PENANGANAN CEDERA KEPALA DI RAWAT INAP

Dr. HERA PRASETIA Sp.BS RS CITRA MEDIKA

ACCIDENT (SPOT OF ACCIDENT) BRAIN SHOCK : ( Seconds-minutes)

A1 B1 C

No pain reaction Apnea Bilateral pupil dilatation, negative light + corneal reflex Pulse is not clear unpredictable

HEMORRHAGESMALL HEMORRHAGEBRAIN COMPENSATED : MILD COMPLAIN Cephalgi, vertigo, restlessness, vomiting, amnesiaUNCOMPENSATED: SEVERER : *Lateralization, anisocoric pupil, hemiparese/paralytic * Cushing responses hypertension bradycardia GCS * Apnea * hyperthermia *Bilateral

LARGE HEMORRAGE

HERNIATION

midriasis pupil *Decerebration *Cardiac arrest

MONRO KELLY DOKTRIN

PERAWATAN DI ICU (Pasca Operasi)1.

Dengan ventilator / respirator - 1 4 jam pasca operasi, evaluasi : - Cushing respon (T , N , RR ) - Defisit neurologis ( Pupil anisokor, Hemiparese) Bila ada : CT Scan kontrol - 4 jam Pasca Operasi : CT Scan Kepala kontrol

2.

Tanpa ventilator - 1 6jam evaluasi : * GCS * Defisit neurologis * Cushing responGCS , Defisit (-), Cushing (-) Tanpa CT scan GCS , Defisit (-), Cushing(-), CT scan GCS Tetap, Defisit (+), Cushing (+) CT scan GCS Tetap, Defisit (-), Cushing (-) Evaluasi EkstrakranialN CT scan AbN Koreksi

-

1. OBSERVATION OF CONSCIOUSNESS 1.

Is done based on GCS Recover

2.

SBI = Secondary brain injury

2. OBSERVATION OF NEUROLOGICAL DEFICIT

NO LATERALITATION Pupil : isochor Motoric : Normal

LATERALIZATION Anisochor Hemi/tetra Paralyse/Paralitic

Caused by : intracranial : Proceses Extracranial : Hypoxemia

Di UGD Hematom parietal kanan 5 cm GCS 456 pupil isokor, hemiparese (-) (Foto skull : fraktur Di ruangan GCS 335 pupil Anisokor 5/3 mm

Proses intrakranial ?

Proses extrakranial ?

CT Scan

Di UGD Hematom parietal kanan GCS 235 pupil isokor, hemiparese (-) (CT scan kepala : Oedem cerebri

Di ruanganGCS 125 pupil isokor, hemiparese (-)

Proses intrakranial

Proses extrakranial Cek : vital sign laboratorik

CT scan

N

AbNKoreksi GCS membaik Konservatif

GCS tetap

3. AIRWAY AND BREATHING1. 2. 3.

Keep in airway + Breathing Keep PaO2 : 80 120 mmhg Is not : * hypoxemia : metabolic anaerob * hyperxemia: reperfusion injury

4. CIRCULATION

To maintain significant brain perfusion Systolic pressure : 100-120 mmhg Dyastolic pressure : 60-80 mmhg

Note :Hypertension Hypotension Shock Anemia Urgency Immediately Treated

5. FLUID, ELECTROLYTE AND NUTRITION IMBALANCE

Day 1-2 : * 2 liters isotonic fluid * has a electrolyte : osmolar stabilization Day 3 : * gastric tube : orally - no gastric retention (100cc/day) - good peristaltic - no abdominal distended - no nausea and vomiting - start low go slow

SOME FACTORS NEED TO BE CONSIDERED IN FLUID ADMINISTRATION ARE

Extra fluid 10-15% must be given in every increased 10C temperature 2. Urinary production : * diabetes insipidus :1/2 1 ltr negative balance * progresive urinary production and prolonged urine production (>days) vasopression administration is needed and electrolyte is periodically examined 3. Its not recommended to give glucose 5% glucose will rapidly metabolize solution changes into hypotonic.1.

6. TEMPERATURE

Rectal temperature Hyperthermia hypermetabolism Causes of hyperthermia 1. intracranial 2. extracranial : infection drug reaction transfusion reaction Treatment + intracranial : without antipyretics + antibiotic + increasing of fluid >10C (+) 10-15% (extra)

HIPERTHERMIAPrimer1.

Sekunder > hr 2 fluktuatif - dehidrasi - infeksi - reaksi tranfusi - reaksi obat - plebitis Kulit basah

Anamnesa : - waktu - sifat panas Penyebab