are you ready to shock

7/25/2019 Are You Ready to SHOCK

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SHOCKOLEH :1. CHRISTIAN HANJOKAR (14710034)2. KIKI AMILIA BRILLIANITA (102011101011)

Pembimbing:

dr. H. Eddy Ario Koentjoro, Sp.S


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DEFINISI

Syok !"#$%k%& k!%'%%& '%"#"% y%&'*+!,%,k%& o-! k!%%-%& $!"/#+* '%"%k! %"*&%& +!*&% !&%k*,%k%&

%%& !%,o-*+! +!-.

O5ENDELI6ER

MITOKONDRIA

O5ENCOMSM8TIO

N (9)

METABOLISME SEL

ANAEROBICKERSAKANIRRE6ERSIBL

E

RES8ON


3/79

Syok '*'!&*+*k%& #% +!,%%* ;o-#!'%"% +*"k#-%+* *'%k %'!k#% y%&!"%&* $!"/#+* $!"%% $%'%

%"*&%& &o&;*%- (k#-* %"*&%& *k%#-%& oo) '%& k!#'*%& k! o"%&;*%- (o%k %& $%"#9 $%"# '%&*&%-). Syok %%# "!&%%& !"#$%k%&+#%# k!%'%%& $%o+*o-o*+ '*&%*ky%& !&%k*,%k%& *$ok+*% %"*&%&'%& +!-.


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KLASIFIKASI

Syok H*$o;o-!*k

Syok K%"'*o!&*k

Syok S!$*k

Syok N!#"o!&*k

Syok A&%-%k*k


5/79

SOK HI8O6OLEMIK

H*$o;o-!*% ,!"%"* ,!"k#"%&&y% ;o-#!'%"%. 8!&'%"%%& %'%-% $!&y!,%, $%-*&+!"*& '%"* +yok *$o;o-!*%. 8!&'%"%%&

%k%& !"#&k%& !k%&%& $!&*+*%&+*"k#-%+* '%& %k*,%&y% !"#&k%& %-*"%&,%-*k ;!&%


6/79

SOK KARDIO5ENIK

Syok k%"'*o!&*k '*+!,%,k%& k%"!&%'*+/#&+* '%"* *ok%"'*%- %%# %%-&y%

%& #k !&%-*"k%& '%"%. D%$%

!"%'* '%"* "%#% #$#- %&!$o&%'! %& !,o-* #'%"% %%#*&/%"k %k*,% "%#% y%& %%k %"%&!"%'*.


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SOK SE8TIK

Syok +!$*k %%# '#-#&y% '*k!&%- '!&%&>k!"%


8/79

SOK NERO5ENIK

Syok &!#"o!&*k '*+!,%,k%& k%"!&%*-%&&y% o+ ;%+ooo" +!


9/79

SOK ANAFILAKTIK

Syok %&%-%k*k %%& $!"/#+*%"*&%& %k*,% %'%&y% "!%k+* %&*!&%&*,o'* y%& !&!-#%"k%& *+%*&!

'!&%& %k*,% $!&*&k%%&$!"!%,*-*%+ !,"%& k%$*-!" '%&!"%'* '*-%%+* %"!"*o-% +!*&% ;!&o#+"!#"& !"#&.


10/79

H*+%*& *&* %k%& !&y!,%,k%&:

1. D*-%%+* 6!&% !&%k*,%k%&$!"#&%& %-*"%& ,%-*k ;!&% +!


11/79

ETIOLO5I


12/79

SOK HI8O6OLEMIK


13/79

SOK KARDIO5ENIK


14/79

SOK SE8TIK

Syok +!$*k !"%'* k%"!&% $!&y!,%"%&%%# *&;%+* k#%& '%& ok+*&&y%'*'%-% #,# y%& ,!"%k*,%

;%+o'*-%%+*.


