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Neuro Pediatrik
Neuro Pediatrik
Neuro Pediatrik
DT
I. IdentitAS
3 minggu yang lalu orang tua pasien mengeluh anak demam tinggi kemudian kejang
3x lamanya 30-60 menit, setelah kejang anak sadar (+), muntah (-), penurunan kesadran
(-)
1 minggu yang lalu anak kejang hingga 7 jam, kejang umum, tonik-klonik, setelah
kejang anak sadar
Riwayat lahir cukup bulan, spontan, lahir di dukun, bbl 3800gram langsung menangis
Batuk(+), pilek(+), asma(-), alergi(-)
objective
General Anestesi
Intubasi Napas Kendali
ASA II
CRANIOTOMY FOR TRAUMA
Emergent surgical
procedure to evacuate
mass lesion or debride
contused or cotaminated
brain
Epidural Hematoma
Subdural hematoma
Intracerebral hematoma
Depressed skull frakture
Gunshot wound of the
brain
CRANIOTOMY FOR TRAUMA
Procedure
Avijit Sarkari
CRANIOTOMY FOR
Summary of
TRAUMA
Procedure
Position :
Supine, lateral, prone or sitting
Surgical Time :
1,5-6 hour
EBL :
25-500 ml
Post operation care :
ICU or Close observation unit
Mortality and Morbidity :
10-50% , higher for acute subdural hematoma,
endocrine disorder : SIADH, Neurologic disability
and Infection
CRANIOTOMY FOR TRAUMA
Preoperative
Surgery is necessary to evacuate
hematomas, control intracranial
bleeding, to débride the wound, and
to remove bone fragments, foreign
material, and damaged brain so that
the cranial vault can better
accommodate the brain swelling that Epidural hematomas form between the
inevitably occurs skull and dura, and are usually due to
bleeding from an artery (e.g., anterior
cerebral or middle meningeal
Subdural bleeding occurs between the
dura and the leptomeninges lining the
brain surface. This bleeding is usually
venous in origin, and usually occurs
more gradually
Preoperative
Serangan kejang
Mual dan muntah
Asma
Riwayat keluarga yang berkaitan dengan reaksi terhadap obat obat
tertentu
Penilaian neurogonik: derajat kesadaran, hipertensi intracranial,
perubahan sensorik, respon pupil, serta fungsi syaraf cranial
Evaluasi tanda vital dan berat badan apakah sesuai umur tumbuh dan
kembang. Lingkar kepala di ukur
Umur
Preoperative
berat Tek darah Detik
jantung
Frekuensi
napas
Prematur < 2.5 50/30 140 35-80
Aterm > 2.5 60/40 140 35-60
1 tahun 10 tanda vital
Nilai rerata 90/65 120 20-40
6 tahun 20 100/60 100 20-25
12 tahun 40 115/60 90
CRANIOTOMY FOR TRAUMA
Hyperventilation to NPE
PaCO2 = 25–30 mmHg ↑ICP
PaO2 > 100 mmHg DIC
Furosemide 10–20 mg
II. Identitas
Sense : aktif
HR :110 beats/mnt, RR : 24 beats/mnt, SpO2 : 99%,
Temp : 36.5
Status Generalis :
Head :CA -/- SI -/-
Neck : mass (-)
Thorax : Cor = SI-S2 reguler, Murmur(-) Gallop (-)
Pulmo = Vesikuler +/+ N, Wheezing-/- Rhonki -/-
Abdominal : normally
Extremity : oedem (-)
Laboratorium
Hidrocefalus comunicans
Dilatasi kistik ventrikel 4
Assessment