Mekanisme Gangguan Kesadaran Power Point

8/18/2019 Mekanisme Gangguan Kesadaran Power Point

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Tanda Klinik Fase Diensefalik.


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Tanda Klinik Fase Diensefalik.


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Tanda Klinik Fase Midbrain Pons Atas.


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Tanda Klinik Herniasi Unkus Fase Dini N. III


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Tanda Klinik Herniasi Unkus Fase Lanjut N.III


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Tanda Klinik Fase Midbrain Pons Bawa


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Cardiac death: Heartbeat and breathing stop

Brain death:

Irreversible cessation of all functions of theentire brain, including the brain stem


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First introduced in a 1968 report authored b aspecial committee of the Harvard !edical "chool

#dopted in 198$, %ith modi&cations, b the'resident(s Commission for the "tud of )thical'resident(s Commission for the "tud of )thical

'roblems in !edicine and Biomedical *esearch'roblems in !edicine and Biomedical *esearch,as a recommendation for state legislatures andcourts

+he brain death standard %as also emploed in

the model legislation -no%n as the .niform.niform/etermination of /eath #ct/etermination of /eath #ct, %hich has beenenacted b a large number of 0urisdictions andthe standard has been endorsed b theinuential #merican Bar #ssociation2


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12 Clinical or radiographic evidence of anacute catastrophic cerebral eventconsistent %3 d4 of brain death

52 )4clusion of conditions that confoundclinical evidence i2e27metabolic

2 Con&rmation of absence of druginto4ication or poisoning

#lso barbiturates, !B;s


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Cerebral motor response to pain "upra7orbital ridge, the nail beds, trape>ius

!otor responses ma occur spontaneouslduring apnea testing spinal ree4es

"pinal ree4 responses occur more often inoung

If pt had !B, then test %3 train7of7four

"pinal arcs are intact?


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*ound, oval, or irregularl shaped !idsi>e e, the

light ree4 remains intact onl in the absence ofbrain death I@ atropine does not mar-edl aAect response 'araltics do not aAect pupillar si>e +opical administration of drugs and ee trauma

ma inuence pupillar si>e and reactivit 're7e4isting ocular anatomic abnormalities ma

also confound pupillar assessment in brain death


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culocephalic ree4 doll;s ees

@estibulo7ocular cold caloric test


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culocephalic ree4 *apidl turn the head 9$D on both sides

ormal response deviation of the ees tothe opposite side of head turning

Brain death oculocephalic ree4es areabsent no /oll;s ees no ee movement inresponse to head movement

ot Barbie, but old fashioned tpe dolls 'ainted vs2 %ooden ees in porcelain heads


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http://images.google.com/imgres?imgurl=http://telemedicine.orbis.org/data/1/rec_imgs/57_9.jpg&imgrefurl=http://telemedicine.orbis.org/bins/volume_page.asp?cid=1-3-4-14&h=115&w=181&sz=8&tbnid=MQ3goRdz9I4J:&tbnh=60&tbnw=94&start=4&prev=/images?q=%22oculocephalic%22&hl=en&lr=&sa=G


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)levate the HB $D

Irrigate both tmpanic membranes %ithiced %ater

bserve pt for 1 minute after each earirrigation, %ith a E minute %ait bet%eentesting of each ear

Facial trauma involving the auditor canal and

petrous bone can also inhibit these ree4es


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stagmus both ees slo% to%ard cold,fast to midline ot comatose

Both ees tonicall deviate to%ard cold%ater Coma %ith intact brainstem

!ovement onl of ee on side of stimulus

Internuclear ophthalmoplegia "uggests brainstem structural lesion

o ee movement Brainstem in0ur 3 death

http://www.fpnotebook.com/NEU90.htmhttp://www.fpnotebook.com/NEU160.htmhttp://www.fpnotebook.com/NEU160.htmhttp://www.fpnotebook.com/NEU90.htm


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Corneal ree4es are absent in brain death Corneal ree4es 7 tested b using a cotton7

tipped s%ab

rimacing in response to pain can be testedb appling deep pressure to the nail beds,supra7orbital ridge, +!G, or s%ab in nose

