Problem 7 KGD

Maria Marcella
405090007
HEAD TRAUMA
Glasgow Coma Scale
Adults Infants/Children
Eye
Opening
4
3

!
Spon"aneo#s
$o %oice
$o pain
&o response
Spon"aneo#s
$o %oice
$o pain
&o response
%erbal 5
4
3

!
Orien"e'
Con(#se'
)nappropia"e wor's
)ncompre*ensible so#n's
&o response
+ler", normal -ocali.a"ion
Cries b#" consolable
Persis"en"ly irri"able
/es"less,agi"a"e', moaning
&o response
Mo"or
/espons
e
0
5
4
3

!
Obeys comman's
1ocali.es pain
2i"*'raws
+bnormal 3e4ion
5'ecor"ica"e6
+bnormal e4"ension
5'ecerebra"e6
&o response
Spon"aneo#s p#rpose(#l
1ocali.es pain
2i"*'raws
+bnormal 3e4ion
5'ecor"ica"e6
+bnormal e4"ension
5'ecerebra"e6
&o response
Classi7ca"ion o( $8)
Depens On Classifcation
Mechanism
8l#n"
Pene"ra"ing
9S*arp
:ig* spee' 5"ra;c acci'en"6, 1ow spee'
5(alls,ge" *i"6
G#ns*o" wo#n's, o"*ers pene"ra"ing in<#ry
Seerit!
Mil'
Mo'era"e
Se-ere
GCS !3=!5
GCS 9=!
GCS > ?
Morpholo"!
8one @rac"#re A
Cal-aria
8ase o( sB#ll
1inear -s s"arlig*" C Depression 9 non C
Open9Close
2i"* 9wi"*o#" 1CS leaBing C 2i"*9wi"*o#" &
%)) paresis
Intracranial
#ession
@ocal
DiD#se
Epi'#ral *ema"ome, S#b'#ral :emorr*age,
)n"racerebral *emorr*age
Conc#ssion , M#l"iple Con"#sio, :ypo4ic9
)sc*emic
Mec*anisms o( craniocerebral
in<#ry
A$ Cranium distorted %!
forceps &%irth in'ur!($
)$ *unshot +ound of the
%rain$
C$ ,alls &also traffc
accidents($
D$ )lo+s on the chin
&-punch
drun./($
E$ In'ur! to s.ull and %rain
%! fallin" o%'ects$
*""pA99ne#ros#rgeryE#claEe'#9bo'yEc(mFi'G07?
8rain
)n<#ry
*""pA99ocwE"#("sEe'#9Con"en"95!9lec"#reno"es907370090740!?
Pa"*op*ysiology 5Primary6
$*e main mec*anisms A

contact 5eg, an ob<ec" s"riBing "*e *ea' or "*e

brain s"riBing "*e insi'e o( "*e sB#ll6 scalp,
(rac"#re "o "*e sB#ll, an' s#r(ace con"#sions

