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Trauma Team Neurosurgery Hasan Sadikin Bandung
Trauma Team Neurosurgery Hasan Sadikin Bandung
Bandung
Kompetensi Dasar
Setelah mengikuti pelatihan ini peserta mampu
untuk memahami teknik dan penatalaksanaan cedera kepala.
KOMPETENSI KHUSUS
1. DAPAT MENJELASKAN PENGERTIAN CEDERA KEPALA
2. DAPAT MENGIDENTIFIKASIKAN KORBAN GAWAT DARURAT CEDERA KEPALA
3. DAPAT MENYEBUTKAN JENIS CEDERA KEPALA
4. DAPAT MENSIMULASIKAN TEKNIK PENATALAKSANAAN CEDERA KEPALA
Head trauma: injury to the head,
which could cause structural or
functional damage to the brain.
Indications:
History of injury to the head, lacerations,
hematoma
Visible wound on the head:, lacerations,
hematoma
Abnormal radiological findings
Clinical evidence of brain injury:
decrease of consciousness, amnesia,
neurological deficits, seizures
Brain Injury is a leading cause of
death and disability worldwide.
Injuries to the brain are among the most
likely to result in death and permanent
disability
Head injuries are commonly presented to the
neurosurgeon, encompassing approximately 2%
of the population annually.
10 % of these die prior reaching a hospital
Of These
80% mild
10% moderate
10% severe
> 20% of head injured patients suffer varying
degrees of disability
The head contents can be divided into the following:
1. Scalp.
2. Skull.
3. Meninges.
4. Brain.
5. Cerebrospinal fluid.
Scalp
1. S : Skin (epidermis, dermis)
2. C : Loose connective tissue
3. A: Epicranial aponeurosis
(galea aponeurotica)
4. L: Loose areolar tissue
5. P: Pericranium (periosteum)
Bleeding from scalp laceration can result in major blood loss, especially in children
Composed of:
Cranial Vault
Cranial Base
The floor of the cranial cavity is
divided into 3 parts:
- Anterior fossa → frontal lobe
- Middle fossa → temporal lobe
- Posterior fossa → brain stem
and cerebellum
Meninges
1. Dura mater
Subdural space is a potential space, where
hemorrhage can occur
2. Arachnoid mater
Cerebrospinal fluid circulate between the
arachnoid and pia matter in the subarachnoid
space
3. Pia mater
Pia mater connects directly to brain
parenchyme
Acceleration –deceleration injury
Coup - Countercoup injury
Rotational/shearing injury
Head injuries are classified according to:
1) Mechanism of injury
2) Severity of the injury
3) Morphology of the injury
Blunt head injury
High-velocity: motor vehicle
accident
Low-velocity: falls, assault
•Epidural Hemorrhage
•Focal •Subdural Hemorrhage
•Intracerebral Hemorrhage
•Subarachnoid Hemorrhage
PREHOSPITAL
SIGN, 2009
Anamnesa
Pemeriksaan CT Scan kepala merupakan indikasi bila memenuhi kriteria kecurigaan perlunya
tindakan bedah saraf sangat tinggi
Sakit kepala berat atau muntah2
Riwayat penurunan kesadaran, rinorea, otorea, amnesia
CT scan abnormal, fraktur skull
Intoksikasi alkohol/ obat
Cedera penyerta bermakna
Tidak ada yang mengawasi di rumah
Letak rumah jauh dari RS
The significance of skull fracture should not be
underestimated since it takes considerable force to
fracture the skull.
linear vault fracture increase the risk of an intracranial
hemorrhage by about 400 times in a conscious patient and
by 20 in comatose patient.
Depressed skull fracture more than the thickness of the
skull require surgical elevation
Open or compound skull fracture require early surgical
repair
Basal skull fractures usually require CT
scan with bone window
Clinical signs of basal skull fracture
Periorbital ecchymosis (Raccoon eye)
Local trauma or not?
Retroauricular ecchymosis (Battle’s sign)
CSF leakage (rhinorrhea, otorrhea)
Halo Sign, litmus paper, β-transferrin
7th nerve palsy
Skull X-Ray is useful
•Linear
•Depressed
•Diastatic
•Linear
•Depressed
•Diastatic
•Basilar
Linear fractures, diastatic fractures:
High probability of intracranial lesion: epidural hemorrhage