24th ASMIHA Coverage: Quick Response in Shock Diagnosis and Management
JAKARTA --- Shock, as a condition of emergency cardiovascular, became a topic highlighted in Workshop on Acute Cardiovascular Care. Shock is hypoperfusion resulting in cell oxygenation be inadequate. Shock is often synonymous with hypotension. Discussion Siska Suridanda Danny, MD the "Shock: Definition and Hemodynamic. Profile ", explains this assumption is not right, because hypoperfusion does not always lead to hypotension, even hypotension is a stage the end of the shock. In his presentation, she explained that the shock is detected clinically based on the signs hypoperfusion, ex cold hands and moist, vasoconstriction, oliguria (urine less than 0.5 ml / kg / h), and disorders of mental status. Hemodynamic profile show different traits each type of shock so important to determine the types, causes, and shock management.
Septic shock as the type most common (67% of cases), followed by shock hypovolemic and cardiogenic. Thanks to its effectiveness in showing various abnormalities in heart and hemodynamic profile, echocardiography can be the first-line noninvasive diagnostics approach for all type of shock. The ability to predict early and classifying shock appropriately is important predictor to the success of shock management.
It should be noted that the diagnosis and shock management should be done simultaneously. This was stated by Dafsah A. Juzar, MD in exposure of the material entitled "Management of Patients with Shock. " At the initial management of shock, hypoxemia and hypotension become the main focus. The management of hypoxemia is to keep the patient's airway, whereas for hypotension fluid resuscitation as much as 1-4 ml /kg (corresponding fluid volume assessment the amount of the patient's body fluids) and evaluated after 10 minutes. Resuscitation fluid is stopped when MAP≥65 mmHg, heart rate 60 -100 times / minute, urine ≥0,5 ml/kg /hour, ScvO2≥70%, SvO2≥60% or when fluid administration no longer provide improvement in cardiac output. Management initial shock patients with hypotension is epinephrine and dopamine, while administration of inotropic agents depends the results of the evaluation parameters hemodynamics.
Modified from Media Aesculapius by KM, Edited by Su