Download - CMS 2014
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Cedera Kepala
KULIAH CMS 2013:DR. dr. Robert Sinurat, SpBS (K)
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InsidensiUSA:
- 200/ 100.000 penduduk (600.000 kasus per tahun)
- Populasi tertinggi usia 15-24 tahun- Laki-laki >2 kali daripada wanita
- CKB: 10 % (Anderson, dkk)
Indonesia:Thn 2000: 1841 orang dirawat di RSHS Bandung, CKB: 144 orang (12,8 %) (R.Sinurat)
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Bahan Buku TEKS:
• 1. Neurosurgery: Youmans
• 2. Head Injury: Pieter Reily
• 3. Head injury: Narayan
• 4. Ilmu Bedah Saraf: Prof. Satyanegara
• 5. Cedera Kepala: Prof. Eka W
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CPP = MABP - ICP
• CPP ≥ 70 mmHg
• MABP= S + 2D
3
• ICP = 0 – 10 mmHg
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Hukum “Monro Kellie”
Volume intra kranial :• Jaringan otak • Darah Konstan• LCS
Volume tek. intra kranial herniasiPerdarahanEdema otak
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Mekanisme Cedera Kepala
• Fleksi
• Ekstensi Akselerasi - deselerasi
• Shearing
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1. Cedera primer
Primary traumatic brain damage Diffuse:
1. Diffuse Axonal Injuryal 2. Diffuse Vascular Injury
Focal : 1. Vascular injury resulting in:
- Intracerabral hemorrhage - Subdural hemorarhage - Extradural hemorrhage
(EDH)
2. Axonal injury 3. Contusion 4. Laceration
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2. CEDERA SEKUNDER
Secondary brain damage
Diffuse
1. diffuse hypoxic-ischemic damage
2. diffuse brain swelling
Focal
1. Focal hypoxic-ischemic injury
2. Focal brain swelling
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Penyebab Cedera Sekunder Ekstra dan Intrakranial
• Ekstrakranial- Hipoksia - Hipotensi - Hiponatremi
- Hipertermia - Hipoglikemia
• Intrakranial- Perdarahan
- Ekstradural(EDH) - Subdural- Intracerebral - Intraventikular- Subarachnoid
- Edema- Infeksi
- Meningitis
- Abses otak
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Dasar Molekuler Cedera Otak
1. Radikal Bebas
2. Gangguan Homeostase Kalsium
3. Efek Cytokine
4. Mekanisme Lain: - Reseptor Opiat
- Konsentrasi Magnesium Intraselluler
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Primary Traumatic Insult
Hypoxia IschemiaHypotension
↓ Energy Metabolism
Free Radical ExcitatoryRelease Cytokines Endorphines
Membrane Damage
Cell Death
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GL NMDA ReceptorU Ca++ HydrolisisTAM AMPAA Na Cell SwellingT
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PENATALAKSANAAN1. Primary Survey
A. Airway, dengan kontrol servikal B. BreathingC. CirculationD. DisabilityE. Exposure
Resusitasi2. Tambahan terhadap primary survey3. Secondary survey4. Tambahan terhadap secondary survey5. Reevaluasi6. Terapi definitif
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Disability
1. NILAI: a. Glasgow Coma Scale (GCS)
b. Periksa Pupil: Bulat, diameter?
Refleks Cahaya?
c. Motorik: Hemiparese Kiri/Kanan
Kesimpulan:
GCS 3-8 : Cedera Otak Berat
GCS 9-12: Cedera Otak Sedang
GCS 13-15: Cedera Otak Ringan
Bila ada pupil dilatasi dan hemiparese: Lateralisasi
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Tindakan:
Cedera Otak Berat:
- Intubasi dan Ct scan kepala tanpa kontras.
Cedera Otak Ringan dan Sedang: Ct scan kepala tanpa kontras
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Tn Rosid (32 Tahun): GCS Berapa?
VID-Tn.Rossid-ICU UKI.3GP
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?
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Terimakasih