coma neurologi dr. anwar
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FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
KEDARURATAN NEUROLOGI(Coma, tik)
Anwar Wardy WMei 2006
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
The General Principle For Managing Neurologic Emergencies
Principle I: (Kaidah I) Kerusakan sistem saraf tidak menyebabkan
kematian organ yang disarafi. Jaringan dan fungsi diharapkan dapat diperbaiki.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Emergency Symptoms
• Confusion
• Drowsiness
• Difficulty speaking clearly
• Numbness in any part of the body
• One pupil that is larger than the other
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Focal brain dysfunction•Brain tumour
•Vascular events (CVA)•Demyelination
•Infection, such as cerebral abcess•Focal head injury
Diffuse brain dysfunction•Infection, such as meningitis or encephalitis•Epilepsy•Hypoxia and hypercarbia•Drugs, poisoning and overdoses ( including alcohol)•Metabolic/endocrine causes, such as diabetic coma, •Hepatic or renal failure, •Hypothyroidism, severe electrolyte disturbances•Hypotension, or hypertensive crisis•Diffuse head injury•Subarachnoid haemorrhage•Hypothermia, hyperthermia
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Primary Events:
• Cell, Axonal atau Myelin (Transmisi terganggu)
Penyebabnya:
1. Anoxia 7. Toxin/Infeksi 2. Intracranial Hemorrhage. 8. Metabolic
3. Ischemia
4. Trauma
5. Hypoglicemia
6. Tumors
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Tumors
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Brain Abscess
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Symptoms of Brain Tumors?
nausea - impaired sense of smell
Vomiting - memory loss
headaches - seizures
behavioral and emotional changes - muscle weakness
impaired judgment -paralysis on one side of the body
loss of hearing -reduced mental capacity
vision loss
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Secondary Events• Edema CerebriEdema Cerebri• TIKTIK• Obstruksi dari Liquor CS.Obstruksi dari Liquor CS.• VasospasmeVasospasme• Kegagalan AutoregulasiKegagalan Autoregulasi• Kegagalan Collateral supplyKegagalan Collateral supply• Gagal JantungGagal Jantung• Gagal Nafas.Gagal Nafas.
AnoxiaICH
IschemiaTumorsTrauma
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Principle II (Kaidah 2)
Selalu memerlukan intubasi
Agar pernapasan terjamin dan oksigenasi ke otak terjamin baik.
Cegah terjadinya:
1. Coma hypoventilasi.
2. Hypoxia otak dan acidosis / hypercarbia.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Glasgow Coma Score • Eye Opening (E) 4=Spontaneous
3=To voice2=To pain1=None
• Verbal Response (V) 5=Normal conversation
4=Disoriented conversation
3=Words, but not coherent Total = E+V+M 2=No words......only sounds
1=None• Motor Response (M) 6=Normal
5=Localizes to pain4=Withdraws to pain3=Decorticate posture2=Decerebrate1=None
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Principle III (Kaidah 3)
• Stop perdarahan (Stop the Bleeding)
PRINCIPLE iv ( Kaidah 4)
• Sirkulasi peredaran daraf keotak dipertahankan.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Principle V (kaidah 5)
• Penyakit tersebut Struktural atau Non- Structural.
Biasanya dilakukan dengan pemeriksaan Rontgen / CT.Scan atau
Suspect N-Struktural dengan LP.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Principle VI (Kaidah 6)
•Diagnosis cepat dan sederhana (Simple & Spot Diagnosis) : yaitu dengan menggunakan pengetahuan Anatomi saraf (Topis Diagnostic) untuk mengetahui letak lesi di Otak.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Herniation: The Brain Under Pressure
• Bleeding or swelling in the brain can cause pressure that forces the brain downward in the skull.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
When Specific Areas of the Brain Are Damaged
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Emboli (Perifer)
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part I. Neurological Examination and Neurodiagnostic Testing
1. Neurological examination; 2. Neuroradiology; 3. Electroencephalography; 4. Lumbar puncture; 5. Electromyography; 6. Electronystagmography; 7. Evoked potentials;
Main D
iagnostic S
upport
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part II. Common Neurological Presentations
8. Altered level of consciousness;
9. Headache;
10. Weakness;
11. Dizziness;
12. Seizures;
13. Gait disturbance;
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part III. Specific Neurological Conditions:
14. CNS infections in adults; 22. Dementia; 15. Viral encephalitis; 23. Neurooncology; 16. Vascular disease; 24. Neuropsychiatric 17. Movement disorders;
25.Neuroanesthesiology; 18. Neuromuscular disorders; 26. TIK 19. Musculoskeletal and neurogenic pain; 20. Neuroophthalmological disorders; 21. Multiple sclerosis; 28. Sleep disorders; 27. Normal pressure hydrocephalus;
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part IV. Neurological Trauma and Environmental Emergencies
29. Traumatic brain injury;
30. Spinal cord injury;
31. Peripheral nerve injury;
32. Neurological complications of environmental emergencies
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part V. Pediatric Neurology
33. Hydrocephalus and shunts in children;
34. Pediatric CNS infections;
35. Pediatric stroke;
36. Pediatric seizures;
37. The hypotonic infant;
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part VI. Neurological Emergencies of Pregnancy:
38. Neurological emergencies of pregnancy;
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
Part VII. Brain Resuscitation and Neurotoxicology:
39. General neurotoxicology;
40. Neurotoxicology of alcohol and substances of abuse;
41. Brain resuscitation.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
EvaluationICP monitoring is most often used in head trauma in
the following situations:• 1) GCS less than 8• 2) Drowsy with CT findings (operative or non
operative)• 3) Post op hematoma evacuation• 4) High risk patients (a) Above 40 yrs. (b) Low BP
(c) Those who require ventilation.• There is nothing to achieve in monitoring ICP in
the patients with GCS of less than 3.
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
•Thank You
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