

BODY FLUIDS MOVEMENTS

1. Osmosis The movement of molecules (solutes) through a semipermeable membrane (permeable elective) from the lower levels towards the higher levels of solutions.

2. DiffusionThe movement of molecules through pores.

3. Sodium potassium pumpPumps sodium ions out through the cell membrane and at the same time pumping potassium ions from outside to inside.

SODIUM POTASSIUM PUMP

VOLUME DEFICIT

VOLUME DEFICIT: DEHYDRATION

Dehydration Adults Child

Mild 4 4-5

Moderate 6 5-10

Severe 8 10-15

Shock 15-20 15-20

VOLUME DEFICIT: DEHYDRATION

HYPOVOLEMIC SHOCK: DEFINITION

Medical condition in which fluid loss occurs rapidly and ended in the failure of some organ functions due to inadequate circulating volume and result in inadequate perfusion.

HYPOVOLEMIC SHOCK: ETIOLOGY

The main cause is blood loss

Causes

Traumatic Non-traumatic

Penetrating Blunt Diabetes mellitus Renal insufficiency

Causes of Hypovolemic Shock

Loss of Blood Internally- rupture of vessels, spleen, liver, extrauterine pregnancyExternally- Trauma, gastrointestinal, pulmonary,renal blood loss

Loss of Plasma Burn Wound, gastrointestinal losses (diarrhea, ileus, pancreatitis)

Loss of Fluids and Electrolytes Gastrointestinal and renal losses (uncontrolled diabetes mellitus, adrenocortical insufficiency)

HYPOVOLEMIC SHOCK: ETIOLOGY

HYPOVOLEMIC SHOCK: PATHOPHYSIOLOGY

Acute bleeding

Hematology Cardiovascular Renal Neuroendocrine

Activates the coagulation cascade and vasoconstriction

Increased heart rate, myocardial contractility, and vasoconstriction.

Increased renin secretion

Increase antidiuretic hormone (ADH)

HYPOVOLEMIC SHOCK: PATHOPHYSIOLOGY

HYPOVOLEMIC SHOCK: CLINICAL MANIFESTATIONS

Class I Class II Class III Class IVBlood lossmL%

<750<15%

750-150015-30%

>1500-2000>30-40%

>2000> 40%

Heart Rate (beat/min)

<100 >100 >120 >140

Systolic blood pressure

Normal Normal Decreased Decreased

Pulse pressure Normal Decreased Decreased Decreased

Capillary refill time

Delayed Delayed Delayed Delayed

Respiratory rate/min

14-20 20-30 30-40 >35

Urine output (ml/h)

>30 20-30 5-15 <5

Mental Status Slightly anxious Anxious Confused Confused and lethargic

HYPOVOLEMIC SHOCK: MANAGEMENTS

1. Maximize oxygen delivery.2. Control further blood loss.3. Fluid resuscitation.

Indication for blood component therapy

Component indication Usual strating

dose

Packed RBC Replacement of

Oxygen-carrying

capacity

2-4 units IV

Platelets Thrombocytopenia

with bleeding

6-10 units IV

Fresh frozen plasma Coagulopaty 2-6 units IV

Crycoprecipitate Coagulopaty with

fibrinogen

10-20 units IV

HYPOVOLEMIC SHOCK: PROGNOSIS

Hypovolemic shock is a life-threatening condition and if not treated immediately, it can be irreversible. Prompt and adequate resuscitation is needed to save lives.

CONCLUSIONS

1. Shock hypovolemia is common circumstances that cause circulatory failure in children and adults.

2. The most common cause of hypovolemic shock is trauma.3. Management of hypovolemic shock aims to meet the needs of

circulation and tissue oxygenation.