HOW SHOCK INDEX HELPS THE ASSESSMENT OF HYPOVOLEMIC SHOCK : A SCOPING REVIEW

Shock is a life-threatening condition that can result in death. The need for fast and accurate treatment to identify the severity of shock patients. One of them is by using the Shock Index (SI). If not treated immediately, there will be a risk of death within 24-48 hours. Studies This made For see shock use Index as Predictor of Outcome for Hypovolemic Shock Patients in the Emergency Room. The method used in this study is the Scoping Review in a manner systematic based on PRISM. Determination say key article search use PICO, And say key Which used is shock index OR hypovolemic shock AND emergency department. The process of searching for articles was carried out in several databases, namely ProQuest, EBSCOhost


INTRODUCTION
Shock is a life-threatening condition that can result in death (Guo et al., 2017) .There are various cases of shock that occur in both trauma and non-traumatic cases, including hypovolemic shock, cardiogenic shock, obstructive shock and distributive shock (Standl et al., 2018).Hypovolemic state of shock is problem bad emergency the most second Which found in the ER And failure in managementa on patient shock hypovolemic has a negative effect, namely organ failure and death (Gitz Holler et al., 2019).
Case death Which caused shock consequence bleeding around 10% of the total deaths in the world (Demuro et al., 2013).Many cases of death occur in uncontrolled bleeding and diarrhea in children (Republic of Indonesia Ministry of Health Data and Information Center, 2019) .The death stems from the loss of a large amount of fluid or blood that occurs within 24 hours or so The first 48 hours since being admitted to the emergency room (Junaedi et al., 2016) .Height case death consequence shock in ER require power medical agar can rate and identify signs shock in a manner fast and accurate.One way that can be used is the use of non parameters invasive shock index (SI) (Koch et al., 2019).Shock index (SI) is mark which obtained from the calculation of heart rate (HR) shared with pressure systolic blood pressure (SBP) used to evaluate the hemodynamic stability of acute patients (Torabi, Mirafzal, et al., 2016) .SI can used for status monitoring dynamics patient so that can evaluate results clinical And predict patient mortality bad emergency, so that can help in management on right time while the patient is in the ER (Pomalango, 2016) .Research conducted by Torobi (2016) explains that S1 > 0.9 will cause death at <24 hours and 48 hours (Torabi, Moeinaddini, et al., 2016) .The benefits of SI in several studies are superior for evaluation level severity shock hypovolemic compared to with standard vital signs.Based on description on writer interested do review of the use of shock index (SI) as a predictor of outcome in hypovolemic shock patients in the Emergency Department.

METHODS
The method used in this literature review is scoping review.The process of developing a review focus and article search strategy, using the format PICO, that is Population (P) is patient with condition shock hypovolemic, Intervention (I) is measuring vital signs, namely the ratio between pulse and systolic blood pressure, Comparison (C), namely the shock index value is seen based on mark minimal, Outcomes (O) that is level mortality (ICU, die).
Based on say key This, writer formulate question the research that will be used in this scoping review is "how is the use of the shock index as a clinical prediction of hypovolemic shock patients in the Emergency Room?".Writer Then do search article on three databases namely ProQuest, EBSCO And PubMed from year 2012 until 2023 with using some predefined keywords in English."shock index ", OR, "shock hypovolemic ", AND, "emergency department".Phrase Booleans used during process search use keyword combination.Articles were selected according to predetermined inclusion criteria, and carried out systematically based on PRISMA.Relevant articles from the list of included literature references were also retrieved to obtain more comprehensive search results.Articles obtained from the search process are then filtered for eligibility use a number of criteria inclusion And exclusion.Criteria Inclusions were patients with hypovolemic shock (trauma, nontrauma, bleeding, diarrhea), patients without heart disease, patients aged 18-84 years, patients without underlying disease and never on take care in the ICU, have data signs vitals (Nadi, Pressure blood) on record medical, Pressure blood systole < 90 -100 mm Hg, and pulse > 100 x/minute.Authors use mendeley citation manager to collect and filter search results.Authors independently filter articles by title and abstract after removing duplicates.Full text articles were then screened for eligibility based on inclusion and exclusion criteria.Data analysis from this study was carried out using narrative synthesis.Where the author sees whole contents from every that article reviewed, then by specifically the author analyzes the results of the study and also the discussion of the article on the use of shock idex as a clinical predictor of hypovolemic shock patients in the installation bad Emergency.After That writer discuss matter the discussed.
Picture 1. Diagram Channel Search Literature

RESULTS
The number of articles that the author got from searching the database is 263 article, Where 122 article obtained from from databases ProQuest, 54 article from EBSCO and 87 articles from PubMed.Furthermore, the authors conducted a screening by looking at the suitability of the title and abstract of the article with the topic in this study , seeing if there were duplicate articles.From the screening process, 20 duplicate articles were obtained.And 169 article Which No in accordance so that writer find 74 article.Then the writer do screening back for read the whole contents of each selected article.In the end, the total number of articles that the author used in this study was 12 articles.