"evere facial trauma can inhibit interpretationof facial brain stem ree4es


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Both gag and cough ree4es are absentin patients %ith brain death ag ree4 can be evaluated b stimulating

the posterior pharn4 %ith a tongue blade, butthe results can be dicult to evaluate in orallintubated patients

Cough ree4 can be tested b using )++suctioning, past end of )++


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'aC5 levels greater than 6$ mmHg, 5$mmHg over baseline

+echniJue: 're7o4genate %ith 1$$K o4gen several min

#llo% baseline 'aC5 to be L


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)) $ minutes

< vessel angiograph

Cerebral blood o% perfusion scan


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http://images.google.com/imgres?imgurl=http://pedsccm.wustl.edu/All-Net/media/gif/neurogif/trauma/cpscanbd.jpg&imgrefurl=http://pedsccm.wustl.edu/All-Net/english/neurpage/trauma/head-5.htm&h=249&w=538&sz=16&tbnid=oBGKQkhMfkYJ:&tbnh=60&tbnw=129&start=3&prev=/images?q=%22cerebral+perfusion+scan%22&hl=en&lr=&sa=N


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ecessar to repeat the clinical e4amination afteran Mappropriate; observation period has passed

Con&rmator )) unless it is determined thatthere is no blood o% to the brain

Age 7 days to 2 monthsAge 7 days to 2 months +%o e4aminations


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12 Clinical or radiographic evidence of anacute catastrophic cerebral eventconsistent %3 d4 of brain death

52 )4clusion of conditions that confoundclinical evidence i2e27metabolic

2 Con&rmation of absence of druginto4ication or poisoning

#lso barbiturates, !B;s


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Cerebral motor response to pain "upra7orbital ridge, the nail beds, trape>ius

!otor responses ma occur spontaneouslduring apnea testing spinal ree4es

"pinal ree4 responses occur more often inoung

If pt had !B, then test %3 train7of7four

"pinal arcs are intact?


58/103

*ound, oval, or irregularl shaped !idsi>e e, the

light ree4 remains intact onl in the absence ofbrain death I@ atropine does not mar-edl aAect response 'araltics do not aAect pupillar si>e +opical administration of drugs and ee trauma

ma inuence pupillar si>e and reactivit 're7e4isting ocular anatomic abnormalities ma

also confound pupillar assessment in brain death


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culocephalic ree4 doll;s ees

@estibulo7ocular cold caloric test


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culocephalic ree4 *apidl turn the head 9$D on both sides

ormal response deviation of the ees tothe opposite side of head turning

Brain death oculocephalic ree4es areabsent no /oll;s ees no ee movement inresponse to head movement

ot Barbie, but old fashioned tpe dolls 'ainted vs2 %ooden ees in porcelain heads


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http://images.google.com/imgres?imgurl=http://telemedicine.orbis.org/data/1/rec_imgs/57_9.jpg&imgrefurl=http://telemedicine.orbis.org/bins/volume_page.asp?cid=1-3-4-14&h=115&w=181&sz=8&tbnid=MQ3goRdz9I4J:&tbnh=60&tbnw=94&start=4&prev=/images?q=%22oculocephalic%22&hl=en&lr=&sa=G


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)levate the HB $D

Irrigate both tmpanic membranes %ithiced %ater

bserve pt for 1 minute after each earirrigation, %ith a E minute %ait bet%eentesting of each ear

Facial trauma involving the auditor canal andpetrous bone can also inhibit these ree4es


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stagmus both ees slo% to%ard cold,fast to midline ot comatose

Both ees tonicall deviate to%ard cold%ater Coma %ith intact brainstem

!ovement onl of ee on side of stimulus Internuclear ophthalmoplegia "uggests brainstem structural lesion

o ee movement Brainstem in0ur 3 death

http://www.fpnotebook.com/NEU90.htmhttp://www.fpnotebook.com/NEU160.htmhttp://www.fpnotebook.com/NEU160.htmhttp://www.fpnotebook.com/NEU90.htm


