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Syok dapat diklasifikasikan menjadi 4 macam, yaitu:

1) Syok hipovolemik

Syok hipovolemik disebabkan oleh volume darah yang rendah (SV turun) yang

disebabkan oleh perdarahan atau dehidrasi

2) Syok kardiogenik

Syok kardiogenik disebabkan oleh penurunan kontraktilitas jantung (SV turun), yang

biasanya disebabkan oleh infark miokardium (MI) masif

3) Syok distributif

Syok distributive disebabkan oleh hilangnya tonus arteri yang normal (PVR turun)

sehingga darah tidak dapat terdistribusi ke seluruh tubuh (misalnya, sepsis, anafilaksis,

transeksi medulla spinalis, overdosis obat, defisiensi endokrin)

4) Syok obstruktif

Syok obstruktif disebabkan oleh obstruksi sirkulasi sentral (SV turun; misalnya, embolus

paru masif, tamponade perikardium, pneumotoraks tegang, tension pneumothorax, atau

diseksi aorta thorakalis, yang menurunkan SV efektif di sebelah distal tempat diseksi)

Sumber : Bresler, JM. Manual Kedokteran Darurat. Ed. 6. Jakarta: EGC, 2006

Tatalaksana perdarahan internal :

Stabilkan kondisi pasien (ABC-nya distabilkan)

Setelah stabil, periksa dengan benar apakah terdapat perdarahan internal atau

tidak dengan melihat ada atau tidaknya tanda dan gejala dari adanya perdarahan

internal (lakukan juga CT scan untuk memastikan sekali lagi apakah terdapatperdarahan internal atau tidak)

Setelah mendapat kepastian adanya perdarahan internal, tindakan selanjutnya

adalah operasi. Operasi dilakukan segera atau tidak tergantung dari seberapa

parah perdarahan internal yang diderita korban atau pasien.

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Catatan buat Indri : ini kesimpulan yang ak dapat habis baca tentang tatalaksana

internal bleeding di emedicine. Kalo ada kesalahan bisa ditambahkan ini ak

sertakan copas dr webnya. Di bawah catatan ini ni ada tanda dan gejala kalo kena

internal bleeding. Alamat webnya juga udh ak sertakan dibawah maaf

ngerepotin ndri, tapi ini yang ak sampaikan di dk kmrn :)

Abdominal pain and/or swelling can be caused by Internal bleeding from trauma in

theliverorspleen.These symptoms get worse as the bleeding continues.

Light-headedness,dizziness,orfaintingcan result from any source of internal bleeding once

enough blood is lost.

A large area of deeply purpleskin(called ecchymosis) can result from bleeding into the skin and

soft tissues. Swelling, tightness, and pain in the leg can result from internal bleeding in the thigh. Most often,

this is caused by a fracture of the thighbone.

Headacheand loss of consciousness could be the result of Internal bleeding in thebrain.

Treatments for Internal Bleeding Due to Trauma

Internal bleeding damages the body both from the loss of blood and from the pressure the

misplaced blood puts on other organs and tissues. Treatment usually takes place in a hospital'semergency department.

Intravenous fluids and blood transfusions may be given to prevent or correct an unsafe drop

inblood pressure.

Imaging tests (usually anultrasound,CT scan,or both) can identify whether internal bleeding is

present. Doctors consider the amount of internal bleeding along with the injured person's blood

pressure and severity of injuries to decide on the best initial treatment -- surgery or observation.

When internal bleeding is slower or delayed, observation may be appropriate at first. Often,

internal bleeding from trauma stops on its own.

Ongoing or severe internal bleeding due to trauma requires surgery to correct the problem. When

internal bleeding is severe, emergency surgery may take place within minutes after arrival at the

hospital.

http://www.webmd.com/digestive-disorders/picture-of-the-liverhttp://www.webmd.com/digestive-disorders/picture-of-the-liverhttp://www.webmd.com/digestive-disorders/picture-of-the-liverhttp://www.webmd.com/digestive-disorders/picture-of-the-spleenhttp://www.webmd.com/digestive-disorders/picture-of-the-spleenhttp://www.webmd.com/digestive-disorders/picture-of-the-spleenhttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://www.webmd.com/migraines-headaches/default.htmhttp://www.webmd.com/migraines-headaches/default.htmhttp://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causeshttp://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causeshttp://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causeshttp://www.webmd.com/a-to-z-guides/what-is-an-ultrasoundhttp://www.webmd.com/a-to-z-guides/what-is-an-ultrasoundhttp://www.webmd.com/a-to-z-guides/what-is-an-ultrasoundhttp://www.webmd.com/a-to-z-guides/computed-tomography-ct-scan-of-the-bodyhttp://www.webmd.com/a-to-z-guides/computed-tomography-ct-scan-of-the-bodyhttp://www.webmd.com/a-to-z-guides/computed-tomography-ct-scan-of-the-bodyhttp://www.webmd.com/a-to-z-guides/computed-tomography-ct-scan-of-the-bodyhttp://www.webmd.com/a-to-z-guides/what-is-an-ultrasoundhttp://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causeshttp://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/migraines-headaches/default.htmhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/digestive-disorders/picture-of-the-spleenhttp://www.webmd.com/digestive-disorders/picture-of-the-liver

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The type of surgery used will depend on the location of the injury and bleeding:

Exploratory laparotomy: A surgeon makes a large incision in the skin of theabdomenand

carefully explores the abdomen. The surgeon will seal the ends of any leaking blood vessels with

a heat probe or suture material.

Thoracotomy: For bleeding around the heart or lungs, a surgeon makes an incision along the rib

cage or the breastbone. Gaining access to the chest, the surgeon can identify and stop the

bleeding and protect the heart and lungs from pressure caused by excess blood.

