Head Trauma Ct

7/26/2019 Head Trauma Ct

1/62

HEAD TRAUMA


2/62

CT SCAN Cara Baca :

CT scan contrast ato bukan Coronal ato axial ( dari atas) Id ntitas Hi!od ns" #i! rd ns ( !uti#) Blood : #i! rd ns Scal! : ca!ut # $ato$% Tulan& : 'raktur% ar nki$ : ! rdara#an %

olu$ ! rdara#an : (*u$la# slic x !an*an& x l bar) : + Diukur dari &a$bar t rb sar

Diba&i + kalo , - &a usa# diba&i kalo .


3/62

M nin& s : T rba&i / : dura$at r" arac#noid" !ia $at r Dura dan arac#noid *d satu Subarac#noid : diantara arac#noid dan !ia $at r


4/62


5/62


6/62


7/62


8/62


9/62


10/62


11/62


12/62


13/62

nin&katan TI0

Midlin s#i'tin& n1 $!itan cist rna (basalis dan ! ri$ s ns 'alik) 0o$!r si 2 ntrik l Dilatasi 2 ntrik l kontralat ral

Dilatasi 2 ntrik l si$ tris (bila ada obstruksi l takr nda#)


14/62

Intracranial Hemorrhage: 4 main types

From outside to inside: 3 E!idural (EDH)

3 Subdural (SDH)3 Subarac#noid (SAH)3 Intra!ar nc#1$al (I H


15/62

EDH

E!idural # $ato$a adala#! rdara#an 1an& t rb ntuk di ruan&!ot nsial antara tubula int rna dandura$at r

4 si bikon2 ks5l ntikular 66 r &iot $!oro!ari tal

Tidak akan $ n1 b ran&i sutura Air bubbles 'raktur t rbuka Bisa t r*adi 7cou!8 atau 7contr cou!8 Midlin s#i'tin& kontralat ral E5C ru!tur A- $ nin& a $ dia dan

! rcaban&ann1a


16/62

EDH: Clinical Presentation

+/- initial loss o' consciousn ss 9 ; uncal # rniation ?$ernohan%s notch $a1 induc i!silat ral # $i!ar sis

(co$!r ssion o' contralat ral c r bral ! duncl b1 t ntorial d& )

?&lo#n pupil al#ays ipsilateral to "lee


17/62

EDH: 'ppearance on C(

Bicon2 x U$u$n1a di t $!oral Calci@ d !in al &land Mass ct :

Midlin s#i't 0o$!r si 2 ntrik l H rniasi


18/62


19/62

EDH TREATMENT

Prompt craniotomy ) evacuation ss ntial to!r 2 nt 'atal outco$ 3 I' C III in2ol2 $ nt arl1 int r2 ntion n c ssar1 to

r &ain 'unction


20/62

SDH 4 si #i! rd ns bikonka' 5 crescent 5 s $ilun r"

d n&an t !i dala$ $ n&ikuti alur &1ri Bisa $ l


21/62

SDH 0ronis

Ti! I : hipodense (//;) s $uako$!on n !adat suda# diabsorbsi

Ti! II : mixed or inhomogenous density (//;)

Ti! III : isodense (+9;) Ti! I : slightly hyperdense ( ?. ;) antara #ari k ?.+ s5d $in&&u


22/62

SDH 0ronis Hi!od ns(Ti! I)

S $ua ko$!on n!adat suda#diabsorbsi

4 si #i!od nsd n&an HU 4CS!ada kon2 ksitaskraniu$


23/62

SDH 0ronis7In#o$o& nous or Mix d d nsit1

SDH kronis bbr! $in&&u s5d ta#un 4i u 'aksi dara# dan r sorbsi d nsitas $ nurun ( HU#ari) dan s $akin la$a ada ar a 1an& $ n*adi s $akin#i!od ns inhomogenous or mixed density


24/62

Subdural Hematoma (SDH)Kronis Isodense

Di $ana l tak l si %% li#at 2 ntrik l 1an& t rko$!r si


25/62

*DH: Clinical Presentation

Depends on chronicity In acut sta& a't r trau$a" o't n @nd 'ocal n urolo&ic d @cits" but: Sx = si&ns $a1 b abs nt" nons! ci@c" or

nonlocaliFin& s! ciall1


26/62

*DH: 'ppearance on C(

Crescentic xtra?axial coll ction not bound b1 sutur$ar&ins" o't n tracks alon& ntir # $is!# ric sur'ac

? *DH may mimic "iconve! EDH in st , hrs 3 Rinto c#ronic SDH layering

o' att nuations = calci@ d mem"ranes 3 Isoattenuatedsu"acute *DH can b

diGcult to d t ct 4ook 'or dis!lac $ nt o' &ra1 $att r (att n 6 7'att18


27/62


28/62


29/62

*DH: (reatment


30/62


31/62

Trau$atic ?


