ppt septic shock.pptx

8/19/2019 ppt SEPTIC SHOCK.pptx

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SEPTIC SHOCK

Ajung Dias P Tarbiyah Catur Sugiarti 105070106111011

PEMBIMBING:r! "r# y$ S%EM


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SHOCK

Distributif

Sh&'( is #)n# as a stat#&* '#++u+ar an tissu#

hy%&,ia u# t& r# u'#&,yg#n #+i-#ry an .&r

in'r#as# &,yg#n'&nsu/%ti&n &r

ina # uat# &,yg#nuti+i ati&n!


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EPIDEMIOLOGI• In'i #n'# an /&rta+ity

– Eur&%# : 50230.100!000 40 – SA : 0.100!000 87 – In In &n#sia$ /&rta+ity 'aus# by

s#%sis sti++ -#ry high i!# 50270an i* s#%ti' sh&'( an /u+ti%+#&rgan ys*un'ti&n &''ur$/&rta+ity b#'&/# 0

9ubis M$ E-a+ina $ Irsa 9! Ma(a+ah +#ng(a% si/%&siu/ %# iatri ga;at arurat


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TerminologySyst#/i' In a//at&ry #s%&ns# Syn r&/#

SI S T#/% 8 &r 86@ 30

=0 &r PaCF= 8=BC 1= &r 4

S#%sisC&n)r/# in*#'ti&n an at +#ast t;& SI S 'rit#ria

S#-#r# S#%sisS#%sis an &rgan ys*un'ti&n as #-i #n'# by art#ria+hy%&,#/ia$ +a'ti' a'i &sis$ &+iguria$ a+t#r# /#nta+ status$ ans& &n

S#%ti' Sh&'(S#%sis an hy%&t#nsi&n r#*ra't&ry t& ui r#sus'itati&n!

T F &ut &* *&ur'rit#ria

a'ut# 'hang# *r&/bas#+in#

Ear+y g&a+2 ir#'t# r#sus'itati&n &* %ati#nts ;ith s#%ti' sh&'(: 'urr#nt #-i #n'# an *utur#ir#'ti&nsa-i G! Gu%ta$ Sarah M! @artigan$ Mar(&s G! >ashi&uris$ Curtis N! S#ss+#r an G&n a+& M! 9!

B#ar/an


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ETIOLOGI

Austra+ian M& i)'ati&n &* ICD210 in'&r%&rating th# Austra+ian C+assi)'ati&n &* @#a+th Int#r-#nti&nsan th# Austra+ian C& ing Stan ar s! S#%sis Manag#/#nt! Nati&na+ C+ini'a+ Gui #+in# N&! 6 =014


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national Guidelines for Management of Se ere Sepsis and Septi! S"o!#$ %&'%


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P(THOGE)ESIS


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Management Prin!iple

Ear+y #'&gniti&n

S&ur'# C&ntr&+

Ear+y an A # uat# Antibi&ti' Th#ra%y


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Triag#

I//# iat#

1st @&ur

Scandinavian Journal of Trauma,Resuscitation and EmergencyMedicine =01=$ %&:41


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s Pati#ntua+i*y *&r EGDT

1st

= h&urs= h&urs

8 h&urs

426 h&urs

-#ry =0280 /in


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EGDT

Ear+yG&a+

Dir#'t#

Th#ra%y

&gniti&n an Manag#/#nt &* S#%sis in A u+ts: Th# "irst Si, @&urs Am Fam Physician. =018 ?u+ 1K 1 :44258!


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ManagementInitial *esu!itation

• "+ui 'ha++#ng#: =0280L''.(g &* n&r/a+ sa+in# &r+a'tat# ring#r s s&+uti&n &-#r 15 80 /inut#s

In %ati#nts ;ith #+#-at# +a'tat# +#-#+s targ#tingr#sus'itati&n t& n&r/a+i # +a'tat#

G&a+s uring th# )rst 6 hrs &* r#sus'itati&n:a C#ntra+ -#n&us %r#ssur# 1= // @gb M#an art#ria+ %r#ssur# MAP O 65 // @g' rin# &ut%ut O 0!5 /9.(g.hr

C#ntra+ -#n&us su%#ri&r -#na 'a-a &r /i,# -#n&us&,yg#n

b saturati&n 70 &r 65 $ r#s%#'ti-#+y gra # 1C !

tional Guidelines for Management of Se ere Sepsis and Septi! S"o!#$ %&'%


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Hemodynami! Support and(d+un!ti e T"erapy

"9 ID T@E APC STA9FID as th# initia+ ui &* 'h&i'#• Against th# us# &* hy r&,y#thy+ star'h#s *&r ui r#sus'itati&n

&* s#-#r# s#%sis an s#%ti' sh&'( gra # 1B !• A+bu/in in th# ui r#sus'itati&n &* s#-#r# s#%sis an s#%ti'

sh&'( ;h#n %ati#nts r# uir# substantia+ a/&unts &* 'rysta++&i sgra # =C !