15/79

SOK NERO5ENIK

Syok N!#"o!&*k !"%'* %%&$!"/#+* %"*&%& y%& '*+!,%,k& k%"!&%'*+/#&+* +*+! +%"%/ +*$%*+ +!*&%

!"%'* ;%+o'*-%%+*. M*+%-&y% : "%#%$%'% #-%& ,!-%k%& +$*&%- +yok%&%+!+* ## y%& '%-% %&%+!+*+$*&%- %%# k%"!&% k!"#+%k%& o%k.


16/79

SOK ANAFILAKTIK

Syok *&* '*+!,%,k%& o-! +#%# "!%k+*%&*!&9%&*,o'* '*%&% %+*- %k*"&y%%k%& !&%+*-k%& *+%*& %%# ,%%&

+!$!"* *+%*&. M*+%-&y%: "!%k+*"%&/#+* +!&%%& +!"%&% **%& #-%",!",*+%.


17/79

8ATOFIOLO5I


18/79

FASE SOK

FASE KOM8ENSASI

FASE 8RO5RESIF

FASEIRRE6ERSIBEL


19/79

SOK HI8O6OLEMIK

S!


20/79


21/79

8%'% /%+! %=%- +o


22/79

6%+oko&+"*k+* o"%& +!k#&'!" (;*+


23/79

A$%,*-% ok+*!& '* '%-% +!- +#'% !"#& '*,%=% **k k"**+ %k% k!"% *oko&'"*% '%&$!,!k%& +!&y%=% /o+/% !&!"+* *&* (AT8)%k%& !"#&. AT8 *&* '*$!"-#k%& #k $o$%

N%"*#.J*k% $o$% &%"*# *'%k ,!k!"% N%"*# y%&

%+#k k! '%-% +!- '%& '**k#* %*" *'%k '%$%'*'o"o& k!-#%" -%*. Ak*,%&y% +!- !&%-%*

!'!%. H%- *&* '**k#* !"%'*&y% %+*'o+*+ '* '%-%+!- '%& -*+*+ -*+o+o y%& !-%$*+* *'"o-%+!.H*'"o-%+! !&y!,%,k%& oo'*!+* +!- *# +!&'*"*.


24/79

5%%& ok+*!&%+* *ok%"' y%&,!"k!$%&%&%& !&y!,%,k%& +o


25/79

SOK KARDIO5ENIK

8%o+*o-o* y%& !&'%+%"* +yokk%"'*o!&*k %'%-% '!$"!+* ko&"%k*-*%+*ok%"' y%& !&%k*,%k%& -*&k%"%&

+!%& $!"#&%&


26/79

Syok k%"'*o!&*k '*%&'%* '!&%& %%&/#&+* ;!&"*k!- k*"* y%& !&%k*,%k%&%%& ,!"% $%'% $!"/#+* %"*&%& '%&$!&%&%"%& ok+*!& k! %"*&%&.

%& k%+ $%'% +yok k%"'*o!&*k o-! *&/%"k*ok%"'*# %k# %'%-% *-%&&y% 40 %%#-!,* %"*&%& oo $%'% ;!&"*k!- k*"*. S!-%*&

'%"* k!*-%&%& %+*/ %"*&%& oo ;!&"*k!-k*"* #% '*!#k%& '%!"%9'%!"% &!k"o+*+/ok%- '*+!-#"# ;!&"*k!-.


27/79

8!,#-# ko"o&!" y%& !"+!"%& #%*'%k %$# !&*&k%k%& %-*"%& '%"%+!


28/79

Ak*,%&y% !"%'*&y% %+*'o+*+ !%,o-*k'%& !"#&&y% $!"/#+* ko"o&!" y%&-!,* -% !&% /#&+* ;!&"*k!-

'%& !&y!,%,k%& !"%'*&y% %"**%.


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30/79

SOK SE8TIK

Syok $%'% $!&y%k* *&/!k+* '%$% !"%'* !-%-#*4. T!"%'*&y% k%+k%'! +!$+*+ *+%-&y% $%'% +!$+*+"% &!%*/.


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32/79

SOK NERO5ENIK

Syok &!#"o!&*k !"%'* %k*,%k!%%-%& $#+% ;%+ooo" k%"!&%*-%&&y% o+ $!,#-# '%"% +!


