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NEUROLOGI
(Level Of Conciousness)
Anwar Wardy W
Juni 2013
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Principle I: (Kaidah I)
Kerusakan sistem saraf tidak menyebabkan
kematian organ yang disarafi. Jaringan dan
fungsi diharapkan dapat diperbaiki.
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Emergency Symptoms
Confusion
Drowsiness
Difficulty
speaking clearly
Numbness in any part of the body
One pupil that is larger than the other
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Primary Events:
Cell, Axonal
Dept.Neyrosain FKK.UMJ.2010
TRAUMA
Concussion
Cerebral
contusion
Epidural hematoma
Subdural hematoma/effusion
Intracerebral hematoma
Diffuse axonal injury
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
EPIDURAL HEMATOMA
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
SUBDURAL HEMATOMA
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
Secondary Events
Edema Cerebri
TIK
Obstruksi dari Liquor CS.
Vasospasme
Kegagalan Autoregulasi
Kegagalan Collateral supply
Gagal Jantung
Gagal Nafas.
anwar wardy w
Anoxia
ICH
Ischemia
Tumors
Trauma
Dept.Neyrosain FKK.UMJ.2010
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.
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Total = E+V+M
Dept.Neyrosain FKK.UMJ.2010
PRINCIPLE iv ( Kaidah 4)
Sirkulasi
Dept.Neyrosain FKK.UMJ.2010
Principle V (kaidah 5)
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
INFRATENTORIAL LESIONS
Brainstem
initially
Sudden onset of coma
Cranial nerve abnormalities
Alteration of the respiratory pattern
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
HERNIATION SYNDROMES
Transtentorial herniation
anwar wardy
FKK UMJ
Anwar Wardy W.FKK.UMJ
Principle VI (Kaidah 6)
Diagnosis
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Bleeding
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
n
ai
M
gn
a
Di
tic
s
o
p
u
S
r
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p
1. Neurological examination;
2. Neuroradiology;
3. Electroencephalography;
4. Lumbar puncture;
5. Electromyography;
6. Electronystagmography;
7. Evoked potentials;
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Dept.Neyrosain FKK.UMJ.2010
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Evaluation
ICP 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.
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
Bahan Bacaan:
Gilroy John, Textbook Medical Neurology, MacMillan Publ. co.Inc. 5th Edition
London, 2009.
Surgery, and Internal Medicine, Neuroscience Intensive Care Unit, 2006.
Epstein, Owen, Clinical Examination on Neurology Emergency, Mosby 2005
TERIMA KASIH,
.Wassalam..//
a2w@telkom.net
FKK.UMJ.Juni 2008