acceleration0deceleration #nres"ric"e'
mo-emen" o( "*e *ea' an' lea's "o s*ear,
"ensile, an' compressi-e s"rains in"racranial
*ema"oma, 'iD#se -asc#lar in<#ry, an' in<#ry
"o cranial ner-es an' "*e pi"#i"ary s"alB
Primary )n<#ry o( $8)
Mechanism
Contusio
ns
are 'is"inc" areas o( swollen brain "iss#eE
(o#n' on A "*e poles, in(erior o( "*e (ron"al lobes, "*e cor"e4
abo-e an' below "*e operc#l#m o( "*e syl-ian 7ss#res, an' "*e
la"eral an' in(erior aspec"s o( "*e "emporal lobes
IntraCra
nial
Hemato
mes
Epidural hematomas A ca#se' by (rac"#re o( "*e "emporal bone
an' r#p"#re o( "*e middle menin"eal arter!E clo""e' bloo'
collec"s be"ween "*e bone an' "*e '#raE so#rce o( blee'ing is
ar"erialgrow H#icBly an' crea"e press#re agains" "*e brain
"iss#eE
Su%dural hematomas Aca#se' by r#p"#re o( "*e %rid"in"
eins in "*e s#b'#ral spaceE grow large eno#g* as mass lesions,
rela"e' wi"* *ig* morbi'i"y an' mor"ali"y ra"esE
Su%arachnoid hematomas 1 resl#" (rom 'amage "o bloo'
-essels in "*e pos"erior (ossa s"alB
Di2use
a3onal
in'ur!
&DAI(
microscopic 'amage,
Mec*anical ca#ses A ro"a"ional accelera"ion o( "*e brain
#nres"ric"e' *ea' mo-emen"pro'#ces s*earing an' "ensile
(orces, an' a4ons can be p#lle' apar" E
Microscopic e-al#a"ion A n#mero#s swollen an' 'isconnec"e'
a4onsE /api' s"re"c*ing o( a4ons 'amages "*e a4onal
cy"osBele"on an' 'isr#p" normal ne#ron (#nc"ion
Secon'ary )n<#ry o( $8)
occ#r *o#rs or 'ays a("er "*e inci"ing "ra#ma"ic e-en"
res#l" (rom impairmen" or local 'eclines in cerebral bloo' 3ow
5C8@6 a("er a $8)E
Decreases in C8@ are "*e res#l" o( A local e'ema, *emorr*age,
or increase' 5)CP6E risB o( a 'ecrease' C8@ A ar"erial
*ypo"ension, *ypo4emia, in"racranial *emorr*age an'
malignan" brain e'ema, an' *yper"*ermia
ina'eH#a"e per(#sion cell#lar ion p#mps (ail casca'e
in"racell#lar calci#m an' so'i#m o-erloa' cell#lar
'es"r#c"ionE
E4cessi-e release o( e4ci"a"ory 5gl#"ama"e an' aspar"a"e6
(ail#re o( "*e ion p#mpsE
casca'e con"in#es cells 'ie ca#sing (ree ra'ical (orma"ion,
pro"eolysis, an' lipi' pero4i'a"ion ne#ronal 'ea"*E
*""pA99wwwEemsmaga.ineEcom9ar"icle9p*o"os9!440777!3I40=3E<pg
Cedera Intra.ranial
Complica"ions

Pos""ra#ma"ic sei.#res

:y'rocep*al#s

D%$

:e"ero"opic ossi7ca"ion

Spas"ici"y

G) an' GJ complica"ions

Gai" abnormali"ies
Mana"ement
Mana"ement
Air+a!
)reathin"
Circulation
Treat sei4ure
Assest the seerit!
AIR5A6

Clear "*e airway (rom 'ebris, -omi",

release ar"i7cial "ee"*, Cer-ical
spine s"abili.a"ion 5p#" collar
cer-ical6, p#" orop*aryngeal "#be
5g#e'el6

)( oro(acial in<#ry "*a" in"er(ere

airway, i"#ba"eE

De"ermine spon"aneo#s brea"*ing

)( no" gi-e o4ygen by masB

)( yes, asses" "*e se-ere c*es" in<#ry

P#" p#lse o4yme"ry "o Beep SaO

minim#m 95K

)( airway #npro"ec"e' or pa"ien"

-omi", in"#ba"e an' -en"ila"e
)REATHI7*
CIRCU#ATIO7
-
S"op all blee'ing p#" press#re on
ar"ery
-
+sses" ab'ominal an' "*ora4
"ra#ma9in<#ry
-
2a"c* (o" :/ an' 8P, p#" EKG
-
)% access, -ena p#nc"ion "o bloo'
lab an' +8G
-
Colloi' 3#i'
Treat the Sei4ure
-
Dia4epam !0 mg )%
-
)( no" worBing, phen!toin !5
mg9Bg82 )% wi"* spee' no" o-er 50
mg9min
Assest Seerit!
Condition
Mild Head In'ur!
&lo+ ris. "roup(
Moderate head
in'ur! &moderate
ris. "roup(
Seere Head In'ur!
&Seere Ris.(
- GCSA !5 5compos
men"is, a""en"e',
orien"e'6
- &o loss o(
conscio#sness 5EEgE
Conc#ssion6
- &o alco*ol
in"o4ica"ion an'
o"*er 'r#gs 5&+PL+6
- Complain" *ea'ac*e
an' 'i..iness
- Pa"ien" e4perience
abra"ion, lacera"ion
or Scalp *ema"ome
- &o mo'era"e=se-ere
*ea' in<#ry cri"eria
- GCSA 9=!4
5con(#sion,
le"*argic, or s"#por6
- Conc#ssion
- +mnesia pos"
"ra#ma
- %omi"ing
- Possibili"y signs o(
Crani#m (rac"#re
58a""leMs sign,
/acoonMs eye ,
*emo"impan#m,
o"or*ea or rinor*ea
CS@6
- Sei.#re
- GCSA 3=? 5comma6
- Decrease'
consio#sness
progressi-ely
- @ocal ne#rologic
signs
- Pene"ra"ing *ea'
"ra#ma or
'epresse' sB#ll
(rac"#re
Managemen"
Simple head in'ur!1

