CEDERA KEPALA PRESENTASI
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Transcript of CEDERA KEPALA PRESENTASI
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CEDERA KEPALA :BEBERAPA ASPEK
PENTING
CEDERA KEPALA :BEBERAPA ASPEK
PENTING
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CEDERA KEPALA
TERJADI TIAP 15 DETIKMATI TIAP 12 MENIT
50 % KEMATIAN PADA TRAUMA60 % KEMATIAN AKIBAT KLL
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TATALAKSANA
AAAIRWAY & C-SPINE CONTROL
BBBREATHING
CCCIRCULATION
PRIMARY
SURVEY
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KONSEPNYA
RESPONSIBILITAS TERPENTING
MANAJEMEN ABC : CEGAHHIPOVENTILASI DAN HIPOVOLEMIA
POTENSIAL TERJADINYASECONDARY BRAIN DAMAGE
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SCALPSCALP
SKIN
CONNECTIVE TISSUE
APONEUROSIS/GALEA
LOOSE AREOLAR TISSUE
PERICRANIUM
vaskularisasi sangat baik, perdarahan hebat potensial menimbulkan syok
ANATOMI FISIOLOGICEDERA KEPALA
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SCALP
SKULL
MENINGES
BRAIN
LCS
TENTORIUM
GCS
ICP
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MENINGESTiga lapis : duramater, arachnoid, piamater
Arteri Meningea Media, potensial terlibat pada kasus EDH
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CAIRAN SEREBROSPINAL
Diproduksi oleh pleksus koroideusRata-rata 30 ml per jamBersirkulasi
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TENTORIUMMembagi 2 ruangan intrakranialSupratentorial dan Infratentorial
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CEREBRAL PERFUSION PRESSURE ( CPP )
Merupakan PRIORITAS UTAMA
Rumus : CPP = Mean Arterial Pressure - ICP
CEREBRAL BLOOD FLOW ( CBF )
Normal : 50 ml/100 gram otak/ menitBila mencapai 5 ml/ menit :
cell death & irreversible damage
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TEKANAN INTRAKRANIAL
Normal : 10 mmHg ( 136 mm air )Makin tinggi TIK makin jelek prognosis
HUKUM MONRO-KELLIE
Prinsip : total volume intrakranial bersifat TETAP,Oleh karena kranium merupakan NON EXPANSILE BOX
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Vk = V darah + V likwor + V parenkim
60
50
40
30
20
10
0
Fatal
DisfungsiOtak
Obati
Normal
mmHg
Volume Intrakranial
100
50
TekananIntrakranial
Monro Kellie
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SECONDARY SURVEYWhole Examination
ANAMNESISPEMERIKSAAN FISIKPENUNJANG
ANAMNESISPEMERIKSAAN FISIKPENUNJANG
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INFORMASI PENTING
USIA DAN MEKANISME TRAUMASTATUS RESPIRASI & KARDIOVASKULER
KESADARAN, REAKSI PUPIL, LATERALISASIADANYA TRAUMA NON SEREBRAL
HASIL PEMERIKSAAN DIAGNOSTIK
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TANDA – TANDA PENTING
PUPIL ANISOKORLATERALISASI MOTORIK
LUKA TERBUKA DGN KEBOCORAN LCSPERBURUKAN NEUROLOGIS
FRAKTUR DEPRESI TULANG TENGKORAKSAKIT KEPALA HEBAT
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KOMPONEN GLASGOW COMA SCALE
E : BUKA MATA: 1 – 4V : SUARA : 1 – 5M : GERAKAN : 1 - 6
E : BUKA MATA: 1 – 4V : SUARA : 1 – 5M : GERAKAN : 1 - 6
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KOMPONEN MATA
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KOMPONEN MOTORIK
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KOMPONEN VERBAL
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KLASIFIKASI CEDERA KEPALA
RINGAN : GCS 14 - 15SEDANG : GCS 9 - 13BERAT : GCS 3 - 8
RINGAN : GCS 14 - 15SEDANG : GCS 9 - 13BERAT : GCS 3 - 8
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KLASIFIKASI
MEKANISMEMEKANISME
TUMPUL
TAJAM(PENETRATING)
KLL
TRAUMA TEMBAKTRAUMA TUSUK
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SEVERITYSEVERITY
RINGAN :GCS 14 - 15SEDANG :GCS 9 - 13BERAT :GCS 3 - 8
MORFOLOGIMORFOLOGI
