PENANGANAN KEGAWATDARURATAN

STROKE DI TINGKAT LAYANAN PRIMER

dr. Achmad Junaidi,SpS
BAGIAN/DEPARTEMEN NEUROLOGI FK UNSRI/RSMH
2016
OVERVIEW

• STROKE
• KONDISI KEGAWATDARURATAN STROKE
• TATALAKSANA KEGAWATDARURATAN STROKE
STROKE

• DEFISIT NEUROLOGIS FOKAL / GLOBAL YANG

BERLANGSUNG CEPAT 24 JAM ATAU LEBIH DAPAT
MENYEBABKAN KECACATAN / KEMATIAN TIDAK ADA
SEBAB LAIN SELAIN GANGGUAN VASKULER ( WHO ).
• INFARK SISTEM SARAF PUSAT YANG MENGENAI
OTAK, MEDULLA SPINALIS DAN RETINA YANG
SESUAI DENGAN TEMUAN PATOLOGIK, IMAGING
DAN KLINIS.
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Anatomi Otak
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Anantomi Otak...cont
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Organisasi Fungsional
Lobus frontal  berkaitan dengan fungsi
emosi, fungsi motorik, dan di hemisfer
dominan pusat ekspresi wicara.
Lobus parietal  berhubungan dengan
fungsi sensorik dan orientasi ruang
Lobus temporal  mengatur fungsi memori,
lobus temporalis kiri berfungsi mengatur
kemampuan dalam menerima rangsangan
dan integrasi bicara.
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Organisasi Fungsional...cont
Lobus oksipital  bertanggung jawab dalam
proses penglihatan.
Lobus limbik  berkaitan dengan
pembentukan emosi dan menerima
informasi dari otak tengah dan belakang.
Lobus insular korteks gustatory utama,
integrasi bahasa dan visual vestibular,
fungsi otonom.
Cerebelum  fungsi koordinasi dan
keseimbangan.
Organisasi Fungsional...cont
Batang Otak

Keluar nervus kranialis 3 dan 4

Midbrain

Keluar nervus kranialis 5,6,7, dan 8

Pons

Medula Keluar nervs kranialis 9,10, 11, dan 12

oblongata
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Vaskularisasi Otak
Terdiri 2 pasang pembuluh darah besar:
A. Carotis interna
A. Vertebralis  A. Vertebralis kanan
dan kiri bergabung menjadi A. basilaris
Vaskularisasi Otak...cont

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Vaskularisasi Otak...cont

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 Faktor Resiko
• Umur
• Jenis Kelamin
• Ras-Etnis
Yang Tidak • BBLR
Dapat
Dimodifikasi • Faktor Genetik

• Hipertensi
• Merokok
• Diabetes
• AF
Yang Dapat
Dimodifikasi
• Dislipidemia
• Kurang Aktivitas Fisik
• Obesitas

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 FAST

Face Drooping – Does one side of the face droop or is it numb?

Ask the person to smile. Is the person's smile uneven

Arm Weakness – Is one arm weak or numb? Ask the person to

raise both arms. Does one arm drift downward?

Speech Difficulty – Is speech slurred? Is the person unable to

speak or hard to understand? Ask the person to repeat a simple
sentence, like "The sky is blue." Is the sentence repeated correctly?

Time to call 9-1-1 – If someone shows any of these symptoms,

even if the symptoms go away, call 9-1-1 and get the person to the
hospital immediately. Check the time so you'll know when the first
symptoms appeared.

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 The Cincinnati Prehospital Stroke
Scale
Facial Droop (have
patient show teeth or
smile):
Normal—both sides of
face move equally.
Abnormal— one side of
face does not move as
well as the other side

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 The Cincinnati Prehospital Stroke
Scale...cont
Arm drift (patient closes eyes and
extends both arms straight out,
with palms up, for 10 seconds):
Normal– both arms move the
same or both arms do not move
at all (other findings, such as
pronator drift, may be helpful)
Abnormal– one arm does not
move or one arm drifts down
compared with the other.

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 The Cincinnati Prehospital Stroke
Scale...cont
Abnormal Speech (have the patient say “you
can’t teach an old dog new tricks”):
Normal—patient uses correct words with no
slurring
Abnormal—patient slurs words,uses the
wrong words, or is unable to speak.
Interpretation: If any 1 of these 3 signs is
abnormal, the probability of a stroke is 72%.
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 Gejala Stroke
Lumpuh sebelah mendadak
Bicara jadi ngaco atau pelo
Lupa mendadak
Gangguan penglihatan mendadak
Mendadak tidak sadar atau koma.
Gangguan sensorik satu sisi tubuh
Diplopia, vertigo, afasia, disfagia, disatria, ataksia, dan
kejang yang terjadi secara mendadak

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KONDISI KEGAWATDARURATAN

• AIRWAY, BREATHING DAN SIRKULASI

• TEKANAN DARAH
• GULA DARAH
• TEKANAN INTRAKRANIAL MENINGKAT
Prehospital Evaluation and Management of
Potential Stroke Patients

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 KONTROL TEKANAN DARAH

In potential stroke patients who are hypotensive, defined as blood

pressure significantly lower than premorbid state or systolic blood
pressure significantly lower than premorbid state or systolic blood
pressure placement of the head of the stretcher flat and administration
of isotonic saline may improve their cerebral perfusion.
In contrast, in patients who are hypertensive (systolic blood pressure
≥140 mmHg), the benefit of routine prehospital blood pressure
intervention is not proven; consultation with medical control may assist
in making treatment decisions regarding patients with extreme
hypertension (systolic blood pressure ≥220 mmHg).

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• TEKANAN INTRAKRANIAL MENINGKAT
– SAKIT KEPALA HEBAT
– MUAL MUNTAH
– PENURUNAN KESADARAN
– PARESE NN VI BILATERAL / DIPLOPIA
– PAPIL EDEMA
• TATALAKSANA TTIK
– ATUR TEKANAN DARAH
– JAGA SUHU NORMAL
– KONTROL KADAR GULA
– BERI MANITOL
– EVAKUASI ICH
– CRANIEKTOMY / V-P SHUNT
 Kemungkinan Trombolisis

Onset ditentukan dengan jelas < 3 jam  ke unit yang

mempunyai fasilitas trombolisis.

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