Ethic and patient safety in

Trauma Patient

dr. Affan Priyambodo Permana, Sp.BS(K)

Neurosurgery Department | Faculty of Medicine, Universitas
Indonesia dr. Cipto Mangunkusumo National Hospital
Kaidah Dasar Bioetik
Beneficence
• (altruism = berbuat baik)

Non maleficence
• (tidak merugikan, first do no harm)

Autonomy
• (hak untuk menentukan nasib diri sendiri)

Justice
• (tidak boleh membedakan kedudukan sosial, tingkat ekonomi, gender, politik,
agama)
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 Ethics in Treating a Patient with Neurotrauma
Informed consent
• Ethical Challenge
• What the complication in neurotrauma?
• Informed consent for emergent intervention?
Ethics of Dealing with Patients in an Altered State of Consciousness
Wishes of the patient
• How the prognosis?
• Level of impairment that a patient may experience after recovery from a neurotraumatic
injury
• Challenging for families to make a decision
Suicide Resuscitation
• Psychiatric disorder
Adhere to guideline
Patient Safety

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IPSG 4 Meningkatkan benar lokasi, benar pasien, benar prosedur
pembedahan/Ensure Correct-Site, Correct-Procedure,
Correct-Patient Surgery
• Melakukan site marking
• Menggunakan dan melengkapi surgical checklist
• Melakukan time out dan sign out

Site marking?
Pada tubuh yang memiliki 2 sisi,
atau level multipel (jari, tulang
bekajang)
Ditulis “Ya”
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Stabilization and Emergency
Management of
Head Trauma

dr. Affan Priyambodo Permana, Sp.BS(K)

Neurosurgery Department | Faculty of Medicine, Universitas
Indonesia dr. Cipto Mangunkusumo National Hospital
 Traumatic Brain Increasing number of TBI in the ER and hospitalization
Injury

Developing countries = rapid surge during

urbanization = rise in motor vehicle use à
increase of TBI-related motor vehicle
crashes in developing countries
 Road accidents cause
700.000 deaths every year in the world
3 out of 4 in developing countries

El-Gindi S, Mahdy M, Abdel AA. Traumatic

brain injuries in developing countries; road war
in Africa. Revista Espanola de Neuropsicologia.
2001;3(3):3-11
Dewan MC et al. estimating the global
incidence of traumatic brain injury. J Neurosurg.
2019; 130:1080-97
ABCD mnemonic – Primary Survey

& C-spine control

Monroe-Kellie Doctrine Brain consume 20% Oxygen
Skull, Brain, Blood, CSF Autoregulation à constant blood supply
CBF ~50 ml per 100 g brain tissue per min
MAP 50 – 150 mmHg
CPP 60 – 160 mmHg
Acute vs Chronic ICP

Compensatory reserve:
•Young 60 – 80
•Elderly 100- 140
Cerebral Herniation

1. Uncal
2. Transtentorial
3. Cingulata
4. Transcalvarial
5. Upward cerebellar / transtentorial
6. Downward cerebellar (tonsillar)
Functional Clinical Anatomy
Clinical Manifestation of Head Injury
Lucid Interval
Gold Standard Diagnostic
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Canadian C-Spine
Rule
Staircase Algorithm severe TBI ; Time is Brain

Youman’s Neurological Surgery 4th

Ed; Chapter 335: Surgical
Management of Traumatic Brain Injury
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Most common cases

Epidural Subdural Brain
hematoma hematoma contusion

Intracerebral Subarrachnoid Impressive

hemorrhage hemorrhage fractur
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Exploratory Burrholes
Kriteria klinis (Kompresi
batang otak yang tidak
perbaikan pasca
stabilisasi)
• Kompresi batang
otak: penurunan
GCS, anisokor
pupil, adanya
lateralisasi atau
deserebrasi
Burr Hole Evacuation
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Most DTICHs visualized on CT scans occur within 48 hours of injury.

2 hours 5 hours shortly 48 hours

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How to transfer head injury patient?
● Stabilize patient at trauma scene
● DO NOT MOVE patient unnecessarily
● Maintain ABC, ABC, ABC, ABC
● Protect cervical spine
● Stop active bleeding
● Relay information to receiving doctors:

○ ABC status

○ GCS & pupil size

○ Suspected injuries
● Transfer patient only if it is SAFE
dr. Affan Priyambodo
Permana, Sp.BS(K) TERIMA KASIH
+62 812-1808-1299
IG: @dokteraffan