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And men should know that fromAnd men should know that fromnothing else but from the brain camenothing else but from the brain came
joys, delight, laughter and jests, andjoys, delight, laughter and jests, and
sorrows, griefs, despondency, andsorrows, griefs, despondency, and
lamentations. And by this, in thelamentations. And by this, in the
especial manner, we acquire wisdomespecial manner, we acquire wisdomand knowledge, and see and hearand knowledge, and see and hear
and know what are foul, and whatand know what are foul, and what
are fair, what sweet and whatare fair, what sweet and whatunsavory.unsavory.
(he !ippocratic writing"(he !ippocratic writing"
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#pdate $enanganan#pdate $enanganan
%edera &epala%edera &epala
'udy unanto'udy unanto
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)evere !ead *njury)evere !ead *njuryModern TreatmentModern Treatment
+entilatory control+entilatory control uick surgeryuick surgery
%ontrol intracranial%ontrol intracranial
pressurepressure -aintain cerebral blood-aintain cerebral blood
owow
-aintain normal physiology-aintain normal physiology
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)evere !ead *njury)evere !ead *njury/./.0ood recovery1 moderate0ood recovery1 moderate
disability increased 234disability increased 234
5.5.)evere disabled1 vegetative)evere disabled1 vegetativeunchangedunchanged
2.2.-ortality reduced by 234-ortality reduced by 234
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%edera kepala%edera kepala
Akut n kritis Dinamis
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%epat%epat
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6$A6$A
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A0'6)*7
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9/63empat kejadianempat kejadian
$enanganan dilakukan8
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&elalaian, kesalahan dan&elalaian, kesalahan dan
keterlambatanketerlambatan
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96:*) %6;6'A &6$A
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$embagian$embagianberdasarkan 0%)berdasarkan 0%)
'ingan (/> ? /@"'ingan (/> ? /@"
)edang ( ? /2 ")edang ( ? /2 "
Berat ( kurang dari C "Berat ( kurang dari C "
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0lassgow %oma )cale0lassgow %oma )cale
Buka mata Motorik VerbalBuka mata Motorik Verbal
/D dk ada dk ada dk ada/D dk ada dk ada dk ada
5D ;gn nyeri 6Etensi )uara5D ;gn nyeri 6Etensi )uara2D ;gn suara 7leEi spastik &ata2D ;gn suara 7leEi spastik &ata
>D )pontan erbatas Bicara ngaco>D )pontan erbatas Bicara ngaco
@D 0erak bebas &omunikasi@D 0erak bebas &omunikasiFD =%FD =%
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$A=7*)*=
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*%$ meningkat*%$ meningkat
%pp menurun%pp menurun
herniasiherniasi
&6-A*A:
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Aspek umum penangananAspek umum penanganan
traumatrauma
$enanganan cedera kepala$enanganan cedera kepala
GBag integrasi dari penangananGBag integrasi dari penanganan
holistikholistik pasien traumapasien traumaGrauma tumpul, terutama kecelakaanGrauma tumpul, terutama kecelakaan
lalu lintas umumnya multi sistemlalu lintas umumnya multi sistem
G$erlu dibuat sistematika penangananG$erlu dibuat sistematika penanganan(A
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;eath 7rom rauma
+ery early ( immediate1instantaneous death( 2>G@34 "8 irremediable central nervus ortrunk injury
6arly (H > jam, /C ? 234"8 kehilangandarah, airway. 0olden period resusitasiprehospital.
