Cara Menghitung Terapi Cairan Pada Pasien Shock

Summary

This video discusses the process of fluid resuscitation in shock patients, explaining how to calculate the appropriate fluid replacement based on shock severity. The speaker outlines shock's clinical definition, types, causes, symptoms, and diagnostic methods. Emphasis is placed on understanding dehydration and trauma-induced shock, as well as how to treat these conditions with oral hydration, intravenous fluids, and blood transfusions. The video also explains how to estimate body fluid needs based on body weight and how to address various shock levels through proper fluid management, including calculating fluid deficits and maintenance for different age groups and shock classifications.

Takeaways

• 😀 Shock is a clinical syndrome caused by the body's failure to meet its physiological needs, leading to organ damage and a drop in blood pressure, respiration rate, or dehydration.
• 😀 Shock can result from various causes such as trauma, hemorrhage, dehydration (e.g., from diarrhea or dengue), or organ failure due to conditions like kidney or heart disease.
• 😀 The body’s compensatory mechanisms in shock include increased heart rate, rapid breathing, and vasoconstriction, but severe cases may lead to organ failure.
• 😀 Dehydration, hemorrhagic shock, and fluid overload are common causes of shock, and understanding the underlying cause is crucial for effective treatment.
• 😀 For shock diagnosis, laboratory tests such as urinalysis, blood chemistry, kidney function tests, and electrolytes are essential in identifying the degree of damage and determining the appropriate interventions.
• 😀 Treatment for shock depends on its severity, with options ranging from oral hydration for mild dehydration to intravenous fluid therapy and blood transfusion for severe shock.
• 😀 The body's normal fluid volume is approximately 90 ml per kg of body weight for adults and 80 ml per kg for infants. This volume is used for estimating hydration needs during resuscitation.
• 😀 Fluid therapy can include crystalloids (e.g., saline) as a first-line treatment, followed by colloids (e.g., albumin or RBC) for more severe cases, particularly those with coagulopathy or significant blood loss.
• 😀 Shock classification involves four stages based on blood loss: Class 1 (15% loss), Class 2 (15-30%), Class 3 (30-40%), and Class 4 (greater than 40%), with each class requiring different fluid resuscitation strategies.
• 😀 In cases of severe shock (Class 4), rapid fluid resuscitation is critical, with the initial fluid volume calculated based on the percentage of blood loss and body weight. Continuous monitoring and adjustments are necessary.
• 😀 When managing dehydration, fluid replacement should be calculated by the degree of dehydration (e.g., 6-9% for mild cases) and distributed over the first 8 hours and the subsequent 16 hours to ensure proper hydration balance.

Q & A

What is shock and what are its causes?

Shock is a clinical syndrome resulting from the failure of the body to meet its essential needs. It can be caused by factors like high blood pressure, rapid breathing, significant blood loss, or severe dehydration. Trauma, accidents, bleeding (internal or external), and conditions like diarrhea, dehydration, or diseases such as dengue fever can also lead to shock.

What are the general symptoms of shock?

Common symptoms of shock include weakness, fatigue, dizziness, thirst, and a desire to drink frequently. There may also be signs of organ failure such as decreased urine output, low blood pressure, and changes in breathing patterns.

How is shock classified in terms of severity?

Shock is classified into different degrees based on severity, such as mild, moderate, and severe. In terms of fluid loss, there are four classes: Class 1 (up to 15% blood volume loss), Class 2 (15-30% blood volume loss), Class 3 (30-40% blood volume loss), and Class 4 (over 40% blood volume loss).

What are the main causes of dehydration-related shock?

Dehydration-related shock often occurs due to excessive fluid loss, such as from vomiting, diarrhea, or severe fluid loss in diseases like dengue. Dehydration causes a reduction in the blood volume, leading to shock.

How can shock be diagnosed?

Shock diagnosis includes evaluating the patient’s clinical symptoms, such as changes in urine output, blood pressure, and vital signs like heart rate and breathing rate. Laboratory tests such as blood chemistry, urinalysis, and electrolyte checks can also help confirm the diagnosis.

What are the initial management strategies for shock?

For initial management, it is crucial to stabilize the patient by restoring fluid balance. Mild dehydration may be managed orally, but severe cases may require intravenous fluids or blood transfusions. The type of shock will guide the choice of treatment.

How is fluid resuscitation calculated in shock cases?

Fluid resuscitation is calculated based on the patient’s weight and the degree of fluid loss. For example, for a child or adult, the fluid requirement is usually calculated as 40-50 mL per kg body weight for the first hour of resuscitation. Subsequent fluid management is adjusted based on the patient’s condition.

What types of fluids are used for shock resuscitation?

Initially, crystalloids are used for fluid resuscitation. If needed, colloids like albumin or red blood cells (RBCs) are introduced, especially in cases of significant blood loss or coagulopathy. Specific solutions like 3% saline can be used for more severe cases of shock.

What is the fluid requirement for a one-month-old child in shock?

For a one-month-old child weighing 4 kg, the fluid requirement can be estimated at 40-50 mL per kg body weight. For a mild dehydration scenario, the child might need 0.32 liters (320 mL) of fluid. This amount is divided into initial resuscitation and maintenance phases.

What steps are involved in fluid management during the first hours of shock treatment?

In the first hour, rapid fluid resuscitation is performed, typically at 20 mL per kg body weight per hour. Maintenance fluids are then calculated, considering the patient’s baseline fluid needs. For a child, this involves calculating fluid deficits and dividing the necessary volumes for the first 8-16 hours of care.