Do "*e wo#n' care

:ea' ra'iograp*y i(
in'ica"e'

Disc*arge pa"ien" an'

(amily s*o#l' obser-e
"*e pa"ien"

2*en s#spec"e'
'ecrease
consio#sness, bring "o
*ospi"al again
Transient consciusness
disrupt1
$ransien" 'ecrease
consci#sness a("er "ra#ma,
b#" (#ll conscio#s w*en
e4amina"e'
:ea' ra'iograp*y
Do "*e wo#n' care
Disc*arge pa"ien" an'
(amily s*o#l' obser-e "*e
pa"ien"
2*en s#spec"e' 'ecrease
consio#sness, bring "o
*ospi"al again
Conscio#s pa"ien" 5GCS G !56
Managemen"
Pa"ien" wi"* 'ecrease conscio#sness
Mild &*CS 8 9:09;( Moderate &*CS 8 <0
9=(
Seere &*CS :0 >(
P*ysical e4amina"ion
2o#n' care
:ea' ra'iograp*y
8e' res"
Obser-e 4 *o#r in
*ospi"al "o asses"
possibili"y o(
in"racranial
*ema"ome 5s#c* as
l#ci' in"er-al,
*ea'ac*e, -omi"ing,
'ecrease
conscio#sness6
1a"era"ion symp"oms
5p#pil #neH#al,
pa"*ologic re3e4 5N66
)( s#spec"
*ema"ome, 'o brain
Scan
in "*is gro#p, pa"ien"
may s#Der (rom
car'iop#lmonary
'isr#p"ion
Do A
+8C
E4amine
conscio#sness A
p#pil, (ocal
cerebral sign an'
in<#ry
:ea' ra'iograp*,
an' o"*er organ i(
nee'es
8rain scan i(
s#spec"
*ema"ome
Obser-e %i"al sign
)n "*is gro#p, pa"ien"
#s#ally wi"* m#l"iple
in<#ries
+8C
Cer-ical (rac"#re
p#" collar necB
)( "*ere is open
wo#n' an' blee'ing
s"op blee'ing wi"*
press#re 'eb
Sys"emic c*anges
)n coma"ose pa"ien" 5GCS O ?6 or
pa"ien" wi"* *ernia"ion signs, 'oA
:ea' ele-a"ion 30P
:yper-en"ila"ion A in"#ba"e an' gi-e
-en"ila"ion in"ermi""en" man'a"oric E +-oi'
se-er *ypocapn#e
Mani"ol 0K !g9Bg )% in 0=30 minE /epea"
'ose can apply in 4=0 * a("er 5!94 ini"ial
'ose9 0 * ma4E @irs" 4? * 6
@oley ca"*e"er
&e#ros#rgeon cons#l" i( opera"ion in'ica"ion
A large epi'#ral *ema"ome,s#b'#ral
*ema"ome, open *ea' in<#ry , impresion
(rac"#re Q ! 'iploe6
Operative Therapy
Closed craniocere%ral in'ur!

Compression (rac"#re

Epi'#ral *ema"om

S#b'#ral *ema"om

)n"racerebral
*emorr*age

Decompression
opera"ion eEg se-ere
con"#sio an' cerebral
e'ema
Open craniocere%ral in'ur!

Craniocerebral wo#n'
in scalp, m#l"iple
(rac"#re, "earing '#ra
wi"* cerebral
lacera"ion

1iH#or*oea

Pne#moencep*ali

Corp#s alien#m

G#ns*o" wo#n'
me'picsE7n'lawEcom9imagescooBe'99?02E<pg
Medicine Therapy

8ol#s Mani"ol 50K, !00ml6 )%, i(

increase )CP

Pro7lac"ic an"ibio"ic basilar sB#ll

(rac"#re

+n"icon-#lsan" sei.#re

Se'a"i-e an' &+PL+ are

CO&$/+)&D)C+$ED, beca#se can
aggra-a"e "*e 'ecrease
conscio#sness
Inpatient/ Hospitality
Indication