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H*-%&&y% o+ ;%+ooo" $!"#&%& ;!&o#+ o&!('*-%%+* ;!&%) $!$#k%& '%"% '* ;!&%

R!%k+* ;%+o;%%- ,!"-!,*%& ;%+o'*-%%+* !&y!-#"# '*"!*o +$-%&k&*k#+ $!"/#+* k! o%k ,!"k#"%&

R%&+%&%& $%"%+*$%*+ k! %& !$!"-%,%k!


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SOK ANAFILAKTIK

Coo, '%& 5!-- (13) %&%-%k+*+'*k!-o$okk%& '%-% *$!"+!&+**;*%+*$! 1 %%# Immediate type reaction.

M!k%&*+! %&%-%k+*+ !-%-#* ,!,!"%$%/%+! :

1. F%+! S!&+**+%+*

2. F%+! Ak*;%+*3. F%+! E/!ko"


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Antigen (allergen)

Antibodi IgE

Histamin, kinin, leukotrien,

prostaglandin

Permeabilitas kapiler Vasodilatasi perifer Konstriksi otot polos (spasme

bronkus, laring, dan kram

saluran cerna)

Ekstravasasi cairan

intravaskular

Edema

Taanan pembulu dara

perifer menurun

Hipovolemia relatif

Penurunan !ardiac "utput

Penurunan perfusi #aringan

$angguan metabolisme

seluler


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STADIM


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S%'*# 1. anticipation stage


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S%'*# 2.pre-shock slide

S%'*# 3 compensated


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S%'*# 3. compensatedshock


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S%'*# 4. decompensated shock,reversible


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S%'*# @. decompensated irreversibleshock


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DIA5NOSIS


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SOK HI8O6OLEMIK

D +yok *$o;o-!*k '*!%kk%& *k% '*!#k%&%&'% ,!"#$% k!*'%k+%,*-%& !o'*&%*k '%&'*!#k%& %'%&y% +#,!" $!"'%"%%&.

8%'% $%+*!& '!&%& k!#&k*&%& +yok %k*,%

*$o;o-!*k "*=%y% $!&y%k* $!&*& #k!&!k%& $!&y!,%, y%& #&k*& '%& #k$!&%&%&%& -%&+#&. Syok *$o;o-!*k %k*,%k!*-%&%& '%"% '%"* -#%" ,*%+%&y% &y%% '%&

#'% '*'*%&o+*+. 8!"'%"%%& '%-%k!#&k*&%& *'%k &y%% +!$!"* $%+*!& %&y%!&!-#k%& k!-!%%& -!%"* %%# $!"#,%%&+%#+ !&%-.


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8!!"*k+%%& L%,o"%o"*#

1. H, '%& H!%ok"*

2. "*&

3. A&%-*+% %+ '%"%

4. E-!ko-* S!"#

@. F%%- 5*&%-

. 8!!"*k+%%& R%'*o-o*


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Diferensial diagnosis

So-#+*o $-%+!&% K!%*-%& !ko$*k

A&!#"*+% %,'o*&%- 8!"'%"%%& $o+

$%"# A&!#"*+% o"%


47/79

SOK KARDIO5ENIK

Syok k%"'*o!&*k '%$% '*'*%&o+%'!&%& !&!%#* %'%&y% %&'%9%&'%+yok '%& '*#$%* %'%&y% $!&y%k*

%& +!$!"* *&/%"k *ok%"' y%&-#%+ %%& *"%% %& "%+% &y!"*'%!"% o"%k %%# %'%&y% !,o-* $%"#%$o&%'! %& k!-%*&%& k%#, %%#

+!k% %&.


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Diagnosis dapat ditegakkan sebagai berikut:

1. T!&+* #"#& : +*+o-*k 0 H %%# !"#& -!,*'%"* 3090 H '%"* +!#-% +!'%&k%& !k%&%&&%'* 30 H.

2. C#"% %& *&'!k+ %& 21 -*!"G!&*G2.3. T!k%&%& '* %"*# k%&%& (!k%&%& ;!&% +!&"%-)

,*%+%&y% *'%k #"#& &o"%- "!&'% +%$%*!&*&*.