Craniotomy: For bleeding due to traumatic brain injuries, a surgeon may create a hole in the

skull. This can relieve pressure and reducing further injury to the brain.

Fasciotomy: Internal bleeding into an area such as the thigh can create high pressure and prevent

blood flow to the rest of the leg. A surgeon can cut deeply into the thigh to relieve pressure andgain access to stop the bleeding.

Some people have additional risk factors for internal bleeding due to trauma. These include:

Use of "blood thinner"medications,such asclopidogrel(Plavix),warfarin(Coumadin), and

dabigatran (Pradaxa)

Severe liver disease orcirrhosis

Inherited conditions that interfere with blood clotting ability, such as von Willebrand's diseaseorhemophilia

People with internal bleeding due to trauma who have these risk factors may receive additional

treatments to help theirblood clotproperly.

Medical Treatment

Initial treatment of internal bleeding will include stabilizing the patient, meaning that the ABCs

of resuscitation take priority for the care provider.

A: Airway.Patients with altered or decreased mental status may not be awake enough to

breathe on their own.

http://www.webmd.com/digestive-disorders/picture-of-the-abdomenhttp://www.webmd.com/digestive-disorders/picture-of-the-abdomenhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/drugs/drug-5190-clopidogrel+oral.aspxhttp://www.webmd.com/drugs/drug-5190-clopidogrel+oral.aspxhttp://www.webmd.com/drugs/drug-5190-clopidogrel+oral.aspxhttp://www.webmd.com/drugs/drug-3949-Warfarin+Oral.aspx?drugid=3949&drugname=Warfarin+Oralhttp://www.webmd.com/drugs/drug-3949-Warfarin+Oral.aspx?drugid=3949&drugname=Warfarin+Oralhttp://www.webmd.com/drugs/drug-3949-Warfarin+Oral.aspx?drugid=3949&drugname=Warfarin+Oralhttp://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/a-to-z-guides/understanding-hemophilia-basicshttp://www.webmd.com/a-to-z-guides/understanding-hemophilia-basicshttp://www.webmd.com/a-to-z-guides/understanding-hemophilia-basicshttp://www.webmd.com/a-to-z-guides/blood-clotshttp://www.webmd.com/a-to-z-guides/blood-clotshttp://www.webmd.com/a-to-z-guides/blood-clotshttp://www.webmd.com/a-to-z-guides/blood-clotshttp://www.webmd.com/a-to-z-guides/understanding-hemophilia-basicshttp://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/drugs/drug-3949-Warfarin+Oral.aspx?drugid=3949&drugname=Warfarin+Oralhttp://www.webmd.com/drugs/drug-5190-clopidogrel+oral.aspxhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/digestive-disorders/picture-of-the-abdomen

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B: Breathing. Even if the airway is open, the lungs may not adequately be functioning and

may need assistive care to allow oxygen to be transferred from the lung to the bloodstream.

C: Circulation.The body requires blood to circulate to all its cells to provide oxygen and

nutrients and to remove waste products. Treatment is aimed to maintain blood pressure and

circulation. Often intravenous fluids only are required. Sometimes blood transfusion is

needed. A few patients will require immediate transfusions with universal donor blood (type

"O negative" blood).

Specific treatment for internal bleeding depends upon the source of the bleeding. The common

goal for treatment is to find the source of bleeding and stop it. At the same time, treatment will

be directed to repair or stabilize any damage that the bleeding caused.

Once the acute situation has resolved, treatment will try to correct the underlying cause of

bleeding to prevent future episodes.

Sumber:

http://www.emedicinehealth.com/internal_bleeding/page8_em.htm#medical_treatment

Darurat adalah suatu keadaan yang tidak terduga yang mana membutuhkan pertolongan segera

Sumber : KBBI

Tanda dan gejala fraktur tulang :

Riwayat trauma

Adanya nyeri lokal dan semakin bertambah dengan adanya gerakan

Hilangnya fungsi anggota gerak dan persendian yang terdekat

Terdapat perubahan bentuk (deformitas)

Adanya nyeri tekan, nyeri ketok, atau nyeri sumbu

Gerakan abnormal

Pemeriksaan keadaan neurovascular di bagian distal dan garis fraktur

http://www.emedicinehealth.com/internal_bleeding/page8_em.htm#medical_treatmenthttp://www.emedicinehealth.com/internal_bleeding/page8_em.htm#medical_treatmenthttp://www.emedicinehealth.com/internal_bleeding/page8_em.htm#medical_treatment

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Stadium shock :

Stadium Plasma yang hilang Gejala

Presyok (compensated) 10-15% 750 mL Pusing, takikardia ringan

sistolik 90-100 mmHg

Ringan (compensated) 20-25% 1000-1200 mL Gelisah, keringat dingin, haus,

diuresis berkurang, takikardia

> 100/menit sistolik 80-90

mmHg

Sedang (reversibel) 30-35% 1500-1750 mL Gelisah, pucat, dingin, oliguri

takikardia > 100/menit sistolik

70-80 mmHg

Berat (ireversibel) 35-50% 1750-2250 mL Pucat, sianotik, dingin,

takipnea, anuria, kolaps

pembuluh darah, takikardia/

tidak teraba lagi sistolik 0-40

mmHg

Sumber buat stadium syok dan tanda dan gejala fraktur : Purwadianto, Agus, Sampurna,Budi. Kedaruratan Medik. Edisi revisi. BINARUPA AKSARA Publisher : Tangerang,

2013 (maaf kalo salah, soalnya ak lupa cara buat dapus -,-)