THE EFFECT OF GIVING OXYGENATION WITH SIMPLE OXYGEN MASK AND

THE POSITION 30° OF HEAD TOWARD TO CHANGE OF CONSCIOUSNESS

LEVELS OF MODERATE HEAD INJURY PATIENTS IN
BANJARMASIN ULIN GENERAL HOSPITAL

*Alit Suwandewi
*University of Muhammadiyah Banjarmasin, South Kalimantan – Indonesia
Email: alit_dewi@ymail.com

ABSTRACT
Head injury is directly or indirectly mechanical injuries that resulted wound in the scalp, skull
fracture, tear the lining of the brain, and brain damage, and neurological disorders. The basic
method for brain protection of head injury patients are freeing the airway and giving adequate
oxygenation. Giving oxygenation with simple oxygen mask and position 30° of head are the
appropriate action for the moderate head injury classification to launch the cerebral oxygen
perfusion and to increase consciousness level. The purpose of this research were to determine
the GCS before and after giving oxygenation with simple oxygen mask the and position 30 ° of
head and to analyze the effect of giving oxygenation with simple oxygen mask and position 30
°of head to change the levels of consciousness of moderate head injury patients. This research
was an quasi experimental study with 30 respondents. The test were used Wilcoxon Test. The
results showed that there was an effect of giving oxygenation with simple oxygen mask and
position 30 °of head toward to change the level of consciousness of moderate head injury
patients. GCS average value before was 17,92 and GCS average after value was 14,09 with p
value was 0.009. This is applicative research, so it’s need to reflikatif and develop to improve the
quality and monitoring of emergency nursing services.

Keywords : Simple Oxygen Mask, Position 30° of the Head Levels of Consciousness GCS,
Moderate Head Injury

I. Introduction The brain is an organ that is vital to all

A preliminary examination of a patient
with a head injury is that the Glasgow coma
scale (GCS) is a standardized assessment
system used to assess the level of
consciousness in patients with impaired
consciousness. GCS is a numerical
calculation of cognitive, behavioral, and
neurological functions. GCS is a standard
instrument that can be used to measure the
level of awareness of head trauma patients,
is one component Which is used as a
treatment reference, the basis of general
clinical decision-making for patients (Ricard
Coton & Michelle 2010).
activities and functions of the body, because
in the brain there are various control
centers such as physical control, intellectual,
emotional, social, and skills. Although the
brain is in a closed space and is protected by
strong bones but can also be experienced
damage. One of the causes of brain damage
is the occurrence of trauma or head injury
that can lead to damage to the brain
structure, so its function can also be
disrupted (Black & Hawks, 2009).
The brain's oxygen balance is
influenced by cerebrospinal blood flow of
15-20% of cardiac output (Black & Hawks,
2009). Brain protection is a series of actions
performed to prevent or reduce damage to
brain cells caused by ischemic state. Brain
ischemia is a hemodynamic disorder that
will cause a decrease in cerebral blood flow
to a level that will cause irreversible brain
damage. The basic method of passing brain
protection is by freeing the airway and
adequate oxygenation (Simon M, Andrew B,
Mark CB, 2006).
The results of Noor khalilati (2014)
study that proper administration of oxygen
in head injured patients is by using ordinary
masks, as it is more effective in increasing
oxygen saturation compared with nasal
cannula. According to Summers et al. (2009)
to maximize oxygenation requires higher
head elevation as it facilitates increased
cerebral blood flow, where in the 30º head
position there is an increase in cerebral
blood flow (CBF).
The primary goal of head injury
management is to optimize recovery from
primary head injury and prevent secondary
head injury caused by ischemic brain (Tisdal
M, 2008). Management of a good head
injury should be initiated from the scene,
during transportation, at the emergency
department, until difinitive therapy. Proper
and proper management will affect patient
outcomes.
The results of preliminary study
conducted by the author on February 2,
2015 in the IGD room Ulin Regional General
Hospital Banjarmasin, there is no SOP
(Standard Operating Procedure) about
handling head injury patients. But the
hospital has provided a policy stating that
the competent officer to perform or use life
saving tools in the ER is one of the
paramedics who have been trained and
certified to use the tool such as oxygen
delivery and position on Head injured
patients. It is not yet known whether
oxygen delivery through simple masks and
30º head positions provided by nurses can
show a change in the level of consciousness
in patients with moderate head injury.
II. Method
This study was an Quasi-Experimental
research that is a method that test the
hypothesis in the form of causal relationship
through manipulation (treatment,
intervention, treatment) independent
variable, then test the changes caused by
the manipulation earlier. The research
design used is Pretest-Postest control
design. Respondent's measurement begins
with pre test, after given treatment /
intervention is done back or post test
(Ircham, 2013). In this study the
intervention was done once that first
intervention was done by measuring GCS
first, after that was given oxygen through
the usual mask and head position 30 ° then
GCS was measured again after 24 hours.
A. Instrument
The instruments in this study are GCS
assessment guides 1. Response open Eyes
(Eye Or E), 2. Response
Best Motoric (Motoric Or M) 3. Response
Verbal Best (Verbal or V) and observation
forms, oxygen with a simple mask 6 Liter
speed and position of t he head 30º
The research was conducted at ICU of
Ulin General Hospital Banjarmasin in June
2015 until July 2015. The population in this
study were all patients whose with
moderate head injury . Samples were taken
by purposive sampling sample teqhnique
were 30 respondents with criteria are: 1.
Patients with a moderate head injury
diagnosis with GCS 9-12, 2.Patients with
SpO2 were less than normal (<95%)
B. Data Analysis
III. Independent sample t-test, because the data distribution is not normal then the
requirement using t-test test is not met then use alternative test Wilcoxon Test with
significancelevel α = 0,05 to see difference in group, If result obtained <α then Ho
Rejected means there is an effect of simple mask oxygen delivery and a 30 ° head
position on the change of GCS awareness level. Results