4.

T!k%&%& '*%"*# k*"* (!k%&%& k%$*-!" ,%* $%"#)"!&'% +%$%* !&*&*.

@. R!+*+!&+* +*+!*+.

. A+*'o+*+.


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7. 8"o'#k+* #"*& k#"%& '%"* 20 -G%

. 5%%& !&%- !-*+% +o$o#"#+

. Ak"%- '*&*&

10. A"**% y%& +!"*#+ ,!"k#"%&&y%%-*"%& '%"% ko"o&!" !&*&k%&y%-%k% k%"'*%-.

11. M!&*&k%&y% %'"!&%-*& -#ko+% freefatty acid cortisol "!&&*& %&*o!&+*&$-%+% +!"% !"#&&y% k%'%" *&+#-*&$-%+%.


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8!!"*k+%%& :

1. S!"# !-!k"o-* /#&+* *&%- '%& /#&+* !$%".

2. J#-% +!- '%"% !"% -!#ko+* (*&/!k+*) "o,o+*(ko%#-o$%*)

3. E&* J%& (Creatinine Kinase "o$o&*&yo-o,*& LDH)

4. A&%-*+% %+ '%"% %"!"* '%$% !&%,%"k%&k!+!*,%&%& %+%9,%+% '%& k%'%" ok+*!&.

@. 8!!"*k+%%& +!"*%- k%'%" -%k% !&%,%"k%&*$o$!"/#+* '%& $"o&o+*+.

. 8!!"*k+%%& y%& %"#+ '*"!&


51/79

SOK SE8TIK

A&%&!+*+ : R*=%y% '!% *&* y%&,!"k!$%&%&%& +!"*& ,!"k!"*&% '%&!&**- !&*-%* /%ko" "!+*ko

!&'!"*% $!&y%k* !&%#&!&ko&+#+* %&*,*o*k %&k%$%&%& $!"&% !&'%$%k%& *&'%k%&!'*+G$!!,!'%%&.

8!!"*k+%%& F*+*k

8!&*&k%%& +## #,# %k"%- '*&*&!k%&%& '%"% #"#& 0 H '%&

'*+!"%* $!"#&%& k!+%'%"%&.


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8!!"*k+%%& :

1. DL

2. F%%- 5*&%-

3. A&%-*+% 5%+ D%"%

4. 8!!"*k+%%& EK5

. D*!"!&+*%- D*%&o+*+ :

S!#% $!&y%k* I&/!k+*


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SOK NERO5ENIK

A&%&!+*+ ,*%+%&y% !"'%$%


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Pemeriksaan penunjang yangdilakukan antara lain:

1. D%"% (H, H -!#ko+* o-o&%&

'%"%) k%'%" !-!k"o-* k%'%" #"!#k"!%*&*& -#ko+% '%"%.

2. A&%-*+% %+ '%"%

3. EK5


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SOK ANAFILAKTIK

A&%&!+*+

8%'% %&%&!+*+ '*'%$%k%& % $!&y!,%, %&%-%k+*+ (*&!k+* *o,% '*+!&% !=%& %k%& +!+#%# %%# +!!-% !+ k#-* ) *,#-,*'#"%& !&'%'%k %%- '*k#-* +#%"% $%"%# +!+%k +!k%"&%/%+-!%+ $#+*& #%-#&% +%k* $!"# +!!-% !"$%$%" +!+#%#.

