Trauma Medula Spinalis Dimas
-
Upload
ardy-santoso -
Category
Documents
-
view
34 -
download
2
description
Transcript of Trauma Medula Spinalis Dimas
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 1/27
TRAUMA MEDULA TRAUMA MEDULA
SPINALISSPINALIS
Dimas Noor Zulfkar FauziFebrina Sylva
Abraam Emes
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 2/27
DefnisiDefnisi
!e"era me"ula s#inalis a"ala$e"era a%au kerusakan #a"a
me"ulla s#inalis yan&
menyebabkan #erubaan'un&sional( baik se$arasemen%ara a%au #ermanen #a"a
'un&si mo%orik( sensorik( a%auo%onom)
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 3/27
E%iolo&iE%iolo&i
*er"asarkan e%iolo&i %erba&i men+a"i!e"era %rauma%ik
!e"era non.%rauma%ik
. kanker
. &an&&uan #embulu "ara
. ra"an&/in'eksi
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 4/27
Pa%o&enesisPa%o&enesis
!EDERA PRIMER0ERUSA0AN ME0ANIS / FISI0
!EDERA SE0UNDER
NE!R1SIS PR12RESSIF SU*S) AL*A3 2RISEA
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 5/27
!EDERA PRIMER!EDERA PRIMER
Akiba% %ena&a mekanis %rauma %er+a"i "es%ruksineuron
Dalam 4ak%u 56 meni% #as$a $e"era( #er"araan#%e$ie b&n sen%ral masa abu.abu( mula, #a"a
$ornu an%erior "an seki%ar $analis sen%ralis) Sa%u +am kemu"ian "ara berkum#ul "i $ornu
#os%erior "an masa #u%i ,+am #as$a $e"era- invasi sel, in7amasi
8+am #as$a $e"era- am#ir se#arume")s#in)nekro%ik
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 6/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 7/27
9 +am #as$a $e"era- %r+" oe"em
#rimer vaso&enik8: +am Pas$a $e"era- akan %er+a"i
oe"ema "an nekro%ik $rosseksional
#a"a %em#a% $e"era
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 8/27
!EDERA SE0UNDER!EDERA SE0UNDER
Meru#akan #erubaan #ro&resi'
#a%olo&is "an fsiolo&is se%ela $e"erneuron #rimer
Mekanismenya karena-
Ra"ikal bebas
!a me%as%ase
Pro&ramme" sel "ea% a%au a#o#%osi
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 9/27
0lasifkasi0lasifkasi
*er"asarkan klasifkasi ASIA "anIMS1P( %erba&i men+a"i
2RADE A- $om#le%e( 'un&si mo%orik /sensorik ;.<s/" se&men S8.S=
2RADE *-in$om#le%e( 'un&sisensorik;.<( 'un&si mo%orik masi ;3<"iba4a level u"ara s#inal s/"se&men S8.S=
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 10/27
2RADE !-in$om#le%e ( 'un&sisensorik ;3<( 'un&si mo%orik masi
;3<"i ba4a level $e"era s#inal"an seba&ian besar >6 o%o%eks%remi%as "i ba4a level $e"era
s#inal #unya kekua%an mo%orik ?52RADE D-in$om#le%e( 'un&sisensorik ;3<( 'un&si mo%orikmasi ;3<"i ba4a level $e"era
s#inal "an seba&ian besar >6 o%o%eks%remi%as "i ba4a level $e"eras#inal #unya kekua%an mo%orik @5
2RADE E-normal ( mo%orik "ansensorik normal
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 11/27
Complete cord transectionComplete cord transection
!e"era kom#li% #a"a $ervi$al -
• Mo%orik
Te%ra#le&ia
• SensorikAnes%esia
• 1%onom
i#o%ensi "an i#o%ermia %an#a%akikar"ia kom#ensasi ;So$kNeuro&enik<
Res#ira%ory arres%
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 12/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 13/27
!e"era kom#li% #a"a %orakal "an lumbal -
•
Mo%orikPara#le&ia
• Sensorik
Anes%esia "i ba4a level $e"era
• 1%onomilan& %onus re$%um "an vu
Re%ensio urin
Ileus
Pria#ismus
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 14/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 15/27
!en%ral $or" syn"rome!en%ral $or" syn"rome
Mo%orik Para#arese ;eB% a%as lebi bera%<
Sensorik 2an&&uan minimal ;Sa4l.like
syn"rome<
1%onom
Re%ensio urin
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 16/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 17/27
An%erior $or" syn"romeAn%erior $or" syn"rome
Mo%orik Paralisis
Sensorik 2an&&uan minimal #a"a 'un&si
#ro#iose#%i'
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 18/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 19/27
Pos%erior $or" syn"romePos%erior $or" syn"rome
Mo%orik Para#arese
Sensorik 2an&&uan #ro#iose#%i'
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 20/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 21/27
*ro4n.SeCuar" syn"rome*ro4n.SeCuar" syn"rome
Mo%orik Para#arese i#sila%eral
Sensorik 2an&&uan #ro#iose#%i' i#sila%eral(
kon%rala%eral normal)
2an&&uan ek%erose#%i' kon%rala%eral)
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 22/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 23/27
!onus.me"ulary!onus.me"ulary
syn"romesyn"rome Mo%orikMo%orik 2an&&uan %i#e LMN2an&&uan %i#e LMN
SensorikSensorik Anas%esia "iAnas%esia "i saddlesaddle areaarea
1%onom1%onom Re%ensio urinRe%ensio urin
2an&&uan "e'ekasi2an&&uan "e'ekasi
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 24/27
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 25/27
Pena%alaksanaanPena%alaksanaan
Umum-. %era#i emer&en$y "& mem#era%ikaA*!( immobilisasi "an %rans'er #asien
. %era#i masala umum se#er%i &&nres#irasi( kar"iovaskuler "an&as%roin%es%inal
. s%abilisasi s#inal
. "ekom#resi be"a bila a"a in"ikasi
. #ro&ram reabili%asi
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 26/27
Cegah hilangnya fungsi motorik permanen. Pemberian steroid segera.
Kejadian sebelum 8 jam:metil prednisolon do tinggi 30 mg/kgBB i..
perlahan !" menit
#" menit kemudian infus "$# mg/kgBB selama %3 jam.
&ika 'edera terjadi antara 3(8 jam infus berakhir s/d#8 jam.
)anitol 0$%"(!$0 gr/kgBB mengobati edema )*. +angguan pernafasan pada 'edera serikal
pera,atan -C. *el(sel dengan 'edera ringan mungkin melakukan
respons adaptif pemberian obat(neuro protektif.
7/18/2019 Trauma Medula Spinalis Dimas
http://slidepdf.com/reader/full/trauma-medula-spinalis-dimas 27/27
Pera4a%an Umum-#era4a%an kan"un& kemi
#era4a%an rek%um
#era4a%an kuli%nu%risi
kon%rol nyeri
#era4a%an #sikia%rireabili%asi