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