8!!"*k+%%& +*k

1. K!%'%%& ## : ,%*k +%$%* ,#"#k

2. K!+%'%"%& :


56/79

8!!"*k+%%& 8!&%&

1. 8!!"*k+%%& DL

2. A&%-*+% %+ '%"%

3. 9 /oo4. EK5

. D*!"!&+*%- D*%&o+*+ : R!%k+* ;%+o;%%-IMA H*$o-*k!*k C%"+*&o*' Sy&'"o!C*&!+! R!+%#"%& Sy&'"o! A+%B"o&k*%- R*&**+ A-!"*k%


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58/79

TATALAKSANA


59/79

SOK HI8O6OLEMIK

T%%-%k+%&% #

A. 8!!"*k+%%& %+%&*

M!-*$#* $!&*-%*%& ABCDE +!"% "!+$o& $!&'!"*%!"%'%$ !"%$* y%k&* !-%-#* %&'%9%&'% ;*%-

$"o'#k+* #"*& '%& *&k% k!+%'%"%&.1. irway'%& !reathing

". #irk$lasi

%. &isability ' (emeriksaan )e$rologis

*. +xpos$re

. &ilatasi amb$ng ' &ekompresi

. (emasangan Kateter /rin


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!. kses (emb$l$h &arah

H%"#+ +!!"% '*'%$%k%& %k+!+ k!$!,#-# '%"%. 8%-*& ,%*k '!&%& 2

k%!!" *&"%;!&% #k#"%& ,!+%"+!,!-# '*$!"*,%&k%& %-#" ;!&%+!&"%-.

T!$% !",%*k %-#" *&"%;!&% o"%&'!=%+% %'%-% -!&%& ,%=%. B*-% *'%k!#&k*&k%& '*#&%k%& %k+!+$!,#-# +!&"%- %%# !-%k#k%&

;!&%+!k+*.


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J*k% k%!!" ;!&% !-% !"$%+%&'*%,*- '%"% #k crossmatch$!!"*k+%%& -%,o"%o"*# $!!"*k+%%&

ok+*ko-o* +!"% !+ k!%*-%& $%'%=%&*% +#,#" +!"% %&%-*+*+ %+ '%"%%"!"*.


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C. T!"%$* C%*"%& L%"#%& !-!k"o-* *+oo&*k '*#&%k%& +!,%%* !"%$*


63/79

E;%-#%+* R!+#+*%+* C%*"%& '%& 8!"/#+*O"%&

%. K!%'%%& #

,. 8"o'#k+* "*&


64/79

R!+$o& T!"%'%$ R!+#+*%+* C%*"%& A=%-

Respon Cepat Respon Sementara Tanpa Respon

Tanda vital Kembali ke normal Perbaikan sementara tek%

&ara dan nadi kemudian

kembali turun

Tetap abnormal

&ugaan Keilangan dara 'inimal (*+) -edang*masi ada (+*.) /erat (0.)

Kebutuan kristaloid -edikit /an1ak /an1ak

Kebutuan dara -edikit -edang*ban1ak /an1ak

Persiapan dara Type specific & crossmatch Type specific Emergency

"perasi 'ungkin -angat mungkin Hampir pasti

Keadiran dini ali beda Perlu Perlu Perlu


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T"%&+/#+* D%"%

T##%& #%% "%&+/#+* '%"% %'%-%!$!",%*k* k!%$#%& !&%&k#

ok+*!& '%"* ;o-#! '%"%. 8!,!"*%&'%"% #% !"%& "!+$o& $!&'!"*%!"%'%$ $!,!"*%&


66/79

SOK KARDIO5ENIK


67/79

SOK KARDIO5ENIK

T%%-%k+%&% '*#-%* '!&%& %&%!!& ABC.8%'% $%+*!& y%& +%&% +!+%k '%$%'*$!"*,%&k%& *,%+* '%& ;!&*-%+* !k%&*k.

8!,!"*%& ;%+o$"!+o" *&"%;!&% ,%*k #k

!&*&k%k%& *&o""o$*k '%& !%k+*%-k%&$!"/#+* k! *ok%"'*# y%& *+k!*k. %& $!"-#'*$!"%*k%& $!,!"*%& ;%+o$"!+o" *# +!&'*"*'%$% ,!"%k*,% $!&*&k%%& '!&y# %&

y%& $%'% %k*"&y% %k%& !$!"-#%+ *&/%"ky%& !-% !"%'*. S!*&% $!,!"*%&&y%%"#+ %*9%*.


