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Syok

I. Definisi :
Syok Suatu keadaan / syndrome gangguan perfusi jaringan yang menyeluruh sehingga tidak terpenuhinya kebutuhan metabolisme jaringan.
(Rupii, 2005)
 Keadaan kritis akibat kegagalan sistem sirkulasi dalam mencukupi nutrien dan oksigen baik dari segi pasokan & pemakaian untuk metabolisme selular jaringan tubuh sehingga terjadi defisiensi akut oksigen akut di tingkat sekuler.
(Tash Ervien S, 2005)

II. Klasifikasi Syock :
a. Syock kupoveolenik
b. Syock distributif (berubahnya tonusvaskuler akibat neurohormonal)
c. Syock kardiogenik (kegagalan pompa jantung)
d. Syock septik
e. Syock obsmertif (obstuksi persision dan jalan keluar jantung)

III. Stadium Syock
a. Kompensasi :
Komposisi tubuh dengan meningkatkan reflek syarpatis yaitu meningkatnya resistensi sistemik dimana hanya terjadi detruksi selektif pada organ penting. TD sistokis normal, dioshalik meningkat akibat resistensi arterial sistemik disamping TN terjadi peningkatan skresi vaseprsin dan aktivasi sistem RAA. menitestasi khusus talekicad, gaduh gelisah, kulit pucat, kapir retil > 2 dok.

b. Dekompensasi
Mekanisme komposisi mulai gagal, cadiac sulfat made kuat perfusi jaringan memburuk, terjadilah metabolisme anaerob. karena asam laktat menumpuk terjadilah asidisif yang bertambah berat dengan terbentuknya asan karbonat intrasel. Hal ini menghambat kontraklilitas jantung yang terlanjur pada mekanisme energi pompo Na+K di tingkat sel.
pada syock juga terjadi pelepasan histamin akibat adanya smesvar namun bila syock berlanjut akan memperburuk keadaan, dimana terjadi vasodilatasi disfori & peningkatan permeabilitas kapiler sehingga volumevenous retwn berkurang yang terjadi timbulnya depresi muocard.
Maniftrasi klinis : TD menurun, porfsi teriter buruk olyserci, asidosis, napus kusmail.

c. Irreversibel
Gogal kompersasi terlanjut dengan kuratian sel dan disfungsi sistem nultragon, cadangan ATP di keper dan jantung habis (sintesa baru 2 jam). terakhir kematian walausirkulasi dapat pulih manifestasi klinis : TD taktenkur, nadi tak teraba, kesadaran (koma), anuria.

IV. Penatalaksanaan Syock
Target utama, pengelolaan syock adalah mencukupi penyediaan oksigen oleh darah, untuk jantung (oksigen deliverip)
a. Obsigonasi adekuat, hindari hyroksemia.
Tujuan utama meningkatkan kandungan oksigen arteri (CaO2) dengan mempertahankan saturasi oksigen (SaO2) 98 – 100 % dengan cara :
1. Membebaskan jalan nafas.
2. Oksigenasi adekuat, pertahankan pada > 65 = 7 mmHg.
3. Kurangi rasa sakit & auxietas.

b. suport cadiovaskuler sistem.
1. Therapi cairan untuk meningkatkan preload
 pasang akses vaskuler secepatnya.
 resusitasi awal volume di berikan 10 – 30 ml/Kg BB cairan kastolord atau kalois secepatnya (<> 95 % ?
- responsitilasi
3. Ciculapis : - HR, kualitas nadi
- Perfusi kulit
- TD
- Praduksi urine
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