Escolar Documentos
Profissional Documentos
Cultura Documentos
SINONIM
trauma kapitis cedera kepala head injury trauma kranio serebral traumatic brain injury
Liquor Cerebrospinal
gangguan fungsi neurologis, fungsi fisik, kognitif, psikososial, temporer atau permanen.
Cedera yg terjadi
kulit kepala ; luka tulang tengkorak ; fraktur selaput otak ; robek pembuluh darah ; pecah jaringan otak ; rusak
Patofisiologi
Primary injury
at the moment of trauma :
skull fractures auditory/vestibular dysfunction intracranial hemorrhages contusion, concussions axonal injury disruption of the BBB cranial neuropathies
Skull fracture
vault fractures basilar fractures
Vault fractures
linear , extend into the sinuses.
closed, or open fractures. depressed or nondepressed a simple or a compound fracture
Depressed fractures
Penetrating injuries
Penetrating injuries
Auditory/vestibular dysfunction
Conductive hearing loss ;
tympanic perforation, hemotympanum, or ossicular disruption. Sensorineural hearing loss ; defect in the inner ear Benign paroxysmal positional vertigo
Intracranial hemorrhages
Epidural hematoma Subdural hematoma Intracerebral hemorrhages Intraventricular hemorrhage Subarachnoid hemorrhage
EPIDURAL HEMATOMA
Bleeding between skull and duramater Usually from an artery Bleeding is applies pressure to the brain Damage from pressure. Usually rapid onset of symptoms Lucid interval classic presentation Can complete recovery with no damage
Epidural hematoma
Epidural hematoma
Subdural hematoma
Subdural hematoma
Subdural hematoma
Intracerebral hemorrhages
Contrecoup contusions
located opposite the site of direct impact
Concussions
deformity of the deep structures, widespread neurologic dysfunction, impaired consciousness or coma,
Secondary injury
immediately, post primary injury
a period of hours or days
Cerebral ischaemia
formation of brain oedema, microvascular pathology, focal compression cerebral vasospasm impairment of autoregulation. systemic hypoxaemia systemic arterial hypotension.
Brain oedema
as cytotoxic or vasogenic the breakdown of ATPase pumps. the disruption of the BBB brain hyperaemia. impairment of autoregulation
inflammation
BBB disruption
Brain trauma
ischemia
ROS
Polyamines
Monro-Kellie doctrine
the total intracranial volume is fixed. The intracranial volume (V i/c) is equal to the sum of its components :
MONRO-KELLIE DOCTRINE
TBI
TTIK
Elevations in ICP
decreased CPP decreased CBF severe elevations
herniation
cerebral ischemia
FATAL
Brain herniation
Supratentorial herniation
Subfalcine herniation Transtentorial herniation Uncal herniation
Cerebellar herniation
Brain herniation
Hydrocephalus
communicating type
more common, presence of blood products in the subarachnoid space
noncommunicating type
caused by blood clot obstruction at the
Type of TBI
GCS
15
Klinis
Pingsan (-), defisit neurologi(-) Pingsan < 10 mnt,
CT Scan
Normal
Ringan
13 15
Normal
Berat
3-8
Abnormal
HEMATOMA EPIDURAL antara tab. interna - duramater hematom massif akibat a.meningea media atau sinus venosus
GEJALA KLINIK
lucid interval (+), pendek kesadaran makin menurun late hemiparese
pupil anisokor
babinsky (+)
fraktur os temporal
- Gangguan serebellum
- Pupil isokor
Lokasi
HEMATOMA SUBDURAL
- duramater - arakhnoid - bridging vein robek
Jenis
1. AKUT : Lucid interval : 0 - 5 hari
: > 3 bulan
Hematoma Intraserebral
perdarahan parenkhim otak
karena
pecah arteri intraserebral
PERDARAHAN SUBARAKHNOID
kaku kuduk
Concussion
komosio, mild TBI goncangan otak physiologic injury tak ada kelainan struktur temporarily perbaikan ; jam - minggu
Concussion
Grade
Grade I Grade II
Symptom
confused temporarily, no memory changes brief disorientation, anterograde amnesia < 5
Grade III
Grade IV Grade V
brief disorientation, anterograde amnesia < 5 retrograde amnesia, loss of consciousness < 5,
brief disorientation, anterograde amnesia < 5 retrograde amnesia, loss of consciousness 5-10 brief disorientation, anterograde amnesia < 5 retrograde amnesia, loss of consciousness > 10
Symptoms of PCS
Changes in ability to think, concentrate. Memory loss Headaches or blurry vision. Tinnitus, dizziness. Changes in sleep patterns, Changes in personality Lack of interest in usual activities. Changes in sex drive. Loss of sense of taste or smell. Vertigo, ataxia,
PENATALAKSANAAN
PENATALAKSANAAN
1. Survei Primer ;
menstabilkan kondisi pasien.