)n"racranial blee'ing or (rac"#re "*a" appear in

8rain C$

Con(#sion, agi"a"ion, or 'ecrease

conscio#sness

@ocal ne#rologic signs

Pos" "ra#ma"ic sei.#re

Dr#gs in"o4ica"iion or alco*ol

Ob-io#s commorbi' 'isease

&o "r#s"e' people "o obser-e pa"ien" a" *ome

30
ALGORITMA PENATALAKSANAAN TRAUMA KEPALA
Trauma Kepala
Faktor Penyulit (-) Faktor Penyulit (+)
Konsultasi Bagian Terkait
CKR (GCS 14-15) CKS (9-1) CKB ! 9
"#ser$asi
%e&isit 'eurologis (-) %e&isit 'eurologis (+)
(ini)al *4 +a)
,ea- CT S.an
/ntra Cere#ral ,e)ato) 0 1 .. (+) -an atau
Su# %ural ,e)ato) 2uas (+) -an atau
34i-ural ,e)ato) (+) -an atau
Fraktur -e4resse- (+) -an atau
Fraktur i)4ressi (+)
Fraktur ter#uka (+)
/ntra Cere#ral ,e)ato) 0 1 .. (-) -an
Su# %ural ,e)ato) 2uas (-) -an
34i-ural ,e)ato) (-) -an
Fraktur -e4resse- (-) -an
Fraktur i)4ressi (-)
Fraktur Ter#uka (-)
Be-a5 Sara&
Sara&
Sara&
Penga6asan -an Penanganan Faktor Penyulit -an Ko)4likasi
Sara&
B2P2
,a.tor pen!ulit 1 Cedera diluar .epala
1+MP)/+& !
3!
Trauma Kepala
Risiko tinggi Risiko ren-a5
Pulang -engan e-ukasi 4a-a .aregi$er
Ce-era /ntrakranial Fraktur Kal$aria Tan4a .e-era intrakranial -an &raktur kal$aria
(on-ok
Ke)ungkinan inter$ensi
GCS 14-15
CT S.an ke4ala
Re-e$aluasi
Fraktur Ter#uka7 #asilar atau -e4resse- Fraktur si)4le
GCS 8 14
Fraktur si)4le
-an GCS 8 15
Konsultasi Be-a5 sara&
9nti#iotik
(on-ok
(on-ok untuk o#ser$asi
Ke)ungkinan inter$ensi
Pulang -engan e-ukasi
4a-a .aregi$er
Re-e$aluasi
GCS 8 14 GCS 8 15
Pulang -engan e-ukasi
4a-a .aregi$er
"#ser$asi :G%
;-1* +a)
%eteriorasi
GCS !8 1
(e)#aik
GCS 8 15
Pulang -engan e-ukasi
4a-a .aregi$er
CT S.an Ke4ala ulang
(on-ok
Ke)ungkinan inter$ensi
1+MP)/+&
3
Trauma Kepala
Pasien Koo4erati& Pasien ti-ak koo4erati&
RS/ 6it5 s5ort a.ting agent
CT (+) CT (-) -an GCS ! 1 CT (-) -an GCS 08 1
Ke)ungkinan inter$ensi
(on-ok
GCS 9-1
CT S.an ke4ala
(on-ok
(+) CT (-) CT
Ke)ungkinan o4erati&
/nter$ensi
(on-ok /C:
CT S.an Ke4ala
(+) CT (-) CT
"#ser$asi -i :G%
;-1* +a)
Ke)ungkinan o4erasi
/nter$ensi
(on-ok
GCS tak #eru#a5 GCS )eningkat
3kstu#asi segera
-gn o#ser$asi *4 +a)
/C: -g ulang CT s.an
GCS 1 atau 14
9tau -e&isit neurologis +
GCS )eningkat )en+a-i 15
%an tan4a -e&isit neurologis
Pulang -engan e-ukasi
4a-a .aregi$er
(on-ok
(e)#uruk GCS )eningkat )en+a-i 15
%an tan4a -e&isit neurologis
Pulang -engan e-ukasi
4a-a .aregi$er
CT S.an ulang segera
"#ser$asi ;-1* +a)
1+MP)/+& 3
33
Trauma Kepala
Proteksi <alan na&as
Sta#ilisasi $erte#ra .er$i.al
(anitol
Tinggikan ke4ala
,i4er$entilasi
Pe)eriksaan lengka4 /
3$aluasi -an 4e)eriksaan /
1= Perta5ankan P1* 0 ;1 )),G7 SBP 0 1*1 )),G7 ,CT 0 1
GCS ! 9
Pen.ega5an ke)ungkinan 4eningkatan T/K
Ree$aluasi -an 4e)eriksaan //
Ke)ungkinan o4erati&
/nter$ensi
(on-ok /C:
Perta5ankan P1* 0 ;1 )),G7
SBP 0 1*1 )),G7 ,CT 0 1
CT (+) CT (-)
CT S.an Ke4ala
(+)
34i-ural
Su#-ural
S9,
Kontusio
3-e)a sere#ri #erat yang -isertai kenaikan T/K
(-)
%9/
Tan4a tan-a 5erniasi
Tan-a 5erniasi (+)
Ree$aluasi -an 4e)eriksaan //
CT S.an Ke4ala
Ke)ungkinan o4erati&
/nter$ensi
(on-ok /C:
'B> P"*> tekanan 4artial "*? S9,> su# ara.5noi- 5ae)orag5e? SBP> systoli. #loo- 4ressure? %9/> -i&&use a@onal in+ury? ,CT> 5e)atokrit
1+MP)/+& 4
Scalp 2o#n'

