Cedera Kepala

KULIAH CMS 2013:

dr. Robert Sinurat, SpBS (K)
 Insidensi
USA:
- 200/ 100.000 penduduk (600.000
kasus per tahun)
- Populasi tertinggi usia 15-24 tahun
- Laki-laki >2 kali daripada wanita
- CKB: 10 % (Anderson, dkk)

Indonesia:
Thn 2000: 1841 orang dirawat di
RSHS Bandung,
CKB: 144 orang (12,8 %) (R.Sinurat)
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Bahan Buku TEKS:

• 1. Neurosurgery: Youmans
• 2. Head Injury: Pieter Reily
• 3. Head injury: Narayan
• 4. Ilmu Bedah Saraf: Prof. Satyanegara
• 5. Cedera Kepala: Prof. Eka W
 CPP = MABP - ICP

• CPP ≥ 70 mmHg
• MABP= S + 2D
3
• ICP = 0 – 10 mmHg

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 Hukum “Monro Kellie”
Volume intra kranial :
• Jaringan otak
• Darah Konstan
• LCS

Volume tek. intra kranial herniasi

Perdarahan
Edema otak

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 Mekanisme Cedera Kepala

• Fleksi
• Ekstensi Akselerasi - deselerasi
• Shearing

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1. Cedera primer

Primary traumatic brain damage

Diffuse:
1. Diffuse Axonal Injuryal
2. Diffuse Vascular Injury
Focal :
1. Vascular injury resulting in:
- Intracerabral hemorrhage
- Subdural hemorarhage
- Extradural hemorrhage (EDH)
2. Axonal injury
3. Contusion
4. Laceration
2. CEDERA SEKUNDER

Secondary brain damage

Diffuse
1. diffuse hypoxic-ischemic damage
2. diffuse brain swelling
Focal
1. Focal hypoxic-ischemic injury
2. Focal brain swelling
Penyebab Cedera Sekunder Ekstra dan Intrakranial

• Ekstrakranial
- Hipoksia - Hipotensi - Hiponatremi
- Hipertermia - Hipoglikemia

• Intrakranial
- Perdarahan
- Ekstradural(EDH) - Subdural
- Intracerebral - Intraventikular
- Subarachnoid
- Edema
- Infeksi
- Meningitis
- Abses otak
 Dasar Molekuler Cedera Otak

1. Radikal Bebas
2. Gangguan Homeostase Kalsium
3. Efek Cytokine
4. Mekanisme Lain:
- Reseptor Opiat
- Konsentrasi Magnesium Intraselluler
 Primary Traumatic Insult

Hypoxia Ischemia Hypotension

↓ Energy Metabolism

Free Radical ExcitatoryRelease Cytokines Endorphines

Membrane Damage

Cell Death
G
L NMDA Receptor
U Ca++ Hydrolisis
T
A
M AMPA
A Na Cell Swelling
T
 PENATALAKSANAAN
1. Primary Survey
A. Airway, dengan kontrol servikal
B. Breathing
C. Circulation
D. Disability
E. Exposure
 Resusitasi
2. Tambahan terhadap primary survey
3. Secondary survey
4. Tambahan terhadap secondary survey
5. Reevaluasi
6. Terapi definitif 15
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