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Mati batang otak

Sri Pramesthi Wisnu Bowo Negoro, S.Ked


Latifah Amalia Zati, S.Ked
Agam Meureza, S.Ked
Nindy Ellena, S.Ked
Erika Dwi P., S.Ked
Part 1
Anatomi Batang Otak

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3 https://www.youtube.com/watch?v=dEgaaJWRf7g
Source: Duus’ Topical Diagnosis in Neurology, ed 5th
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Source: Duus’ Topical Diagnosis in Neurology, ed 5th
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Source: Duus’ Topical Diagnosis in Neurology, ed 5th
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Source: Duus’ Topical Diagnosis in Neurology, ed 5th
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Source: Duus’ Topical Diagnosis in Neurology, ed 5th
Part 2
Mati

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Henti Napas (tidak ada gerakan napas spontan)
Henti sirkulasi (jantung)
MATI KLINIS
Aktivitas otak terhenti
Tidak irreversible
(Wijdicks,2001; Buckley, et al.,1995)

Lanjutan dari Mati Klinis jika tidak dilakukan resusitasi


MATI BIOLOGIS Nekrotisasi semua jaringan, dimulai dari otak hingga seluruh organ
(Arnold, et al.,1999)

Kerusakan irreversible serebrum terutama neokorteks.


MATI SEREBRAL Mati otak adalah mati serebral + nekrosis sisa otak lainnya termasuk batang otak
(Buckley, et al.,1995; Arnold, et al.,1999)

Kerusakan berat irreversible pada pasien yang pasien yang tetap tidak sadar dan
MATI SOSIAL /
responsive, tetapi memiliki EEG aktif dan beberapa reflek yang utuh
VEGETATIVE STATE
(Arnold, et al.,1999)

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Part 2
Mati Batang Otak (MBO)

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1959
Mollaret and goulon

an irreversible state of apneic coma with absent


brain-stem refl exes and electroencephalography
(EEG) activity, but with preserved cardiac and
metabolic activities.

coma dépassé (irreversible coma)

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1968
Harvard medical school

apneic coma and absence of elicitable


brain-stem reflexes for a period of 24 h
as confirmed by an
electroencephalogram

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1976
The Conference of Medical Royal
Colleges

complete, irreversible loss of brain-


stem function

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1995
American Academy of Neurology
(AAN)

irreversible coma (with a known


cause), absence of brain-stem
reflexes and irreversible apnea

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2015
American Academy of Neurology
(AAN)

a clinical state that involves an


apneic patient with irreversible
coma and absent brainstem reflexes

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Part 3
Patofisiologi MBO

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ETIOLOGI:

MOST COMMON:
• Direct traumatic injury to the head (e.g. road accident)
• subarachnoid hemorrhage
• ischemic stroke

OTHERS:
• intracerebral hemorrhage
• hypoxic-ischemic
• Encephalopathy
• Etc.

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Severe
Damage Oedema Increase ICP
neuronal tissue

Hypoxia Brain-stem Herniation at


Crush brain-stem Foramen
magnum

Brain-stem
death
Dhanwate, AD. 2014. Brainstem death: A comprehensive review in
Indian perspective. Indian Journal of Critical Care Medicine. Indian
Society of Critical Care Medicine

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Part 5
Kriteria MBO

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American Academy of Neurology
(AAN)

Declaring a patient brain dead is often


considered in a comatose patient with a
major destructive brain injury, loss of at
least three brainstem reflexes, and no
evidence of a breathing effort

Wijdicks et al. 2015. Determining Brain Death.


Neurocritical Care. American Academy of Neurology

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Pernyataan IDI No. 336/PB/A.4/88
Seseorang dinyatakan mati bila
a) Fungsi spontan pernafasan dan jantung telah
berhenti secara pasti
Atau
b) Telah terbukti terjadi MBO (mati batang otak)

Ismail S. 2013. PPT Mati Batang Otak. Bagian Ilmu


Penyakit Saraf UGM

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Part 4
Pemeriksaan MBO

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Tes Klinis MBO

1. Koma atau tidak ada respon


2. Tidak ditemukan refleks-refleks
batang otak.
3. Apneu komplit yang dikonfirmasi
dengan tes apnea

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COMA
Coma is best defined as an eyes-closed
unresponsive state

