Penanganan Trauma Kepala

Kuliah Pakar Neuropsikiatri

2014
Anatomi
Cedera Kepala
Scalp Wounds
Skull Injuries
Traumatic Brain Injury
Scalp Injuries
Skull Fractures
Traumatic Brain Injury
Cedera otak primer
Cedera otak sekunder
Tekanan Intrakranial
TIK ==> CSF, Blood, Brain
CPP = MAP - TIK
Sindroma Herniasi Serebri
GCS < 9 dengan deceberate
GCS < 9 dilatasi pupil, pupil bilateral, no reflek
GCS < 9, kemudian turun > 2 poin
Klasifikasi TBI
Gegar otak
Kontusio serebri
Perdarahan subarakhnoid
Cedera aksonal difuse
Intracranial hemorrhage
Hematom epidural akut
Hematom subdural akut
Intraserebral hemorrhage
Anoxic Brain Injury
Management
Scene Size Up
Assesment
LOC : AVPU, GCS
Vital Signs:
Jarang menyebabkan syok, jika syok mungkin
multiple injury
Cushing Syndrome
Pupil: Dilated, unequal, absent response
Herniation syndrome




10
Management of Head Injury
ABCs with C-spine control
C-collar, long board
Ensure adequate oxygenation
If signs of cerebral herniation present, controlled hyperventilation
with BVM at 20-24 breaths/minute
Any patient with significant head injury has neck injury
until proven otherwise
11
Management of Head Injury
Controlled hyperventilation
Lowers blood carbon dioxide levels
Causes constriction of blood vessels in brain
As vessels constrict brain shrinks
As brain shrinks intracranial pressure drops
Circulation:
delayed resuscitation Vs early
resuscitation
Koloid Vs Cristaloid
12
Management of Head Injury
Do NOT apply pressure to open or
depressed skull fractures
Do NOT attempt to stop flow of blood
or CSF from nose, ears
Do NOT remove penetrating objects