FRAKTUR KRANIUM linear terbuka/tertutup depresi
basis cranii
LESI INTRAKRANIALFokal : EDH,SDH,ICH,IVHDifus : kontusio
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MEMELIHARA KEBUTUHAN METABOLIK OTAK
CEGAH/OBATI HIPERTENSI INTRAKRANIALHIPOKAPNEAKONTROL CAIRANDIURETIK ( MANNITOL )
PRINSIP
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RINGKASAN
JAGA PATENSI JALAN NAFASJAGA VENTILASIATASI SYOKPERIKSA NEUROLOGISCEGAH CEDERA OTAK SEKUNDERCARI CEDERA YANG TERKAITBILA STABIL, PERIKSA PENUNJANGBILA PERLU KONSUL BEDAH SARAFTERUSKAN ASESMENT
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ILUSTRASI KASUSCEDERA KEPALAILUSTRASI KASUSCEDERA KEPALA
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Fraktur ImpresiFraktur Impresi
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CT scan Impresi Fraktur
CT scan Impresi Fraktur
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TINDAKAN OPERATIF FRAKTUR DEPPRESI
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BASILAR SKULL FRACTURES
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Basal Skull Fracture
CSF rhinorrhea :
anterior skull base CSF otorrhea : Mid
skull base Hemotympanum Periorbital
ecchymosis
Retroauricular ecchymosis
Facial nerve injury
Loss of hearing Pneumocephalus
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Classifications of Head InjuryBy Morphology
Focal Injury
Diffuse Injury
• Epidural• Subdural• Intracerebral
• Mild concussion• Classic concussion• Diffuse axonal injury
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EpiduralEpidural
EPIDURALHEMATOMEPIDURALHEMATOM
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Terkumpulnya darah/bekuan darah dalam ruang antara tulang kepala dan duramater
Kausa : trauma Klinis :
Lusid interval Lateralisasi
Rontgen : Fraktur linear Gambaran hematom (+)
Terkumpulnya darah/bekuan darah dalam ruang antara tulang kepala dan duramater
Kausa : trauma Klinis :
Lusid interval Lateralisasi
Rontgen : Fraktur linear Gambaran hematom (+)
Epidural Hematom (EDH)Epidural Hematom (EDH)
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PERJALANAN KLINIK EDH
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ACUTE EPIDURAL HEMATOMA
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Subdural hematomSubdural hematom
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Subdural Hematom (SDH)Subdural Hematom (SDH)
Terkumpulnya darah / bekuan darah dalam ruang antara duramater dan arakhnoid
Terbagi dalam : akut dan kronis Kausa : trauma (akut lebih >> kronis) Klinis :
Penurunan kesadaran Lateralisasi
Rontgen : Gambaran hematom (+)
Terkumpulnya darah / bekuan darah dalam ruang antara duramater dan arakhnoid
Terbagi dalam : akut dan kronis Kausa : trauma (akut lebih >> kronis) Klinis :
Penurunan kesadaran Lateralisasi
Rontgen : Gambaran hematom (+)
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Intraserebralhematom
Intraserebralhematom
Pre operasi
Pre operasi
Pasca OperasiPasca Operasi
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KorpusAlienumKorpusAlienum
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FUNGSI OTAK
• Sisi dominan untuk yang tidak kidal adl yg
sebelah kiri
• Orang kidal, 75 % sisi dominan adalah kiri
• Fungsi sisi dominan adalah untuk bahasa
dan memori yang berdasarkan bahasa
• Sisi kanan untuk memori visual
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LOBUS FRONTALIS
1. PRE-SENTRAL GIRUS
Pusat motorik untuk muka, tangan, kaki, badan, dsb.
2. AREA BROCA
Pada sisi dominan adalah pusat bicara ekspresif motorik
3. AREA MOTOR TAMBAHAN
Untuk gerakan mata dan kepala sisi yang berlawanan
4. AREA PRE-FRONTAL
Untuk inisiatif dan personalitas
5. PARASENTRAL LOBUS
Pusat penahan BAK dan BAB
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