CONTACT INJURY
Epidural Hemorrhag
Laserasi / avulsi scalp
Fraktur tulang tengkorak
Epidural hematoma
CONTACT INJURY
FRACTURES EDH
1. Acceleration Force PRIMARY BRAIN DAMAGE SDH
2. Deceleration Force 1. Cerebral laceration
2. Cerebral contusion ICH
Liniair/Rotation / Angular 3. Diffuse Axonal Injury IVH
SAH
1. Systemic Insult
2. Intracranial Insult
Reaksi intracranial
PRO ANTI
APOPTOSIS APOPTOSIS
TERAPI DASAR
Ditujukan terhadap Primary Brain Damage , Systemic Insults dan
Intracranial Insults
1. Mengatasi cerebral edema dan mengatasi
peningkatan tekanan intrakranial :
a. Larutan hipertonis : Mannitol 20% , Totilac®
b. Tindakan hiperventilasi terbatas
c. Tindakan operasi
2. Mengatasi hipoksia :
a. Saluran pernafasan yang ‘patent’
b. Perawatan dibawah ventilator
c . MAP yang normal
3. Mencegah terjadinya infeksi
1. Simvastatin (hydroxymethylglutaryl-coenzym A
reductase inhibitor) , inhibits posttraumatic brain
edema, reduces inflammatory cytokine release from
astrocytes after TBI
Cholestatat® 40 – 80 mg perhari oral
SKULL FRACTURES
Raccoon’s eyes
1. Rhinorrhea
2. Hyposmia / Anosmia
Kemungkinan terjadi
CSF leakage
1
1
2 2
1. Petrosum
2. Mastoid
1. Otorrhea (1)
2
2. Battle’s sign (2)
Sudden death
ags 27
Occulomotor (III), Trochlear (IV),
Abduscens (VI) nerves
ags 28
Reflex consensual
TINDAKAN :
Extraventricular drainage (EVD)
Kelumpuhan