Ns Enny Mulyatsih, Mkep, SpKMB

Pendidikan:
- Lulus S2 Keperawatan Medikal Bedah FIK UI 2010
Pelatihan: Organisasi:
Manajemen Stroke (RPH, 1995) Ketua Umum PP HIPENI
Multiple Schlerosis (Singp, Anggota Collegium KMB
Perth) Anggota Australasian
Kegiatan Lain: Clinical Training ( Japan, 2015) Neuroscience Nursing
Association (ANNA)
- Konsultan Surveyor KARS ( Jakarta, 2017)
Keperawatan Anggota Asian Neuro
Surveyor SNARS (Jakarta, 2018) Surgical Nursing Forum
- Dosen tamu,
Penulis buku Pekerjaan:
- Surveyor KARS/ - RSCM: ICCU, ICU, IGD, Unit Stroke, Diklat, Manag Kep
SNARS 1 (1982-2012)
- Koordinator - Kepala Bidang Keperawatan RS Pusat Otak National (2012-
Home Care 2019)
- Kepala Bidang Penunjang (2019-skg)

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 Emergency Stroke Management,
the Nurse’s Role

Enny Mulyatsih

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 STROKE is

A BRAIN ATTACK!!!

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  Suatu keadaan terputusnya atau terhentinya
aliran darah ke otak secara tiba-tiba, yang
mengakibatkan terjadinya kerusakan atau gg
fs pergerakan, perasaan, memori, perabaan,
dan bicara yg bersifat sementara atau
menetap ( Hickey, 2014 )

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 GLOBAL BURDEN OF STROKE
• 3rd leading cause of death in the USA and 2nd leading
cause of death worldwide.
• Major cause of long-
long-term disability.
• 795.000 new cases and 200.000 recurrent cases of
stroke occur each year in the USA (AHA 20162016)
• In the year 2000 total prevalence of stroke 4.7 million
and stroke cost appr.
appr. $51.2 billion every year for
acute care and long-
long-term consequences.

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Data Terapi Trombolitok (Alteplase)
RS Pusat Otak Nasional Tahun 2018

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 Faktor risiko stroke

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 KLASIFIKASI
 Patologi: perdarahan, penyumbatan/ iskemik

 Perjalanan penyakit: TIA, stroke involusi, stroke

komplit

 Lokasi: hemisfer, batang otak

 Bamford: TACS, PACS, LACS, POCS

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 Klasifikasi Stroke
Iskemik (Infak) Perdarahan
Karena penyumbatan karena pecahnya pembuluh darah

• Both cause clinically very similar symptoms but need opposing

treatment from the coagulation perspective

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Stroke Iskemik & Perdarahan

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Ahmed SH,et al. In: Fisher M,ed. Stroke Therapy. 2nd ed. Butterworth Heinmann;2001

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 MANIFESTASI KLINIS STROKE:
tergantung lokasi dan luas lesi

 Penurunan tingkat  Ggn sensori

kesadaran persepsiGangguan
bicara dan bahasa
 Ggn penglihatan
 Ggn sensibilitas
 Ggn memori
 Ggn fungsi kandung
 Ggn lapang pandang
kemih
 Ggn menelan
 Ggn keseimbangan

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STROKE IS A BRAIN ATTACK
 Kedaruratan medik
 Intervensi dini dpt mengurangi “sequel”
 Penanganan yg komprehensif dan terkoordinir
dari tim stroke.
 Starting with pre hospital and emergency
department care

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STROKE is
A BRAIN ATTACK!!!

Medical Emergency

Early response and Emergency Treatment

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 Stroke Care Managemenent

 Hyperacute phase
 Acute Phase
 Subakut phase (recovery)
 Chronic phase/ adaptation/rehabilitation

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 In hyper acute stroke care….
 Time is of the utmost importance
 “therapeutic window”
 Perlu keterlibatan pasien, klg & tim kes
 Stroke management protocols: well known,
rehearsed ( trained ),easy to follow, should
be in place.

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 A stroke “Chain of survival”
 Detection
 Dispatch
 Delivery
 Door
 Data
 Decision
 Drug

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 Detection:

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Remember: Time is Brain

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 Dispatch & Delivery

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En route…EMS personal should
 Obtain time of onset
 Time the pt was last seen to be a normal.
 The presence of seizure/ trauma
 The pt’s health history
 the pt’s medication therapy

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 En route…EMS personal should
 Elevate the head of bed 15-30
 Begin with ABCs degree
 A neurological  Measuring Oxygen saturation
examination:  Oxygen 2 L/ mnt
The Cincinnati Pre-  Intravenous lines
hospital Stroke  Measuring serum glucose
Scale  Administaring glucose in
 Specific intervention hypoglycemic
 NPO/ NBM

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DOOR – Emergency Room

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 Emergency Dept Evaluation
 Time is of the essence of
stroke care Neurological examination
 receive the highest triage  Vital sign
priority  GCS
 Rapid assessment &  Kekuatan motorik
treatment  Pupil
 Stroke CP or protocol  Other neurological
should be in place dysfunction
 A collaborative team
approach

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 Stroke / brain attack team
 Nursing
 Neurology
 Neurosurgery
 Radiology
 Pharmacy
 Clinical laboratory personel

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 DATA:
Neuron imaging
Laboratory

 Glucose & electrolytes  CT Scan

 Complete blood cell count  MRI
 PT/ aPTT  MRA
 Cardiac enzyme  CT Angiography
 ABG  Conventional Cerebral
Angiography

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 Phycical examination
 Be strategic & directed
toward:
 ABC’s
 Vital signs: especially BP
 Tanda SAH: kaku kuduk,
nyeri kepala
 Neurologic examination
 Level of consciousness
 Visual function
 Motor function
 Sensation & neglect
 Cerebellar function
 language

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 Decision

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 DRUG……
DRUG ……General Management
 Goal: speed and efficiency
 Supplement O2 if indicated
 Monitor blood pressure
 Continuous monitoring for cardiac ischemic or AF
 Identify & treat hypoglycemia/ hyperglycemia
 Avoiding hypotonic and excessive fluids
 NBM in the first few hours
 Avoid hyperthermia

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 Blood pressure management
Tekanan darah sebaiknya jangan diturunkan kecuali:
 Bila sistolik >220 mmHg, Diastolik >
120mmHg (2x pengukuran) atau MABP
>130mmHg – 140mmHg.
 Terdapat AMI, gagal jantung/ ginjal akut

 Stroke berdarah, tensi dapat diturunkan sedikit

(maks. 20%)
 Hipotensi harus dilakukan koreksi.

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Fase Hiperakut..Terapi Trombolitik
 Acute Ischemic Stroke.
 The administration of recombinant tissue
plasminogen activator (t-PA) improves the
outcome after stroke when given very early, and
within 4,5 hours of onset of stroke in carefully
selected persons.

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 Stroke Service in Thailand

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 Stroke Service in Thailand

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 Stroke Service in Thailand

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 Stroke Service in Thailand

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 Telestroke System

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 Stroke Service in Thailand

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 Stroke Service in Thailand

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Remember: Time is Brain

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