0.Trauma Kepala

8/13/2019 0.Trauma Kepala

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HEAD TRAUMA

Oleh :Litany alamudi

Pembimbing :Dr. Jovizal,Sp.S


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Layers of the Cranial Vault

Anatomy of the Brainwww.neurosurgery.org/pubpgages/patres/anatofbrain.html#micro


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Definition Traumatic Brain Injury

Traumatic brain injury (TBI) is a seriousneurodisorder commonly caused by car accidents,

sports related events or violence

Review molecular mechanisms in the pathogenesis of traumatic brain injuryhttp://www.hh.um.es


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Mechanisms of Injury for TBI


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Traumatic Brain Injury

Primary Brain Injury

Results from what hasoccurred to the brain at

the time of the injury

Secondary Brain Injury

Physiologic andbiochemical events which

follow the primary injury

World journal of emergency surgerymolecular mechanisms of traumatic brain injury:the missing link in management


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Traumatic Head Injury

www.med.ub.es/All-Net/english/neuropage/trauma/head-8htm


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HEAD INJURIES / BRAIN INJURIES

Skull fractureDiffuse Axonal InjuryEpidural HematomaSubdural Hematoma

Coup contussionContracoup contussion



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EPIDURALANDSUBDURALHEMATOMA

www.med.ub.es/All-Net/english/neuropage/trauma/head-8htm


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SUBDURALHEMATOMA

C d C


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Coup and ContracoupContusions

A combination of vascular and tissue damage leadsto cerebral contusion

Coup contusions occur at the area of direct impact

to the skull and occur because of the creation ofnegative pressure.

Contracoup contusions are similar to coupcontusions but are located opposite the site of

direct impact



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ASSESSMENT

Note: Monitorsecure airway and protect c-spine

Assess breathing

Assess circulation Control major bleeding

Prevent hypotension

Transport decision and interventions

GCS

Guidelines for the management of severe traumatic brain injury 3rd edition


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ASSESSMENT DETAILEDEXAM

Vital signs SAMPLE history Head-to-toe exam, including neurological

and GCS, fluid Continuous observation



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Management ofTraumatic Head Injury

Maximize oxygenation and ventilation

Support circulation / maximize cerebral

perfusion pressure

Decrease intracranial pressure

Decrease cerebral metabolic rate


P i S d


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Primary vs. SecondaryBrain Injury

Primary injury is immediate from bruising orpenetrating objects

Secondary injury is from hypoxia orperfusion of the brain Caused by swelling, hypoxia, or hypotension Hyperventilation decreases perfusion of the brain

tissueProtect airway, give oxygen, maintain BP



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Intracranial Pressure (ICP)

ICP is usually low (15mmhg was one of five

independent risk factors associated with death.



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Lowering ICP

Evacuate hematoma Drain CSF Intraventricular catheters use is limited by degree of

edema

Craniotomy Permanence, risk of infection, questionable benefit

Reduce edema Promote venous return Reduce cerebral metabolic rate Reduce activity associated with elevated ICP



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Diuretic Therapy

Osmotic Diuretic Mannitol (0.25-1 gm / kg) Increases osmolarity Vasoconstriction

(adenosine)

Loop Diuretic Furosemide Decreased CSF formation Decreased systemic and

cerebral blood volume(impairs sodium and water

movement across blood brainbarrier)



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Hypertonic Fluid Administration

Hypertonic saline Comparing mannitol with barbiturates for controlICP after TBI



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Anesthetics, Analgetic and sedatives

High dose barbiturate therapy can result in control ofICP when all others medical and surgical treatmentshave failed.

Anticonvulsants - Prevent seizure activity

PentobarbitalAdverse effects include hypotension and bone

marrow dysfunction

Used only after unsuccessful attempts to control

ICP and maximize CPP with other therapies



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Dose regimens


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Factors that Effect Secondary BrainInjuries

Blood PressureOxygenationTemperature

Control of Blood GlucoseFluid Volume Status Increased Intracranial Pressure



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References

Dr. Baxter Larmon, Director of the UCLA CPCand Professor of Medicine, UCLA School ofMedicine

UCLA EMT Lectures, Barry Jensen and EMTTeam, 2003

Brady / DOT paramedic lectures and curriculum

www.emedicine.com


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Evidence SupportingNormoventilation

Forbes et al. (1998) Journal of Neurosurgery, 88(3)

Marion et al. (1995) New Horizons, 3(3)

McLaughlin & Marion (1996) Journal of Neurosurgery, 85(5

Muizelaar et al. (1991) Journal of Neurosurgery, 75(5)

Newell et al. (1996) Neurosurgery, 39(1)

Skippen et al. (1997) Critical Care Medicine, 25(8)

Yundt & Diringer (1997) Critical Care Clinics, 13(1)

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