68/79

B!,!"%$% ;%+o$"!+o" y%& '%$% '*,!"*k%& +!$!"*:

%. Do$%*& '!&%& 'o+*+ *&* !&%k*,%k%&$!&*&k%%& ko&+#+* ok+*!& *ok%"' 'o+*+y%& '*#&%k%& @910


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8"!$%"% &*"% %%# o"& '*#&%k%& #k%&%-!*k !%$* $!"-# '**&% ,%=% k!'#%&y%'%$% !&%k*,%k%& *$o!&+* +!*&% %&%&+%$%* !$!"$%"% k!%'%%& +yok $%+*!&

'!&%& $!,!"*%& $"!$%"% *&*. A&*%"!%+* "o,o+* +!$!"* %+$*"*& !"+!'*%

'%-% 1 32@ @00 '%$%!"#&k%& o"%-*%+ %k*,% *&/%"k *ok%"'.

6%+o'*-%o" y%& #% '%$% '*#&%k%& %'%-%&*"o-*+!"*& I6 y%& ,!k!"% '!&%&!"!-%k+%+*k%& oo $o-o+ $!,#-# '%"%+!*&% !"#&k%& "!+*+!&+* $!"*/!".

SOK SE8TIK


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SOK SE8TIK

8%'% SIRS (systemic in0ammation response syndrome '%&+!$+*+ ,*-% !"%'* +yok *&* k%"!&% ok+*& %%# !'*%o"$!&y!,%, ;%+o'*-%%+*.

8"*&+*$ #%% +!#% +yok !%$ ABC. 8!&o,%%& ,!"#$%"!+#+*%+*


71/79

SOK NERO5ENIK

Ko&+!$ '%+%" #k +yok '*+"*,#*/%'%-% '!&%& $!,!"*%& ;%+o%k*/+!$!"* /!&*-!/"*& '%& !/!'"*& #k

!"%&* '%!"% ;%+k#-!" '!&%&$!&y!$*%& +&!" $"!k%$*-!" '%&;!&% k%$%+*%& #k !&'o"o& k!-#%"'%"% y%& ,!"k#$#- '*!$%

!"+!,#.


72/79

B%"*&k%& $%+*!& '!&%& $o+*+* k!$%-%-!,* "!&'% '%"* k%k* ($o+*+*

T"!&'!-!&,#").

8!"%%&k%& %-%& &%/%+ '!&%&!,!"*k%& ok+*!& +!,%*k&y% '!&%&!&%k%& %+k!". 8%'% $%+*!&'!&%& '*+"!++ "!+$*"%+* '%& *$o!&+*

y%& ,!"% $!&%%& endotrachealt$be '%& ;!&*-%o" !k%&*k +%&%'*%"k%&.


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k k!+!*,%&%& !o'*&%*k+!,%*k&y% '*#&%& '!&%& "!+#+*%+*


74/79

SOK ANAFILAKTIK


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SOK ANAFILAKTIK

S!!"% ,%"*&k%& $!&'!"*% $%'% %-%+y%& k!"%+. K%k* '*%&k% -!,* *&*'%"* k!$%-% #k !&*&k%k%& %-*"%&

'%"% ,%-*k ;!&% '%-% #+%%!$!",%*k*


76/79

D%-% %- !"%'* +$%+! ,"o&k#+ '*%&% $!,!"*%& %'"!&%-*& k#"%&!,!"* "!+$o&+ %,%k%& A*&o-*&

@9 GkBB *; 'o+*+ %=%- '*!"#+k%&0490 GkBBG!&* '%-%


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B*-% !k%&%& '%"% !%$ "!&'% '*$!"-#k%&$!%+%&%& %-#" *&"%;!&% #k ko"!k+**$o;o-!*% %k*,% k!*-%&%&


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8"o&o+*+ +yok *$o;o-!*k !"%& '!"%%

k!*-%&%&

S!'%&k%& $%'% +yok +!$+*+ ,%*k %$%,*-%$!&%%-%k+%%& !o'*&%*k


79/79

are you ready to shock

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