!ospital death ( 5> jamH 5/4 " After day or weeks ( 53 ? 5I4 "8 multi organ
failure, sepsis kerusakan otak
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AnamnesaAnamnesa
Jaktu dan tempatJaktu dan tempat
9enis trauma9enis trauma
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$emeriksaan Ksik$emeriksaan Ksik
anda vitalanda vital
-ini neurologis-ini neurologis
GG 0%) ( 6 - + "0%) ( 6 - + "
GG $upil ( isokor1 unisokor$upil ( isokor1 unisokor
GG -otorik ( hemiparese1 hemiplegi "-otorik ( hemiparese1 hemiplegi "
)tatus lokalis)tatus lokalis
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atalaksanaatalaksana(cedera kepala ringan"(cedera kepala ringan"
$osisi head up 23 derajat$osisi head up 23 derajat
AnamnesisAnamnesis
anda vitalanda vital $emeriksaan umum$emeriksaan umum
&ondisi lokal&ondisi lokal
-ini neurologis-ini neurologis 'adiologis'adiologis
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'awat'awat((cedera kepala ringancedera kepala ringan""
% )can tidak ada% )can tidak ada
% abnormal% abnormal
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$rimary care$rimary care
=5 tinggi ( /3G/5 l1m "=5 tinggi ( /3G/5 l1m "
0uedel,*ntubasi,ventilator0uedel,*ntubasi,ventilator
*+ line dengan iv cat besar, ( 5 atau lebih"*+ line dengan iv cat besar, ( 5 atau lebih" %ateter%ateter
:0:0
6&06&0 &ontinyu tekanan darah&ontinyu tekanan darah
=ksimetri=ksimetri
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'esusitasi respirasi'esusitasi respirasi
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=bstruksi airway=bstruksi airway
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'espirasi'espirasi
534 cedera kepala8 gangguan respirasi534 cedera kepala8 gangguan respirasi !ipoksia 8 23G>24 %&B yang sampai #0;!ipoksia 8 23G>24 %&B yang sampai #0; 534 0ood outcome534 0ood outcome
>I4 vegetatif state>I4 vegetatif state
$enyebab utama8$enyebab utama8 G periode apnoeG periode apnoe
G obstruksi airwayG obstruksi airway
G trauma paruG trauma paru
G trauma thoraksG trauma thoraks
G edema paruG edema paru
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BreathingBreathing
&ontrol ventilator pada ps8&ontrol ventilator pada ps8
G !ipoventilasiG !ipoventilasi
G ApneicG Apneic
G 'espirasi distres beratG 'espirasi distres berat
&=:'=< A0;&=:'=< A0;
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*ntubasi*ntubasi
0%) D C atau kurang0%) D C atau kurang
)pasme otot sal nafas)pasme otot sal nafas
=bstruksi sal nafas yang sulit=bstruksi sal nafas yang sulitdibebaskandibebaskan
rauma maEilloGfacial beratrauma maEilloGfacial berat
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!iperventilasi!iperventilasi
ujuan8 menurunkan $a %o5(23G2@ujuan8 menurunkan $a %o5(23G2@mm!g"mm!g"
idak boleh berlebihan ( lama, berat "idak boleh berlebihan ( lama, berat "
!indari $a %o5 H 5@ mm!g!indari $a %o5 H 5@ mm!g
A0; perlu dipantauA0; perlu dipantau
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)irkulasi)irkulasi
!*$=6:)*8!*$=6:)*8
%&B 2@4 hipotensi, /54 anemia%&B 2@4 hipotensi, /54 anemia
-ortalitas meningkat 5L-ortalitas meningkat 5L
!ipotensi M hipoksia, mortalitas I@4!ipotensi M hipoksia, mortalitas I@4; ideal /53 ? /C3 mm!g; ideal /53 ? /C3 mm!g $enyebab utama8$enyebab utama8
G Blood lossG Blood loss G
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!ipotensi!ipotensi
)egera cairan kristaloid)egera cairan kristaloid
Bila perlu, inotropik vasopresorBila perlu, inotropik vasopresor
; ideal /53 ? /C3 mm!g.; ideal /53 ? /C3 mm!g.
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%airan intravena%airan intravena
$ertahankan normovolemi$ertahankan normovolemi
$ilihan utama8 :acl 3,4, '
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-anitol-anitol
ujuan8 menurunkan *& dengan menaikanujuan8 menurunkan *& dengan menaikanosmolaritas plasma.osmolaritas plasma.