Huff JS, Dulebohn SC. 2018. Coma. Treasure Island (FL): StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430722/

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a state in which the patient does not open his or her
eyes even on very vigorous stimulation and displays
no evidence of psychologically interpretable contact
with the outside world, even after the discontinuation
of analgesic and/or sedating drugs that might impair
consciousness

Bender et al. 2015. Persistent Vegetative State and Minimally


Conscious State A systematic review and meta-analysis of diagnostic
procedures. Dtsch Arztebl Int Journal. 112(4): 235-242

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Refleks Batang otak
Dhanwate, AD. 2014. Brainstem death: A comprehensive review in Indian perspective.
Indian Journal of Critical Care Medicine. Indian Society of Critical Care Medicine
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PUPIL

Bilateral Pupil fixed-dilatasi > 4 mm


Tidak ada respon reflex cahaya

Sagishima K, Kinoshita Y. 2017. Pupil diameter for confirmation of


brain death in adult organ donors in Japan. Acute Medicine &
Surgery. (4).329-12. Japan
DOLL’S EYE MANEUVER

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CALORIC TEST

34 death. Pract Neurol. (16). 129-135. London.


Cameron EJ et al. 2017. Confirmation of brainstem
Nervus III

- Fungsi Pupil
- Pergerakan Mata

Nervus IV, V, VI

- Pergerakan mata konjugat


- Refleks Kornea

Nervus IX, X

- Gag reflex faringeal


- Reflex tracheal (batuk)

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Tes Apneu
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Persistent Vegetative State
a state in which the patient’s eyes are intermittently
open (wakefulness), but there is nonetheless no
evidence for an ability to make contact, or for
awareness
(Persistent Vegetative State/Unsresponsive Wakefulness Syndrome)

Bender et al. 2015. Persistent Vegetative State and Minimally


Conscious State A systematic review and meta-analysis of diagnostic
procedures. Dtsch Arztebl Int Journal. 112(4): 235-242

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Bender et al. 2015. Persistent Vegetative State and Minimally
Conscious State A systematic review and meta-analysis of diagnostic
procedures. Dtsch Arztebl 41
Int Journal. 112(4): 235-242
Locked-In Syndrome
a condition in which a patient is aware but cannot
move or communicate verbally due to complete
paralysis of nearly all voluntary muscles in the body
except for vertical eye movements and blinking. The
individual is conscious and sufficiently intact
cognitively to be able to communicate with eye
movements.
(Pseudocoma)

Duff JR. 2007. Motor speech disorders substrates, differential


diagnosis, and management. Elsevier. p 295

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Lesion in Ventral Pontine

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SOURCE

✣ Wijdicks et al. 2015. Determining Brain Death. Neurocritical Care. American Academy of
Neurology
✣ Dhanwate, AD. 2014. Brainstem death: A comprehensive review in Indian perspective. Indian
Journal of Critical Care Medicine. Indian Society of Critical Care Medicine
✣ Baehr M, Frotscher M. 2012. Duus’ Topical Diagnosis in Neurology: Anatomy, Physiology,
Signs, Symptoms. 5th ed. Thieme. Germany
✣ Wijdicks, Eelco FM. 2001. The Diagnosis of Brain Death. N Engl J Med. 344 (16)
✣ Buckley. 1995. Guidelines On Certification Of Brain Death, The Hong Kong Society Of
Critical Care Medicine, journal of the Royal College of Physicians of London, 29:381-2
✣ Sagishima K, Kinoshita Y. 2017. Pupil diameter for confirmation of brain death in adult organ
donors in Japan. Acute Medicine & Surgery. (4). 9-12. Japan
✣ Cameron EJ et al. 2017. Confirmation of brainstem death. Pract Neurol. (16). 129-135. London.
✣ Bender et al. 2015. Persistent Vegetative State and Minimally Conscious State A systematic
review and meta-analysis of diagnostic procedures. Dtsch Arztebl Int Journal. 112(4): 235-242
✣ Duff JR. 2007. Motor speech disorders substrates, differential diagnosis, and management.
Elsevier. p 295

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