Guide to the essestials in emergency medicine by Sherly

Oii and Peter Manning

1
 Klasifikasi

Cephalgia

Trauma Non trauma

2
 Nyeri kepala e.c
Trauma Kepala
Trauma

Tidak
langsung/
Langsung secondary
brain
damage

Cortical Difuse
Herniasi
confusions white Intra Iskemia
Edema otak tentorii/ Infeksi
& matter kranial otak
tonsilaris
laceration lesion haematom

Extra+intradura
Extradural Intradural
l

3
 Penatalaksanaan
 Airway  cek patensi jalan napas
 Breathing  rate, rhythm, quality, deep,
saturasi oksigen
 Circulation  akral, CRT, nadi, tekanan
darah
 Disability  chest, abdominal, head and
limb

4
Perhatikan :
 GCS
 Periode post traumatic amnesia
 Kausa/arah/derajat trauma
 Adanya sakit kepala dan muntah

5
Periksa:
 Laserasi +/-
 Fraktur basis cranii
 GCS
 Respons pupil
 Kelumpuhan
 Pergerakan bola mata

6
 Pemeriksaan penunjang
Alat Indikasi
Foto polos skull Penurunan kesadaran singkat
Gejala neurologis focal (-)
Rhinorrhoe/otorrhae
Hematom scalp
Sulit dianamnesa

CT scan kepala Derajat trauma immediate

Penurunan kesadaran (delirium)
Gejala neurologis focal (+) ≤ 8 jam
Kejang (+)
Derajat delayed
Penurunan kesadaran persisten
Gejala neurologis focal > 8 jam
Fraktur kompresi (+)
Peningkatan CSF > 7 hari 7
Skull x-ray
What to look:
 Linear/ deppressed skull fractures
 Midline position of calcified pineal gland
 Air fluid levels in sinuses
 Aerocele
 Facial fractures
 Foreign bodies
 Widening of sutures

8
 Terapi
 Intubasi  oksigenasi
 Depresi nafas  ventilasi
 Tanda peningkatan TIK  manitol
 Laserasi : debridement, antibiotik
 Koreksi kehilangan cairan
 Anti konvulsan
 Neuroprotector agent
9
Indikasi intubasi
 Coma (GCS<8)
 Rapidly deteriorating GCS of ≥2
 GCS ≤14 in the presence of unilateral dilated pupil
 Clinical respiratory distress
 Concomitant maxillofacial injuries
 Repeated convulsions
 Concurrent severe pulmonary edema, cardiac / upper
abdominal injury

10
ventilasi
 Bila ada kecurigaan kenaikan TIK, hiperventilasi harus
dilakukan untuk mencapai PCO2 30-35mmhg
 Secara umum PCO2 normal berkisar 35-40mmhg

11
mannitol
 Indikasi:
 Comatose patient with initial normal reactive pupils -
>pupillary dilation with/without hemiparesis
 Bilateral dilated and non reactive pupils that are not
hypotensive

12
13