TINJAUAN PUSTAKA 1

TATALAKSANA AWAL PADA CEDERA

OTAK AKIBAT TRAUMA (TRAUMATIC
BRAIN INJURY/ TBI)

Pembimbing :
dr. Zainal Abidin, Sp.BS

B A G I A N / S M F B E DA H
FA K U L TA S K E D O K T E R A N U N L A M / R S U D U L I N
BANJARMASIN
MEI, 2017
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TRAUMATIC BRAIN INJURY

Worldwide
burden

Silent
epidemic
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Major cause of death and

WHO disability by the year 2020

55.495 cases of traffic Indonesia,

accident, 85% of those
case causes death. 1982

Langlois JA, Rutland-Brown J, Wald MM. The epidemiology and impact of

traumatic brain injury: a brief overview. J Head Trauma Rehabil.
2006;21:375-8.
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TRAUMATIC BRAIN INJURY

10% due to
work and
sport injury
10% due to
violence

20-30% due
to falls incident

60% due to
traffic accident

Langlois JA, Rutland-Brown J, Wald MM. The

epidemiology and impact of traumatic brain injury: a
brief overview. J Head Trauma Rehabil. 2006;21:375-8.
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Acute brain injury

arising from
mechanical energy to
the head from external
physical forces. Carney N, Totten AM, Oreilly . Guideline for
management of severe traumatic brain injury.
Brain Trauma Foundation.Miami: 2016.
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Classifications

Severity Mechanism of
trauma

Morfology CT Scan
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SEVERITY

Mild Moderate Severe

GCS 13-15 GCS 9-12 GCS <8
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MECHANISM OF INJURY

BLUNT PENETRATING
TRAUMA TRAUMA
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MORFOLOGY
SCALP
INJURY
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MORFOLOGY

SKULL INJURY
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FOCAL BRAIN INJURY

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Gambar 2.2 cedera otak yang bersifat fokal: a)

hematom epidural b) subdural hematom c)
multiple kontusio cerebri dengan perdarahan
intaparenkim, d) perdarahan intraventrikular
dextra dengan pergeseran garis tengan dari
kanan ke kiri.8
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DIFFUSE BRAIN INJUY

DIFUSE AXONAL
INJURY

EDEMA CEREBRI

CONTUSIO
CEREBRI
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Gambar 2.3 Difuse Axonal Injury CT-Scan Gambar 2.4 Contusion Cerebri CT-Scan Gambar 2.5 Edema Cerebri CT-Scan
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MARSHALL CT CLASSIFICATION
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PRE HOSPITAL MANAGEMENT

REFER TO THE ED WHEN

THERES INDICATION

ABCDE
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REFFERAL INDICATION
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HOSPITAL CARE
PRIMARY SURVEY

Exposure
Disability
Circulation
and
bleeding
Breathing control
and
ventilation
Airway American College of Surgeon
and C Committee of Trauma.
Advanced Trauma Life Support
spine Ninth Edition. Indonesia:
control IKBI.2015.
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HOSPITAL CARE
SECONDARY SURVEY

Exposure
Last meals

Present
ilness
Mechanism
of injury

Allergies American College of Surgeon

Committee of Trauma.
Advanced Trauma Life Support
Ninth Edition. Indonesia:
IKBI.2015.
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American College of Surgeon

Committee of Trauma.
Advanced Trauma Life Support
Ninth Edition. Indonesia:
IKBI.2015.

MILD HEAD INJURY

ALGORITHM
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American College of Surgeon

Committee of Trauma.
Advanced Trauma Life Support
Ninth Edition. Indonesia:
IKBI.2015.

MILD HEAD INJURY

ALGORITHM
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MODERATE HEAD
INJURY ALGORITHM
American College of Surgeon
Committee of Trauma.
Advanced Trauma Life Support
Ninth Edition. Indonesia:
IKBI.2015.
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SEVERE HEAD INJURY ALGORITHM

American College of Surgeon

Committee of Trauma.
Advanced Trauma Life Support
Ninth Edition. Indonesia:
IKBI.2015.
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THANKS!