2. Survei Sekunder ;
pemeriksaan dan tindakan lanjutan
Survei Primer
A
B
=
=
C
D
=
=
Circulation (Sirkulasi)
Pemeriksaan Umum dan Neurologi
B = Breathing (Pernafasan)
Pastikan pernafasan adekuat. Perhatikan frekuensi, pola nafas, tipe nafas dan simetrisitas. Bila ada gangguan, cari penyebab, - sentral atau - perifer Bila perlu, berikan oksigen dg target saturasi O2 > 92%.
C = Circulation (Sirkulasi)
Pertahankan TD Sistolik > 90 mmHg.
Pasang sulur intravena. Berikan cairan iv ;
D = Pemeriksaan
Tanda Vital :
tekanan darah, nadi, nafas, suhu
Pemeriksaan neurologi
Survei Sekunder
E : Laboratorium
Darah Hb, Al, Trombosit, Ureum, Kreatinin, Gula darah, Analisa Gas Darah, Urine : perdarahan (+) / (-) Radiologi : - Ro kepala ; AP, Lat - CT sken kepala. - Foto lain :
Pemeriksaan
Pemeriksaan tanda vital Pemeriksaan luka, fraktur, dislokasi Otorrhea, Rhinorrhea PeriorbitalEcchymosis/RacoonEyes MastoidEcchymosis/BattlesSign
Motor response ( M )
Withdrawal movements to pain Flexor posturing to pain Extensor posturing to pain No response Oriented to person, place, date
5
4 3 2 1
Verbal response ( V )
Converses but is disoriented Says inappropriate words Says incomprehensible sounds No response
Jumlah
Pola pernafasan
Pola
Cheyne stoke CNH Apneustic breath Ataxic Hemisfer Mesencephalon - pons Pons Medulla oblongata
Lesi
Pemeriksaan Pupil
bentuk ukuran simetris reaksi
Pemeriksaan neurologi
1. Brainstem examination 2. Motor examination 3. Sensory examination 4. Reflex examination
Brainstem examination
pupillary examination ocular movement corneal reflex gag reflex
Pemeriksaan motorik
kekuatan otot lateralisasi tonus refleks tendon refleks patologis
Funduskopi
papil oedem
Gangguan otonom
miksi
defaekasi
ereksi
heart rate
hydrosis
Pemeriksaan Ro foto
- Ro foto kepala - Ro foto servikal - Ro foto lain
CT Sken Kepala
Gambaran Kontusio
Gambaran Edema Otak Gambaran Perdarahan Gambaran fraktur Midline shifting Hidrosefalus
F : Manajemen Terapi
1. Medikamentosa /simptomatis ; untuk perdarahan neuroprotektor untuk TTIK anti kejang penenang
2. Operasi
INDIKASI OPERASI
> 40 cc dg midline shifting, temporal / frontal / parietal, fungsi batang otak baik.
> 30 cc pada fossa posterior, hidrosefalus, penekanan batang otak, fungsi batang otak baik.
perdarahan progresif
edema/kontusio serebri,
midline shifting, fungsi batang otak baik
Indikasi lain
Fraktur impresi > 1 diploe.
Fraktur kranii dg laserasi serebri. Fraktur kranii terbuka Edema serebri berat dg TTIK
MANAGEMEN
DI RUANG RAWAT
Kritikal
Rawat di Unit Intensif Neurologi
(Neurological ICU)
Hindari !!!!
1. TD Sistolik < 90 mm Hg,
2. Suhu > 380Celcius,
Cegah TTIK
a. Posisi kepala 30 derajat.
b. Pemberian Manitol 20%. - dosis awal 1 gr / kg BB, guyur, - lanjutkan dg dosis - 0,5 gr / kg BB, guyur, (stlh 6 jam pemberian I), - 0,25 gr / kg BB, guyur, (stlh 12 jam pemberian I)
Komplikasi
kejang infeksi hidrosefalus stress ulcer demam
Terima kasih