;osis8 3,5@ ? / gr1&g BB1kali dalam @G/@;osis8 3,5@ ? / gr1&g BB1kali dalam @G/@
menit, boleh > kali1harimenit, boleh > kali1hari Bersifat8 G diuretik jgn lupa keteterBersifat8 G diuretik jgn lupa keteter G hipotensifG hipotensif
$emberian proKlaksi tidak dianjurkan$emberian proKlaksi tidak dianjurkan
9angan diberikan pada gagal ginjal9angan diberikan pada gagal ginjal Bila tidak tersedia, furosemid dapat digunakanBila tidak tersedia, furosemid dapat digunakan
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BarbituratBarbiturat
Bersifat neuroproteksi dan menurunkanBersifat neuroproteksi dan menurunkan*&*&
!atiGhati8 sedatif ,hipotensif!atiGhati8 sedatif ,hipotensif ;osis8 G /3 mg1kgBB pada N jam pertama;osis8 G /3 mg1kgBB pada N jam pertama
G lanjut dgn @ mg1kgBB selama 2G lanjut dgn @ mg1kgBB selama 2
jamjam
G / mg1kg BB pemeliharaanG / mg1kg BB pemeliharaan
;apat diberikan selama >C jam;apat diberikan selama >C jam
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Anti konvulsanAnti konvulsan
&ejang terjadi8&ejang terjadi8G @4 %& non misilG @4 %& non misil
G/@4 %&BG/@4 %&B
G/@4 7raktur depresG/@4 7raktur depres Antikonvulsan bermanfaat mencegah kejang awal (Antikonvulsan bermanfaat mencegah kejang awal (
/ minggu pertama "/ minggu pertama "
$ilihan8 $henitoin atau phenobarbital$ilihan8 $henitoin atau phenobarbital
;osis phenitoin8 awal @33 mg dalam /3 menit atau;osis phenitoin8 awal @33 mg dalam /3 menit atau53 mg1kgBB, selanjutnya diatur sesuai kadar dlm53 mg1kgBB, selanjutnya diatur sesuai kadar dlmplasma (/@G53 ug1ml" selama I hari dan dikurangiplasma (/@G53 ug1ml" selama I hari dan dikurangibertahapbertahap
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)teroid)teroid
idak dianjurkanidak dianjurkan
idak memperbaiki otucomeidak memperbaiki otucome
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*ndikasi operasi*ndikasi operasi
MODERN PRACTICAL STEPWISE MANAGEMENT FLOW CHART WHEN A PATIENT WITH
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MODERATE OR SEVERE HEAD INJURY IS BROUGHT TO EMERGENCY ROOM
EMERGENCY ROOM
Level of consciousness(Glasgow Coma Scale),Pupils
Airway, Respiratory Pattern
Blood Pressure!ternal Bleeding wound
"uic# assessment of
Assessment to $e done almost
Simultaneously w%ile %istory of
&rauma $eing ta#en
Level of Consco!ness
Glasgow Coma Scale
'ild *+
'oderate *-
Severe./Pupils
0ec# (Cervical spine )
A"#$%
0asal 1 2ral Suction
'etal or Plastic
Airway,2-in%alation
Asses Respiration
ndotrac%eal3ntu$ation or
&rac%eostomy
(if essential)
Connect to ventilator
(if essential)
Bloo& P"ess!"e
&o record BP, pulse
Also to start good 345
Line, C5P line
3f BP low
345 fluids, crystalloids3nfusion, lonotrops
Blood transfusion
(if essential)
3f Persistent low BP*6ltra sound a$domen*7 8uadrant test
0asogastric Rylestu$e
(Suction of stomac%
contents to prevent
aspiration pneumonia)
9oleys Cat%eter
E'(e"n$l )lee&n* #o!n&s
:ounds to $e sutured
Patient sta$ilised*0ormal Airway, Breat%ing well*0ormal BP*:ounds sutured
Re$ssess
Glasgow Coma Scale pupils,
S!"ve%
;ead, nec#, c%est, a$domen,musculo s#eletal, vascular
Cervical collar if essential $efore transportation
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ALL MODERATE + SEVERE HEAD INJURY
,-./01 ,231
C4 T4 Sc$n )"$n3f C& not availa$le
3f lateralising sign present t%en proceed
:it% e!ploratory $urr%oles after
Assesing ot%er in -+ mm
5ol > + mm midline s%ift)Clot wit% no mass effect Brain edema wit% effacement of cisterns 2t%er in
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&esimpulan&esimpulan
%edera kepala merupakan kondisi serius%edera kepala merupakan kondisi serius $erlu tindakan cepat, tepat dan agresif.$erlu tindakan cepat, tepat dan agresif.
-erupakan bag integrasi penanganan-erupakan bag integrasi penangananholistik pasien traumaholistik pasien trauma $enanganan awal berupa tindakan AB%$enanganan awal berupa tindakan AB%
sangat menentukan keberhasilan terapisangat menentukan keberhasilan terapi
deKnitif dan outcome.deKnitif dan outcome. $erlu tenaga terlatih dan terampil dan$erlu tenaga terlatih dan terampil danmenguasai dasar neurotrauma.menguasai dasar neurotrauma.
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'agu1 simsalabim
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Bingung
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:ekat
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hank youhank you
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hank youhank you
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hank youhank you
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