Characteristics of Respondents
Table 1.
Distribution of Respondents gender and Age
Characteristics Amount Percentage(%)
1. Gender
a. Man 20 66,7
b. Women 10 33,3
Total 30 100
2. Age
a. <=32 Years 17 56,7
b. >32 Years 13 43,3
30 100

Normality Test of GCS Value Before And After Simplified Oxygen Mask And Head Position 30 °
Based on Test of Normality Shapiro-Wilk
Table 2.
Normality test analysis based on Shapiro-Wilk test of normality GCS values before and after
simple oxygen mask administration and head position 30 °
Variables Kolmogorov-Smirnov Shapiro-Wilk
GCS Before 0,000 0,000
GCS After 0,001 0,002

GCS Awareness Value Before Simple Mask Giving Simple And Head Position 30 ° In Medium
Head Injury Patients
Table 3.
Distribution of GCS awareness level values before simple oxygen mask administration with 30º
head position
Results before delivery
Simple oxygen mask Total
With a head position of 30 °
F %
9 14 46.7 14
46.7
Level 10 7 23.3 7
Awareness 23.3
11 4 13.3 4
13.3
 12 5 16.7 5
16.7
30 100% 30
Total 100

GCS Awareness Value After Simple Mask Giving Oxygen And Head Position 30 ° In Medium
Headache Patients
Table 4.
Distribution of GCS awareness levels after simple oxygen mask administration and 30º head
position

Results after simple oxygen mask administration

Total
With a head position of 30 °
Up Fixed Down
f % f % F %
9 10 33.3 0 0 4 13.3 14
46.7
Level 10 6 20.0 0 0 1 3.3 7
Awareness 23.3
11 4 13.3 0 0 0 0 4
13.3
12 4 13.3 0 0 1 3.3 5
16.7
24 80 0 0 6 20 30
Total 100

Effect of GCS Values Before and After Giving Simple Oxygen Mask
Table 5.
Results of GCS value analysis before and after oxygen administration of simple mask and head
position 30 °

Variables Mean Rank P value

GCS Before 17.92 0,009
GCS After 14.90 0,009

IV. Discussion of 15 or 50% while distribution of

The results of this study obtained the
youngest respondent age is 11 years and
the oldest 68 years, whereas for the sex of
respondents in this study at most is male
gender. GCS difference value with age
category of less than or equal to 32 years
difference of GCS value with total difference
respondent with age category over 32 years
difference of GCS value with total difference
of 9 or 30%.
Evan (1996) in Nasution (2010) which
mentions the distribution of head injury
cases in men twice as often as women.
Other studies also mention the same thing

that most 74% of cases of head injury are
male (Suparnadi, 2002 in Nasution, 2010).
The large number of men in the event of a
head injury is closely related to the
mobilization of more frequent individuals.
After a simple mask oxygen delivery
and a 30 ° head position an increase in GCS
value is mean 10 to mean 11.07,
Sastrodiningrat (2006) GCS is a strong
predictor of prognosis. In the Jannet et al
study reported 82% of patients with GCS
score of 11 or more, within 24 hours after
injury had good outcome or moderately
disabled and only 12% died or got severe
disability. Outcomes will progressively
decrease if the initial GCS score decreases.
The main focus of management of
patients with head injury is to prevent
secondary brain injury. Giving oxygenation
and maintaining good blood pressure and
adequate for adequate brain perfusion is
paramount and especially to prevent and
limit the occurrence of secondary brain
injury that will ultimately improve the
patient's final outcome. This is in
accordance with what is described by Patria
(2012) that in patients head injury should be
given oxygen therapy by using a mask or
reservoir mask with a concentration of 40-
80% oxygen.
Hypoxia is inadequate tissue
oxygenation at the tissue level, this
condition occurs due to oxygen delivery
deficiency or the use of oxygen diular
(Potter and Perry, 2005). Oxygenation is the
most basic basic human need. The presence
of oxygen is one component of gas and vital
elements in metabolic processes and to
maintain the viability of all body cells
(Sulistyo, 2010).
Basic human needs according to the
theory of Maslow's Hierarchy is a theory
that nurses can use to
understand the relationship between basic
human needs while providing care.
Physiological needs are essential for
survival, one of which is the need for
oxygenation (Potter and Perry 2005).
Christopher B, et.al (2012) they
concluded that oxygenation of brain tissue
is closely related to some outcome
parameters and patient prognosis.
Application of intervention therapy to keep
oxygenation of brain tissue above a certain
threshold can Improve mortality and
neurological outcome in head injury
patients.
Head elevation based on physiological
responses is a change in position to increase
blood flow to the brain and prevent the
occurrence of increased ICT. Some clinical
nurses perform bedrest acts with head
elevation of no more than 30 °, rationally
preventing increased risk of decreased
cerebral perfusion pressure and may further
worsen cerebral ischemia if vasospasm is
present (Anne et al., 2005).
V. Conclusion
There is effect of oxygen delivery through
simple mask and head position 30 ° to
change of consciousness level with p value
0,009 with average GCS value before oxygen
delivery intervention through simple mask
and head position 30 ° that is 10 with
standard deviation 1,145 and mean of GCS
value after done The oxygen delivery
intervention through a simple mask and a
30 ° head position is 11.07 with a standard
deviation of 2.766.
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