Post on 16-Feb-2021
Penanganan Awal Cedera OtakDr. Tedy Apriawan, SpBS (K)11 Desember 2020
DEATHS FROM TRAUMA(Trimodal Distribution, Reinfurt et al., 1978, Trunkey, 1993)
Immediate/Instant (very early) Death
• Instant death
• Severe CNS damage.
• Cardiac Damage &
Severe vascular
damage
Early Death
• < 4 hours
• (EDH, SDH, ICH)
• “Golden Period”
Late Death
• Day - Week
• Septicemia, MODS,
Secondary Brain
Injury.
RAPID TRANSPORT FOR THE PATIENT
“TIME”
The Important To Do…..
CLINICAL SYMPTOMPS (RAISED INTRACRANIAL PRESSURE)
SUBJECTIVE :
1. Cefalgia
2. Vomitting
3. Seizure
4. Decreased
concioussnes
OBJECTIVE :
1. Cushing response
• Hipertension
• Bradicardia
• Irreguler
respiratory rate
2. Kelumpuhan
N.cranialis
3. Increased ICP
Monitoring
PRIMARY SURVEY
SECONDARY SURVEY
Airway
Breathing
Circulation
Disability
Exposure
PRIMARY SURVEY
+
C-Spine Control
Airway
Cek patensi airway, head tilt, chin lift, jaw trust, mayo
Breathing
O2 masker, cek gerakan dada (simetris, flail chest, jejas, frekuensi napas)
Circulation
Nadi, Tekanan darah , Akral, Capillary Reffil Time
AIRWAY, BREATHING
CIRCULATION
EYE
4 Alert3 Open withcommand2 Open with pain1 Not opening
VERBAL
5 Oriented4 Disoriented3 Words2 Sound1 no verbal
MOTORIC
6 Obey command5 Localize pain4 Withdrawal3 Flexion posturing2 Extension posturing1 No motor respon
TINGKAT KESADARANMENILAI GCS SETELAH ABC STABIL
DISABILITY
EXPOSURE
• Jejas
• Vull Appertum
• Excoriasi
• Fraktur extremitas
SECONDARY SURVEY
1. Head : Inspeksi cranium• Fraktur basis cranii (racoon’s eye, battle sign, CSF rhinorrhea/otorrhea,hemotympanum/laserasi MAE)• Fraktur wajah (fraktur lefort, fraktur rima orbita)
2. Neck• Jejas, deformitas, nyeri tekan.
3. Thoraks• Gerakan dada (simetris/asimetris, see saw), jejas, open wound
4. Abdomen :• inspeksi (distended jejas, open wound)• palpasi : defans musculare, nyeri tekan)
5. Extremities• Jejas, fraktur, open wound
Head to Toe Examination
PEMERIKSAAN NEUROLOGIS(STATUS NEUROLOGIS)
(DISABILITY)
STATUS NEUROLOGIS
1. Meningeal sign & Tingkat kesadaran : GCS
2. N. Cranialis 2-3
3. N. Cranialis lain : N. 346, N. 5, N. 7, N.8, N.9, N. 10, N. 12.
4. Motorik
5. Sensorik
6. R. Fisiologis
7. R. Patologis
8. Autonomic Nevous System
9. Columna vertebralis
EYE
4 Alert3 Open withcommand2 Open with pain1 Not opening
VERBAL
5 Oriented4 Disoriented3 Words2 Sound1 no verbal
MOTORIC
6 Obey command5 Localize pain4 Withdrawal3 Flexion posturing2 Extension posturing1 No motor respon
TINGKAT KESADARANMENILAI GCS SETELAH ABC STABIL
Eye : X → Edema Palpebrae
Verbal : X → Tracheostomy
Motorik : X → Tetraplegi
SPECIAL CASES!!!!
Jumlah Total GCS Tertinggi : 15Jumlah Total GCS Terendah : 3
XXX = 3X = 3 → X = 3/3X = 1
GCS vs GCS-P
N Cranialis 1
• Nervus Olfactorius : Pembauan
• Gangguan Pembauan : Anosmia
Nervus 2-3
• Nervus 2 : Nervus opticus : Penglihatan (Visus)
• Nervus 3 : Nervus Occulomotorius : Gerakan pupil
• Fungsi Bersama N. 2-3 : Pupil Bulat Isokor/anisokor dan Reflek Cahaya
Nervus 3,4,6
Nervus 5
Nervus 7
Nervus 8
Nervus 9
Nervus 10
Nervus 11
Nervus 12
Motorik
bila sadar
cek kekuatan motorik, bandingkan kanan dan
kiri, atas dan bawah
bila tidak sadar
bandingkan responmotorik kanan dan kiri
Kekuatan motorikdengan penilaian 1-5
Motorik Keterangan
5 Melawan kuat pemeriksa
4 Melawan ringan pemeriksa
3 Melawan gravitasi
2 Bergerak kesamping
1 Kontraksi
Sensorik
bila sadar
cek sensoris, bandingkan kanan dan kiri, atas dan bawah
Refleks
1. Fisiologis
2. Patologis
BPR•+4, +3, +2, +1, 0
TPR•+4, +3, +2, +1, 0
KPR•+4, +3, +2, +1, 0
APR•+4, +3, +2, +1, 0
REFLEK FISIOLOGIS
•Babinski
•Chaddock
•Hoffman Tromner
•Dan lain lain
REFLEK PATOLOGIS
AUTONOMIC NERVOUS SYSTEM
• Pemeriksaan Rectal :
• TSA : Tonus Spincter Ani
• Bulbous Cavernosus Reflek
COLUMNA VERTEBRALIS
Jejas
Fraktur
Columna Vertebralis
TERIMA KASIH