MANAGEMENT OF
SHOCK
HYPOVOLEMIC SHOCK
MANAGEMENT OF HYPOVOLEMIC SHOCK
PHYSICAL EXAMINATION
Leads to a diagnosis of injuries suffered that are related to therapy
PRIMARY SURVEY
A: It is the first priority in management to ensure that the respiratory tract is smooth B: Given additional oxygen to maintain oxygen saturation
C: control obvious bleeding
D: brief neurological examination determines the level of consciousness, eye movements, and pupil response
E: complete body examination
Addition
Gastric decompression is done by inserting a tube or tube through the mouth or nose into the stomach to remove the stomach contents
Insert a urinary catheter to assess hematuria and renal perfusion by monitoring urine production
Initial fluid therapy
Isotonic electrolyte solutions are used to replenish intravascular fluid in a short time and stabilize vascular volume by replacing subsequent fluid into the interstitial and
intracellular spaces.
The solution used is Ringer's lactate (first choice) or physiological NaCL (second choice) with an initial dose of 1 to 2 liters for adults and 20 ml/kg for children.
Evaluate
Recovering blood pressure and returning to normal is a positive sign indicating that perfusion has returned to normal
Normal urine production indicates adequate renal blood flow
CARDIOGENIC SHOCK
MANAGEMENT
● Fluid resuscitation to correct hypovolemia and hypotension, unless pulmonary edema is present
● Rapid initiation of pharmacologic therapy to maintain blood pressure and cardiac output
● Admission to an intensive care setting (e.g., cardiac catheterization room or ICU or critical care transport to a tertiary care center)
● Early and definitive restoration of coronary blood flow; Currently, this is standard therapy for patients with cardiogenic shock due to myocardial ischemia
● evaluate of electrolyte and acid base abnormalities (e.g. hypokalemia, hypomagnesemia, acidosis)
Pharmacological therapy
● Patients with MI or acute coronary syndrome are given aspirin and heparin
● Inotropic and/or vasopressor drug therapy may be necessary in patients with
inadequate tissue perfusion and adequate intravascular volume to maintain a mean arterial pressure (MAP) of 60 or 65 mm Hg.
● Diuretics are used to reduce plasma volume and peripheral edema
If the patient remains hypotensive despite moderate doses of dopamine, a direct vasoconstrictor can be administered, as follows:
● Norepinephrine is initiated at a dose of 0.5 mcg/kg/minute and titrated to maintain a MAP of 60 mm Hg
● The dose of norepinephrine can vary from 0.05-0.5 mcg/kg/minute
● Doses as high as 3.3 mcg/kg/min have been used
Reference
Saputra, D. N., Rahman, A. and Sutanto, B. (2021) ‘Tatalaksana syok hipovolemik pada
perdarahan intraabdominal’, Proceeding Book National Symposium and Workshop Continuing Medical, pp. 1–18. Available at: https://publikasiilmiah.ums.ac.id/xmlui/handle/11617/12785.
SIDHI LAKSONO and Besmaya, B. M. B. (2022) ‘Manajemen Syok Kardiogenik: Suatu Panduan Singkat’, Hang Tuah Medical Journal, 20(1), pp. 107–121. doi: 10.30649/htmj.v20i1.334.
Tafwid, M. I. (2015) ‘Tatalaksana Syok Hipovolemik Et Causa Suspek Intra Abdominal Hemorrhagic Post Sectio Caesaria’, Jurnal Agromed Unila, 2(3), pp. 203–210.