• Initia+ ui 'ha++#ng# in %ati#nts ;ith s#%sis2in u'# tissu#hy%&%#r*usi&n ;ith sus%i'i&n &* hy%&-&+#/ia t& a'hi#-# a/ini/u/ &* 80 /9.(g &* 'rysta++&i s a %&rti&n &* this /ay b#a+bu/in # ui-a+#nt ! M&r# ra%i a /inistrati&n an gr#at#ra/&unts &* ui /ay b# n## # in s&/# %ati#nts gra # 1C !

ational Guidelines for Management of Se ere Sepsis and Septi! S"o!#$ %&'%


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INFT FPIC T@E AP• A tria+ &* &buta/in# in*usi&n u% t& =0

/'g.(g./in b# a /inist#r# &r a # t&-as&%r#ss&r i* in us# in th# %r#s#n'# &*

a /y&'ar ia+ ys*un'ti&n &r b &ng&ingsigns &* hy%&%#r*usi&n

• N&t using a strat#gy t& in'r#as# 'ar ia'in #, t& %r# #t#r/in# su%ran&r/a++#-#+s gra # 1B !



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ManagementDiagnosis

• Cu+tur#s as '+ini'a++y a%%r&%riat# b#*&r# anti/i'r&bia+th#ra%y i* n& signi)'ant #+ay 45 /ins in th# start &*anti/i'r&bia+ s

• s# &* th# 1$8 b#ta2D2g+u'an assay gra # =B $ /annan an anti2/annan antib& y assays gra # =C $ i* a-ai+ab+# an in-asi-#'an i iasis is in iQ#r#ntia+ iagn&sis &* 'aus# &* in*#'ti&n!

• I/aging stu i#s %#r*&r/# %r&/%t+y t& '&n)r/ a %&t#ntia+s&ur'# &* in*#'ti&n G !



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Management

(ntimi!robial T"erapy

• Anti/i'r&bia+ r#gi/#n sh&u+ b# r#ass#ss# ai+y *&r %&t#ntia+ #2#s'a+ati&n

• s# &* +&; %r&'a+'it&nin +#-#+s &r si/i+ar bi&/ar(#rs t& assist th#'+ini'ian in th# is'&ntinuati&n &* #/%iri' antibi&ti's in %ati#nts ;h&initia++y a%%#ar# s#%ti'$ but ha-# n& subs# u#nt #-i #n'# &* in*#'ti&n

• Pati#nts ;ith s#-#r# in*#'ti&ns ass&'iat# ;ith r#s%irat&ry *ai+ur# ans#%ti' sh&'(: #,t#n # s%#'tru/ b#ta2+a'ta/

• P. aeruginosa ba't#r#/ia : a/in&g+y'&si # &r a u&r& uin&+&n#!• Stre tococcus neumoniae in*#'ti&ns: b#ta2+a'ta/ an /a'r&+i #• E/%iri' '&/binati&n th#ra%y sh&u+ n&t b# a /inist#r# *&r /&r# than

825 ays 2 D##s'a+ati&n• Durati&n &* th#ra%y ty%i'a++y 7 10 ays

itia+ #/%iri' anti2in*#'ti-# th#ra%y &* &n# &r /&r# rugs

#rnati&na+ Gui #+in#s *&r Manag#/#nt &* S#-#r# S#%sis an S#%ti' Sh&'($ =01=


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Compli!ation• (!ute respiratory distress syndrome•

(!ute #idney in+ury• DIC• Chr&ni' r#na+ ys*un'ti&n• My&'ar ia+ is'h#/ia an ys*un'ti&n• 9i-#r *ai+ur#• Fth#r '&/%+i'ati&ns r#+at# t& %r&+&ng#

hy%&t#nsi&n an &rgan ys*un'ti&n

htt%:..#/# i'in#!/# s'a%#!'&/.arti'+#.16 40=2

ppt septic shock.pptx

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