Kuliah Mahasiswa

7/17/2019 Kuliah Mahasiswa

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CEREBROVASCULARCEREBROVASCULARDISEASE : AN EMERGENCYDISEASE : AN EMERGENCY

dr. Nilamsari Sp.S M.Kesdr. Nilamsari Sp.S M.Kes

Neurolo! Depar"eme#"Neurolo! Depar"eme#"

Medi$al %a$ul"! o& Sri'i(a!aMedi$al %a$ul"! o& Sri'i(a!aU#i)ersi"!*U#i)ersi"!*

M. +oesi# Ge#eral +ospi"alM. +oesi# Ge#eral +ospi"al



,+A- IS S-ROKE,+A- IS S-ROKE





-Y1ES O% S-ROKE -Y1ES O% S-ROKE



-Y1ES O% S-ROKE -Y1ES O% S-ROKE



SUBARAC+NOID +EMORR+AGESUBARAC+NOID +EMORR+AGE



RISK %AC-ORRISK %AC-OR



+O, O%-EN DOES+O, O%-EN DOES

S-ROKE OCCURS IN COMMUNI-YS-ROKE OCCURS IN COMMUNI-Y



S-A-IS-ICSS-A-IS-ICS

► E)er! 23 se$o#dsE)er! 23 se$o#ds

►

-4e "4ird leadi# $ause o& dea"4 5 $ause o& -4e "4ird leadi# $ause o& dea"4 5 $ause o&

lo#6"erm disa0ili"!lo#6"erm disa0ili"!



,+Y IS S-ROKE CONSIDERED AS,+Y IS S-ROKE CONSIDERED AS

AN EMERGENCY CASEAN EMERGENCY CASE



-IME IS CRI-ICAL : 7 +OURS ,INDO, -IME IS CRI-ICAL : 7 +OURS ,INDO,

► -o sa)e is$4emi$ pe#um0ra -o sa)e is$4emi$ pe#um0ra

► -o redu$e mass e8e$" -o redu$e mass e8e$"





REDUCING MASS E%%EC-REDUCING MASS E%%EC-



+O, -O ES-ABLIS+ -+E DIAGNOSIS+O, -O ES-ABLIS+ -+E DIAGNOSIS



ANAMNESISANAMNESIS

Suddenly

• delirium, decrease of consciousness• trouble speaking or understanding

• trouble seeing• trouble walking, dizziness, loss of

balance or coordination• one side numbness or weakness

of the face, arm or leg

• severe headache



1+YSICAL E9AMINA-ION1+YSICAL E9AMINA-ION

► Co#s$ious#esCo#s$ious#es

► Vi"al si#Vi"al si#► Ge#eral s"a"usGe#eral s"a"us

► Neuroloi$al eami#a"io#Neuroloi$al eami#a"io#



DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

Si# 5 S!mpSi# 5 S!mp -4rom0o"i -4rom0o"i$$

Em0oli$Em0oli$ +emorr4a+emorr4aee

SA+SA+

A$"i)i"! a"A$"i)i"! a"o#se"o#se"

66 ;; ;; ;;

Neuro de$i"Neuro de$i" 'orse#i#'orse#i# Ma a"Ma a"o#se"o#se"<impro)<impro)ee

Ma a"Ma a"o#se"o#se"

mi#imalmi#imal<'ors<'orsee

+eada$4e+eada$4e 66 ;*6;*6 ;*6;*6 ;;;;

Vomi""i#Vomi""i# 66 ;*6;*6 ;*6;*6 ;*6;*6

Sei=ureSei=ure 66 ;*6;*6 ;*6;*6 ;*6;*6

De$rease o&De$rease o&

$o#s$ious#es$o#s$ious#esss

66 ;*6;*6 ;*6;*6 ;*6;*6

-IA -IA ;; 66 66 66

B1B1 ↑↑ N*N* ↑↑ ↑↑ ↑↑ N*N* ↑↑

Nu$4alNu$4al

riidi"!riidi"!

66 66 66 ;;

Bleedi# L1 66 66 6; 6 ;;



TIME ISTIME ISBRAINBRAIN

MANAGEMENMANAGEMENTT



MANAGEMEN-MANAGEMEN-

►1re 4ospi"al1re 4ospi"al

►ERER



1RE +OS1I-AL MANAGEMEN-1RE +OS1I-AL MANAGEMEN-

Earl! de"e$"io#Earl! de"e$"io#

1a"ie#" "ra#spor"ed > am0ula#$e1a"ie#" "ra#spor"ed > am0ula#$e

I#i"ial assessme#"I#i"ial assessme#"

ABC ?Normal Sali#e/ Ri#er Ase"a"e@ABC ?Normal Sali#e/ Ri#er Ase"a"e@

-ra#s&erred "o re8eral 4ospi"al immedia"el! -ra#s&erred "o re8eral 4ospi"al immedia"el!



MANAGEMEN- A- ERMANAGEMEN- A- ER

AnamnesisAnamnesis

Airway & BreathingAirway & Breathing

► Orop4ari#eal "u0eOrop4ari#eal "u0e

► E--E--

► O!e# 0i#asalO!e# 0i#asal

Circuati!nCircuati!n

►I#"ra)e#ous li#e :Normal sali#e/ ri#er ase"a"I#"ra)e#ous li#e :Normal sali#e/ ri#er ase"a"

► 1roper ma#aeme#" &or B11roper ma#aeme#" &or B1





Ma#aeme#" a" ERMa#aeme#" a" ER

Initia "hysica e#amInitia "hysica e#am

C!ntr! ee$ate% cerera "ressureC!ntr! ee$ate% cerera "ressure

►

+ead ele)a"ed 73+ead ele)a"ed 73°°

► Ma#i"ol 3. > 3. m*B, o)er 3 mi#/Ma#i"ol 3. > 3. m*B, o)er 3 mi#/

repea"ed e)er! 26 4rrepea"ed e)er! 26 4r

► %urosemide m*B, i)%urosemide m*B, i)




Sei'ure C!ntr!Sei'ure C!ntr!

► Dia=epam > 3 m slo' i)Dia=epam > 3 m slo' i)

►

14e#i"oi# &or prop4!la$"i$ a#"iepilep"i$14e#i"oi# &or prop4!la$"i$ a#"iepilep"i$

Feris c!ntr!Feris c!ntr!

► A$e"ami#op4e# 3 mA$e"ami#op4e# 3 m




La0ora"oriumLa0ora"orium

ECGECG

C4es" ra!C4es" ra!C- s$a#C- s$a#

L1L1



C- SCAN O% ISC+EMIC S-ROKEC- SCAN O% ISC+EMIC S-ROKE



C- SCAN O% +EMORR+AGE S-ROKEC- SCAN O% +EMORR+AGE S-ROKE



C- SCAN O% SA+C- SCAN O% SA+



MANAGEMEN- A- ER : %LO, C+AR-MANAGEMEN- A- ER : %LO, C+AR-

Ide#"i$a"io# 5 i#i"ial

assessme#"

ABC

+ead C- s$a#La0or

C4es" 9 ra!ECGL1

Co#sul" "o$orrela"eddep"Cardio/I#"er#al dep"/NC

Dia#osis

-4erap!



-4a#H !ou -4a#H !ou

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