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Corneal ree4es are absent in brain death Corneal ree4es 7 tested b using a cotton7

tipped s%ab

rimacing in response to pain can be testedb appling deep pressure to the nail beds,supra7orbital ridge, +!G, or s%ab in nose

"evere facial trauma can inhibit interpretationof facial brain stem ree4es


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Both gag and cough ree4es are absentin patients %ith brain death ag ree4 can be evaluated b stimulating

the posterior pharn4 %ith a tongue blade, butthe results can be dicult to evaluate in orallintubated patients

Cough ree4 can be tested b using )++suctioning, past end of )++


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)) $ minutes

< vessel angiograph

Cerebral blood o% perfusion scan


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#bsent Cerebral Function

#bsent Brainstem Function

#pnea


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Cerebral Corte4

Brain "tem

*eticular#ctivating"stem


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Cognition

@oluntar

!ovement "ensation


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Midbrain

Cranial Nerve III

pupillary function

eye movement


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Pons

Cranial Nerves IV, V, VI

conjugate eye movement

corneal reflex


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Medulla

Cranial Nerves IX, X

Pharyngeal (Gag) eflex

!racheal (Cough) eflex

espiration


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*eceives multiple

sensor inputs

!ediates

%a-efulness


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NormalCere"ral #noxia


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Normal Cere"ral $emorrhage


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Normal%u"arachnoi& $emorrhage


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Normal !rauma


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Normal'eningitis


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Neuronal Injury

ecrease& Intracranial

loo& *lo+

Neuronal %+elling

Increase& Intracranial

Pressure

ICP'#P is

incompati"le

+ith life


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'ersistent @egetative "tate

Noc-ed7in "ndrome

!inimall *esponsive "tate


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ormal "leep7Oa-e Ccles

o *esponse to )nvironmental "timuli

/iAuse Brain In0ur %ith 'reservation

of Brain "tem Function


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!entral Pontine Infar"t

Complete Paralysis

Preserve& Consciousness

Preserve& -ye 'ovement


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/iAuse or !ulti7Focal Brain In0ur

'reserved Brain "tem Function

@ariable Interaction %ith

)nvironmental "timuli

%tatic -ncephalopathy


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Clinical 'rereJuisites:

Pno%n Irreversible Cause

)4clusion of 'otentiall *eversible Conditions /rug Into4ication or 'oisoning

)lectrolte or #cid7Base Imbalance )ndocrine /isturbances

Core Bod temperature = 5D C


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Coma

#bsent Brain "tem *ee4es

#pnea


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o *esponse to o4ious "timuli

ail Bed 'ressure

"ternal *ub

"upra7rbital *idge 'ressure


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'upillar *ee4

)e !ovements

Facial "ensation and !otor *esponse

'harngeal ag *ee4

+racheal Cough *ee4


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Pupils &ilate& +ith no constriction to "right light


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.cculo/Cephalic esponse

0oll1s -yes 'aneuver2


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.culo/Vesti"ular esponse

0Col& Caloric !esting2


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Corneal *ee4

Ga% *ee4

rimace to "upraorbital or

+emporo7!andibular 'ressure


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'rereJuisites

Core Bod +emperature = 5D C

"stolic Blood 'ressure 9$ mmHg

ormal )lectroltes

ormal 'C5


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12 're74genation 1$$K 4gen via +racheal Cannula

'5 5$$ mm Hg

52 !onitor 'C5 and '5 %ith pulse o4imetr

2 /isconnect @entilator


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Facial +rauma

'upillar #bnormalities

C" "edatives or euromuscularBloc-ers

Hepatic Failure

'ulmonar /isease


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##

$

Normal -lectrocere"ral %ilence


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Cerebral#ngiograph

Normal No Intracranial *lo+


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+echnetium799 Isotope Brain "can


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!*7 #ngiograph


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!ranscranial

3ltrasonography


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"omatosensor )vo-ed 'otentials

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Mekanisme Gangguan Kesadaran Power Point