DISCUSSION
Shock is a clinical syndrome that occurs due to hemodynamic and metabolic disturbances characterized by failure of the circulatory system to maintain adequate perfusion to the organs of the human body (Fachrurrazi et al., 2022) .Shock is state of organs and peripheral tissues that experience perfusion and are categorized based on the etiology of each shock, namely hypovolemic, cardiogenic, obstructive And distributive (Kislitsina et al., 2018) .Shock can occur if the body's tissues cannot use oxygen properly and oxygen levels are insufficient.Clinical manifestations of shock include organ decompensation, changes in mental status, organ dysfunction, lactic acidosis, and decreased blood pressure (Pottecher et al., 2016) .
Hypovolemic shock is a condition of inadequate organ perfusion caused by loss of intravascular fluid volume in the form of blood and plasma fluids (Qi et al., 2020) .Hypovolemic shock is divided into four types, namely hemorrhagic shock (resulting from acute bleeding without soft tissue injury), traumatic hemorrhagic shock (resulting from acute bleeding with soft and deep tissue injury), traumatic hypovolemic shock (due to a critical reduction in circulating plasma volume without acute bleeding, due to soft tissue injury and release of mediators system immune), And Shock hypovolemic narrower sense (result from reduction critical in pliasma Which circulate volume without bleeding acute) (Standl et al., 2018) .
Pathogenesis, pathophysiology of hemorrhagic shock and traumatic hemorrhagic shock is bleeding.The difference lies in the degree of soft tissue damage.Clinically the most significant cause of hemorrhagic shock is bleeding I from injury isolated to vessels blood big, gastrointestinal bleeding, nontraumatic vascular rupture (eg, aortic aneurysm), obstetric hemorrhage (eg, uterine atony), and bleeding in the ear, nose, and throat area (vascular erosion) (Standl et al., 2018).A typical example of this type of shock is polytrauma, most commonly caused by traffic accidents and fall from height, Bleeding diffuse, hypothermia, And acidosis cause coagulopathy death (Al Aseri et al., 2020) Typical causes of traumatic hypovolemic shock are burns and chemical burns.Hypovolemic shock in a sense narrow and traumatic hypovolemic shock lost fluid Which significant without bleeding (Can et al., 2019) .Narrower sense hypovolemic shock , namely external or internal fluid loss coupled with inadequate fluid intake (Daş et al., 2020) .This can be caused by hyperthermia, vomit And diarrhea persistent (for example, cholera), or lost fluid due to uncompensated renal impairment (eg, diabetes insipidus, hyperosmolar diabetic coma) (Standl et al., 2018) Blood loss of more than 20% was reported as the only criterion for life-threatening conditions in acute hypovolemia (Can et al., 2019).Clinical manifestations of hypovolemic shock do not coexist in the patient's symptoms clinical seen clear If volume circulation reduce more from 15% (Gupta & Nature, 2021) .If Hypovolemic shock is not treated immediately, it can result in hypoxia, decreased consciousness due to reduced blood supply to the brain, irreversible tissue damage and death and ends in death (Kislitsina et al., 2018) .These four categories of hypovolemic shock are based on estimates of blood volume loss, vital signs (blood pressure, pulse, respiration), mental state, shock index (SI) and the appropriate Glasgow Coma Scale which can show the assessment of hypovolemic shock as in the ATLS classification (Frohlich, 2016).However, regular blood pressure and pulse checks are lacking effective in monitoring status hemodynamics patient.By Because it is necessary to modify this assessment, namely the use of SI (Shock Index), because SI is superior in predicting the severity of shock experienced by patients (Torabi, Mirafzal, et al., 2016) .
