kuliah mahasiswa
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7/17/2019 Kuliah Mahasiswa
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CEREBROVASCULARCEREBROVASCULARDISEASE : AN EMERGENCYDISEASE : AN EMERGENCY
dr. Nilamsari Sp.S M.Kesdr. Nilamsari Sp.S M.Kes
Neurolo! Depar"eme#"Neurolo! Depar"eme#"
Medi$al %a$ul"! o& Sri'i(a!aMedi$al %a$ul"! o& Sri'i(a!aU#i)ersi"!*U#i)ersi"!*
M. +oesi# Ge#eral +ospi"alM. +oesi# Ge#eral +ospi"al
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,+A- IS S-ROKE,+A- IS S-ROKE
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-Y1ES O% S-ROKE -Y1ES O% S-ROKE
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-Y1ES O% S-ROKE -Y1ES O% S-ROKE
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SUBARAC+NOID +EMORR+AGESUBARAC+NOID +EMORR+AGE
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RISK %AC-ORRISK %AC-OR
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+O, O%-EN DOES+O, O%-EN DOES
S-ROKE OCCURS IN COMMUNI-YS-ROKE OCCURS IN COMMUNI-Y
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S-A-IS-ICSS-A-IS-ICS
► E)er! 23 se$o#dsE)er! 23 se$o#ds
►
-4e "4ird leadi# $ause o& dea"4 5 $ause o& -4e "4ird leadi# $ause o& dea"4 5 $ause o&
lo#6"erm disa0ili"!lo#6"erm disa0ili"!
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,+Y IS S-ROKE CONSIDERED AS,+Y IS S-ROKE CONSIDERED AS
AN EMERGENCY CASEAN EMERGENCY CASE
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-IME IS CRI-ICAL : 7 +OURS ,INDO, -IME IS CRI-ICAL : 7 +OURS ,INDO,
► -o sa)e is$4emi$ pe#um0ra -o sa)e is$4emi$ pe#um0ra
► -o redu$e mass e8e$" -o redu$e mass e8e$"
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REDUCING MASS E%%EC-REDUCING MASS E%%EC-
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+O, -O ES-ABLIS+ -+E DIAGNOSIS+O, -O ES-ABLIS+ -+E DIAGNOSIS
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ANAMNESISANAMNESIS
Suddenly
• delirium, decrease of consciousness• trouble speaking or understanding
• trouble seeing• trouble walking, dizziness, loss of
balance or coordination• one side numbness or weakness
of the face, arm or leg
• severe headache
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1+YSICAL E9AMINA-ION1+YSICAL E9AMINA-ION
► Co#s$ious#esCo#s$ious#es
► Vi"al si#Vi"al si#► Ge#eral s"a"usGe#eral s"a"us
► Neuroloi$al eami#a"io#Neuroloi$al eami#a"io#
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DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
Si# 5 S!mpSi# 5 S!mp -4rom0o"i -4rom0o"i$$
Em0oli$Em0oli$ +emorr4a+emorr4aee
SA+SA+
A$"i)i"! a"A$"i)i"! a"o#se"o#se"
66 ;; ;; ;;
Neuro de$i"Neuro de$i" 'orse#i#'orse#i# Ma a"Ma a"o#se"o#se"<impro)<impro)ee
Ma a"Ma a"o#se"o#se"
mi#imalmi#imal<'ors<'orsee
+eada$4e+eada$4e 66 ;*6;*6 ;*6;*6 ;;;;
Vomi""i#Vomi""i# 66 ;*6;*6 ;*6;*6 ;*6;*6
Sei=ureSei=ure 66 ;*6;*6 ;*6;*6 ;*6;*6
De$rease o&De$rease o&
$o#s$ious#es$o#s$ious#esss
66 ;*6;*6 ;*6;*6 ;*6;*6
-IA -IA ;; 66 66 66
B1B1 ↑↑ N*N* ↑↑ ↑↑ ↑↑ N*N* ↑↑
Nu$4alNu$4al
riidi"!riidi"!
66 66 66 ;;
Bleedi# L1 66 66 6; 6 ;;
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TIME ISTIME ISBRAINBRAIN
MANAGEMENMANAGEMENTT
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MANAGEMEN-MANAGEMEN-
►1re 4ospi"al1re 4ospi"al
►ERER
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1RE +OS1I-AL MANAGEMEN-1RE +OS1I-AL MANAGEMEN-
Earl! de"e$"io#Earl! de"e$"io#
1a"ie#" "ra#spor"ed > am0ula#$e1a"ie#" "ra#spor"ed > am0ula#$e
I#i"ial assessme#"I#i"ial assessme#"
ABC ?Normal Sali#e/ Ri#er Ase"a"e@ABC ?Normal Sali#e/ Ri#er Ase"a"e@
-ra#s&erred "o re8eral 4ospi"al immedia"el! -ra#s&erred "o re8eral 4ospi"al immedia"el!
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MANAGEMEN- A- ERMANAGEMEN- A- ER
AnamnesisAnamnesis
Airway & BreathingAirway & Breathing
► Orop4ari#eal "u0eOrop4ari#eal "u0e
► E--E--
► O!e# 0i#asalO!e# 0i#asal
Circuati!nCircuati!n
►I#"ra)e#ous li#e :Normal sali#e/ ri#er ase"a"I#"ra)e#ous li#e :Normal sali#e/ ri#er ase"a"
► 1roper ma#aeme#" &or B11roper ma#aeme#" &or B1
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Ma#aeme#" a" ERMa#aeme#" a" ER
Initia "hysica e#amInitia "hysica e#am
C!ntr! ee$ate% cerera "ressureC!ntr! ee$ate% cerera "ressure
►
+ead ele)a"ed 73+ead ele)a"ed 73°°
► Ma#i"ol 3. > 3. m*B, o)er 3 mi#/Ma#i"ol 3. > 3. m*B, o)er 3 mi#/
repea"ed e)er! 26 4rrepea"ed e)er! 26 4r
► %urosemide m*B, i)%urosemide m*B, i)
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Ma#aeme#" a" ERMa#aeme#" a" ER
Sei'ure C!ntr!Sei'ure C!ntr!
► Dia=epam > 3 m slo' i)Dia=epam > 3 m slo' i)
►
14e#i"oi# &or prop4!la$"i$ a#"iepilep"i$14e#i"oi# &or prop4!la$"i$ a#"iepilep"i$
Feris c!ntr!Feris c!ntr!
► A$e"ami#op4e# 3 mA$e"ami#op4e# 3 m
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Ma#aeme#" a" ERMa#aeme#" a" ER
La0ora"oriumLa0ora"orium
ECGECG
C4es" ra!C4es" ra!C- s$a#C- s$a#
L1L1
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C- SCAN O% ISC+EMIC S-ROKEC- SCAN O% ISC+EMIC S-ROKE
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C- SCAN O% +EMORR+AGE S-ROKEC- SCAN O% +EMORR+AGE S-ROKE
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C- SCAN O% SA+C- SCAN O% SA+
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MANAGEMEN- A- ER : %LO, C+AR-MANAGEMEN- A- ER : %LO, C+AR-
Ide#"i$a"io# 5 i#i"ial
assessme#"
ABC
+ead C- s$a#La0or
C4es" 9 ra!ECGL1
Co#sul" "o$orrela"eddep"Cardio/I#"er#al dep"/NC
Dia#osis
-4erap!
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