32/62

Clinical Presentation

Trau$atic 2ariabl xt rnal = n uro si&ns 3 Nontrau$atic: si&ns = s1$!to$s +o to subarac#noid blood: N5 " con'usion" obtundation" 4KC .orst headache o my li e0 HA o' sudd n ons t b

$ost si&ni@cant 'or its ne#ness

Incr as d blood !r ssur 2 r ($ nin& al irritation) Nuc#al ri&idit15$ nin& al si&ns (#rs a't r HA) ri!a!illar1 r tinal # $orr#a& s $ost su&& sti2 o' dx

(du to incr as d IC )


33/62

'ppearance on C(

(rauma #i att nuation in sulci3 'neurysm #i att nuation in basilar

cist rns (r &ion o' circl o' Lillis) Cr at s star0!att rn

3 Ass ss 'or intra!ar nc#1$al xt nsion Co$$on


34/62


35/62


36/62

Intrac r bral H $orr#a&

4 si #i! rd ns !ada !ar nki$ otak Bisa :

Trau$atik : kortikal atau subkortikal lobus 'rontal atau t $!oral ant rior

Multi!l +?/; l takn1a dala$ (biasan1a di an&liabasalis)

Strok # $orr#a&ik : l tak l bi# dala$ s rin& di &an&lia basalis


37/62


38/62

Intra2 ntricular H $orr#a& (I H)

0ausa : ru!tur ICH k intra2 ntrik l ! rdara#an 2asa !l xus c#oroid us dan sub

! nd1$al r uks dari SAH

Mun&kin ada fuid-blood level


39/62


40/62


41/62

Tatalaksana Tra $a 0 !ala


42/62

Tatalaksana Trau$a 0 !ala

Tidak s $ua !asi n c d ra k !ala ! rlu dira


43/62

Indikasi untuk tindakan o! rati'

olu$ $asa # $ato$ $ nca!ai l bi# dari O $l di da ra#su!rat ntorial atau l bi# dari + cc di da ra# in'rat ntorial

0ondisi !asi n 1an& s $ula sadar s $akin $ $buruk s cara klinis"s rta & *ala dan tanda 'okal n urolo&is s $akin b rat

T r*adi & *ala sakit k !ala" $ual" dan $unta# 1an& s $akin # bat ndoron&an &aris t n&a# sa$!ai l bi# dari / $$

T r*adi k naikan t kanan intrakranial l bi# dari +9 $$H&- T r*adi ! na$ba#an ukuran # $ato$ !ada ! $ riksaan ulan& CT

scan T r*adi & *ala akan t r*adi # rniasi otak T r*adi ko$!r si 5 oblit rasi sist rna basalis


44/62

Mild H ad In*ur1 ( CS ./?.9)

did @snisikan s ba&ai ri


45/62


46/62

Pika t rda!at abnor$alitas !ada CT scan atau *ika!asi n $ n*adi $ $ilik si$!to$ atau b rlan*ut adan1a&an&&uan n urolo&is" !asi n t rs but #arus dira


47/62


48/62

Mod rat H ad In*ur1 ( CS Q?.+)

M r ka $asi# $a$!u untuk $ n&ikuti ! rinta#" t ta!ibiasan1a $ r ka bin&un& atau so$nol n dan $ $ilikid @sit n urolo&is 'okal s ! rti # $i!ar sis-

$ riksaan ulan& n urolo&is dilakukan s tidakn1a .+ *a$ ! rta$a sa$!aid n&an +O *a$- ollo


49/62


50/62

S 2 r H ad In*ur1 ( CS /? )

!asi n 1an& tidak bisa $ n&ikuti ! rinta# s d r#anas kali!un s t la# dilakukan stabilisasi kardio!ul$onar

ada !asi n d n&an c d r k !ala b rat" *an&an$ nun&&u untuk dilakukan CT scan k !ala


51/62


52/62

ana$n sis

$ kanis$ injury nin&katan TI0 : $unta# # bat% Sakit k !ala # bat%

nurunan k sadaran% la$a !asi n tidak $ r s!on% k *an&%

! ruba#an tin&kat k


53/62

Sur2 i ri$ r

Air


54/62

Air a1 dan br at#in& :

n&&unaan intubasi ndotrak al #arus dilakukan !ada!asi n 1an& ko$a-

dib rikan 2 ntilasi . ; oksi& n sa$!ai d n&ananalisa &as dara# suda# di! rol # #asil

Pulse oksi$ tri da!at di!antau dan saturasi oksi& n#arus 6Q ;

Ci l i


55/62

Circulation

0 adaan u2ol $ia #arus diban&un s & ra $un&kina!abila !asi n $ n&ala$i #i!ot nsi" dn &an$ n&&unakan !roduk dara#" whole blood " atau caisotonik s $uan1a da!at di&unakan-


56/62


57/62

MKTKRI0 : Ins! ksi : atro@ al!asi : tonus 0 kuatan : lat ralisasi %

R ks @siolo&is : bic !s% Tric !s%

R ks !atolo&is : babinski %


58/62

Di & tik


59/62

Dia&nostik

CT SCAN NKN CKNTRAST CT an&io&ra$ Ro T#oraks CBC Urin Anal1sis

T !i $ k


60/62

T ra!i ar$ako

Cairan Intravena : */12 Hiperventilasi : 13 lpm 3annitol 5 6 : g/7g&&

$ontraindi7asi : hipotensi Indi7asi : deteriorasi neuro a7ut8 edema cere"ri

Hipertoni7 salin 'nti 7e9ang

Conto# t r !i $od r t BI


61/62

Conto# t ra!i $od rat BI K+ . l!$

H ad l 2asi / $ n&uran&i t kanan intrakranial I D Rin& r 4actat Manitol + ; s suai b rat badan .&5k&BB dala$ / $ nit nitoin + $& c &a# k *an& In*- Citicolin 9 $& n ro!rot ctor In*- C 'triaxon +&r In*- 0 torolac / $& In*- Rantidin 9 $& 0onsul S!BS rsia!an ruan& ICU !ost o!


62/62

Documents

Head Trauma Ct