Coma Neurologi Dr. Anwar

FKK.UMJ.2006

Anwar Wardy W.FKK.UMJ

KEDARURATAN NEUROLOGI(Coma, tik)

Anwar Wardy WMei 2006

FKK.UMJ.2006


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.

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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


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

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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

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Tumors

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Brain Abscess

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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

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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

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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.

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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

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Principle III (Kaidah 3)

• Stop perdarahan (Stop the Bleeding)

PRINCIPLE iv ( Kaidah 4)

• Sirkulasi peredaran daraf keotak dipertahankan.

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Principle V (kaidah 5)

• Penyakit tersebut Struktural atau Non- Structural.

Biasanya dilakukan dengan pemeriksaan Rontgen / CT.Scan atau

Suspect N-Struktural dengan LP.

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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.

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Herniation: The Brain Under Pressure

• Bleeding or swelling in the brain can cause pressure that forces the brain downward in the skull.

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When Specific Areas of the Brain Are Damaged

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Emboli (Perifer)

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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

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Part II. Common Neurological Presentations

8. Altered level of consciousness;

9. Headache;

10. Weakness;

11. Dizziness;

12. Seizures;

13. Gait disturbance;

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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;

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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

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Part V. Pediatric Neurology

33. Hydrocephalus and shunts in children;

34. Pediatric CNS infections;

35. Pediatric stroke;

36. Pediatric seizures;

37. The hypotonic infant;

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Part VI. Neurological Emergencies of Pregnancy:

38. Neurological emergencies of pregnancy;

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Part VII. Brain Resuscitation and Neurotoxicology:

39. General neurotoxicology;

40. Neurotoxicology of alcohol and substances of abuse;

41. Brain resuscitation.

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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.

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•Thank You

Coma Neurologi Dr. Anwar

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