12 strategi NS

Diagnostic: GCS, Cushing response, neurologic deficit Imaging: Skull X-Ray, Head CT Scan, head MRI, Cervical Xray Skull X RAY INDICATIONS * Open fracture, * Deformity, * Stab wound * Corpus alienum , * Scraped wound CERVICAL SPINE X RAY INDICATIONS * Scraped wound on the neck, * Neck pain * Traumatic mechanism ( wisplash injury ) * Cervical signs : tetra plegia / paralytis * Unconscious patients CT SCAN INDICATIONS * Seizures * GCS < 15 * Decreased of GCS > 1 point * Continuous cephalgi, vomiting and vertigo with medicine * Corpus alienum or stab wound * Lateralization ( anisocor / hemiparalysis ) * Cushing response : hypertension + bradicardy * Brain + multiple organ injury * Social indication OUT PATIENTS CONDITION * Conscious + good orientation * No neurological deficit, * Decreased of complain * No fracture * Social Problems nobody care at home hospital distance home / village from the hospital NOTES : Back to the hospital if patient has : * Seriously complain (severe complain) * Restlessness, * Decreased of conscious ( GCS ) * Seizures, * Lateralization 1.Observation Of Consciousness (based on GCS Score)

2. Observation of neurological deficit 8. Seizures Occurred due to iritative of brain and Ca 2+, IC *Treatment : 1. Diazepam : 10 40 mg iv during attack Phenitoin : 3 5 mg Kg/BW Phenobarbital : 3 5 mg Kg/BW 2. In epileptic status : should be more intensively treated 3. Until EEG normal or 2 years seizures free * Prevent : - Severe BI, - ICH Traumatic, - Edema, Depressed Fracture - Foreign Bodies, - Acute Seizures 9. Urinary : micturation Dauer catheter is inserted with the aim * to monitor urinary production * to calculate the fluid balance * to keep the bed clean and dry * to prevent restlessness due to full bladder 10. Skin care * Skin area with continuous pressure decubitus * Dangerous : - infection sepsis - serum fluid hypoalbumin * Treatment - turning position periodically - giving soft pillows beneath parts of the body which are under continuos pressure 11. ICP monitoring ICP : Monitoring Out Come Prediction Intraventricular Monitoring < 20 mm H2O CPP : MAP ICP ( Target CPP : + 75 mmHg) MAP Slight Hypertension ICP Mechanical : Position CSFIC Medical : Acetazolamic , Mannitol ,Corticosteroid 12. Drug medicine Ca2+ Blocker Antioxidant Dehydration Agent Nootrophic : Nicholin Piracetam :* Rheology * CBF SUMMARY 1. It is important to observe the changes of consciousness, especially when the patient is firstly

3. Pernafasan Mencegah hipoksia Mbersihkan sal nafas dr sekret, Darah,muntahan & benda asing menidurkan dg posisi miring & ekstensikepala Posisi diubah tiap jam Bila perlu trakheostomy Sirkulasi: Mencegah hipertensi , Mencegah hipotensi , Mencegah anemia 4. Position: Head elevation (10-30o Not >30o), CBF :N, ICP : Mechanical 5. Fluid, electrolyte and nutrition imbalance DAY 1 2 :* 2 liters isotonic fluid * has an electrolyte : osmolar stabilization DAY 3 :* nasogastric tube : - no gastric retention (100 cc/day) - good peristaltic - no abdominal distension - no nausea and vomiting - start low go slow Some factors need to be considered in fluid administration are: 1.Extra fluid 10 15% must be given for every increased 1C 2.Urinary production : * diabetes insipidus : 1 ltr negative balance * progressive urinary production and prolonged urine production ( > days) vasopression administration is needed and electrolytes is periodically examined 3.Its not recommended to give glucose 5% glucose rapidly metabolize solution changes into hypotonic 6. Temperature

Rectal temperature Hyperthermia brain Hypermetabolism * Causes of hyperthermia 1. Intracranial : Primary 2. extracranial: Secondary infection drug reaction transfusion reaction *Treatment + intracranial : without antipyretics + antibiotic + increasing of fluid : > 1 C (+) 10 15% (extra) 7. Restlessness Factors : 1.Intracranial : +start to be alert +ICP : intracranial 2.Extracranial : Pain : + full bladder, bone fracture + uncomfortable feeling due to dirty bed/ clothing + patient is tightened, + hyperthermia + respiratory disturbance Treatment :+ etiologic factors must be found and treated + medical :chlorpromazine : 25 mg diazepam : 5 10 mg

seen, during transportation to / at the hospital 2. 17.5 20% patient expected to die before arriving in the hospital 3. In the hospital : ( recent management) * primary survey : stabilization : A B C * diagnostic * definitive treatment - operative - conservative - observation 12 points 4. Goal of brain injury treatment a. curable b. to prevent of SBI c. to minimize invalidity and death d. the end results of treatment is good outcome