A new classification of hypovolemic shock based on the shock index (SI) was proposed in year 2013.classification four class shock And show correlation Which both with acidosis, need for blood products and death (Frohlich, 2016).The Shock Index (SI) is a ratio obtained by dividing the heart rate (HR) by the systolic blood pressure (SBP).This is used to determine changes in cardiovascular performance before the body experiences systemic hypotension (Kurt, 2021).Shock Index is known as hemodynamic stability.The shock index (SI) is used to assess the severity of hypovolemia (hypovolemic blood loss).And degrees shock hypovolemic) And level severity shock other (Frohlich, 2016) .SI is indicator classic Which more sensitive than sign vital traditional method for evaluating shock (Qi, 2020).An increase in the shock index (SI) indicates a decrease in left ventricular output and circulatory insufficiency which, if not treated promptly, will increase the patient's risk of death.An increased SI also reflects vascular and myocardial dysfunction related to the organ perfusion index which is reflected in the oxygen saturation tool and lactate concentration (Gupta & Alam, 2021) .Many studies explain the advantages of using SI in predicting mortality in trauma patients, pneumonia, ectopic pregnancy, pulmonary embolism and predicting prognosis in acute myocardial infarction (Tseng & Nugent, 2015) (Lie, 2021).The shock index has also been proven to be accurate in emergency obstetrics and gynecology.In a study of postpartum hemorrhage patients who lost 1500 mL of blood, score SI correlated with results study the that is : SI <0.9 convincing, and SI 1.7 requires immediate intervention (Aseri, 2020).SI is useful in predicting ICU requirements and in-hospital mortality in COVID-19 patients admitted to the emergency department (Kurt, 2021 Koch (2019) and Lie (2021) Research by Torobi (2016), Koch (2019) and Lie (2021) identified emergency department patients whose shock severity could be measured to predict mortality between other SBP (Systole Blood pressure) < 90 mm Hg, DBP ( Diastolic Blood Pressure ) < 60 mmHg, ages 18 -85 years, and Pulse > 100 x/minute.2021) explained that the shock index is used as an early detection of patients with hypovolemic shock SI score >0.9 is the most sensitive cutoff value for predicting critical bleeding in trauma patients.SI 0.8 increases the sensitivity to detect bleeding and the need for hemostatic intervention (Pottecher et al., 2016) .SI also predicts death in polytrauma patients, with an SI score of 0.9 predicting mortality.
In geriatric trauma patients, an SI score of 1 is related to level morbidity And the mortality higher geriatric (Al Aseri et al., 2020) .A high SI score has prognostic significance in cases of trauma and cardiovascular events such as acute myocardial infarction and stroke.A higher SI can also predict poor clinical outcomes from death, ICU, and disability (Myint, 2018).SI value is often used as an indicator of severity and poor prognosis on patient traumatized.Although SI is measurement non-invasive, This is an important measurement marker for the initial evaluation of hemodynamics and tissue perfusion (Myint et al., 2018).Although term shock index at first investigated in condition shock, has been studied as a prognostic tool in other critical illness conditions (Tseng & Nugent, 2015) .SI values are normal is between 0.5 And 0.7.Mark SI> 0.9 defined as predictor early shock hemorrhagic, mortality, And transfusion (Gitz Holler et al., 2019).SI Also has studied as predictor of hemodynamic instability, morbidity, and predictor of death (pneumonia, myocardial infarction, gastrointestinal bleeding.Patients with an SI higher than 1.3 over risky For treated in ICU And happening death (Kurt & Bahadirli, 2021)

CONCLUSIONS
The shock index (SI) serves as an assessment tool to identify high-risk patients and guide the medical team in providing management Which appropriate for patient.SI Also function for give prognostic information to patient and family.With use shock Index as detection early or screening beginning and monitoring can help identify level severity shock and level mortality on patient as well as help medic (nurse) in prepare What is will needed patient Accordingly, patients can be treated in the emergency room, ICU or in the treatment room, and the main focus is staff during 24 O'clock -48 O'clock For maintenance patient Which intensive, so that the patient does not fall into a more severe condition.Shock Index is recommended as a non-invasive parameter to detect the patient's hemodynamic status earlier and can be used in triage of patients in the Emergency Room.The need for more in-depth research and research methods by direct observation of shock patients in the Emergency Room using a shock index.

Potential conflict of Interest
The author says that there is no possible conflict of interest between writing this article and getting it published.

Table 5 Description shock Index as predictors outcome on patient emergency.
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