Scalp lacera"ions are e4"remely common a("er

*ea' in<#ry an' may be a source of si"nifcant
%leedin"

)n s"able pa"ien"s see (rom -i"al signH#icB

clos#re o( "*e wo#n',a("er proper 'ebri'emen"
an' irriga"ion is "*e mos" eDec"i-e way "o s"op a
blee'ing scalp lacera"ion an' pre-en" "*e "iss#e
cr#s* in<#ry "*a" may occ#r i( o"*er compressi-e
me"*o's are #se' (or "oo longE

)n #ns"able pa"ien", *ig*er priori"y in"er-en"ions

"aBe prece'ence o-er wo#n' careE
Scalp 2o#n'

Con"amina"e' or in(ec"e' scalp wo#n's "*ere(ore

*a-e "*e po"en"ial "o ca#se serio#s intracranial
infections$

Digi"al e4plora"ion o( a scalp wo#n' s*o#l' be

care(#lly per(orme'E

Clipping away a small area o( *air parallel "o "*e

e'ges o( "*e wo#n' may (acili"a"e

an"ibio"ic oin"men" can be applie' "o "*e *air

imme'ia"ely s#rro#n'ing "*e wo#n' an' #se' "o
plas"er "*e *air away (rom "*e in<#ry si"eE
Scalp 2o#n'

Disr#p"ion o( "*e galea #s#ally res#l"s in a gaping

scalp lacera"ionE

8eca#se o( "*e ric* bloo' s#pply o( "*e

scalp,e-en -ery large scalp a-#lsions can s#r-i-eE

Scalp abrasions are o("en con"amina"e' wi"*

pieces o( 'ir" or o"*er 'ebrisE

+n"ibio"ics are #s#ally no" nee'e' (or care(#lly

manage' scalp wo#n's beca#se rapi' *ealing is
(acili"a"e' by "*e ric* bloo' s#pply o( "*e scalpE
Scalp lacera"ion an' applica"ion o(
/aney clips "o con"rol blee'ingE
SB#ll @rac"#re

1inear @rac"#re

Occ#rs beca#se o( con"ac"=

impac" in *ea'

Ca#se' by "*e impac" o( a

*ar' ob<ec"

$*e ob<ec" #s#ally large

eno#g* no" pene"ra"e "*e
sB#ll large eno#g* impac"
p*enomena is no" con"in#e'
"o allo-er sB#ll

Par"ic#lar care s*o#l' be "aBen in

e-al#a"ing (rac"#res "*a" cross "*e
mi''le meningeal ar"ery or a ma<or
-eno#s sin#sE

1inear occipi"al (rac"#res *ig*er

in"racerebral complica"ion ra"esE

@rac"#res "*a" are 'epresse' beyon'

"*e o#"er "able o( "*e sB#ll reH#ire
opera"i-e repairE
Depresse' SB#ll @rac"#re

1oa' more energy beca#se o( smaller

s#r(ace

Con"ac" mec*anism in *ere is more

(oc#se' an' *ar'er ob<ec" an' o-er
"*e elas"ici"y o( sB#ll per(ora"ion

Can caused meningitis / infection and seizures

Can reach tissue and dura laceration

Usually happen because of smash

Location : parietal atau temporal

Sign and Symptoms :

epends on depth of depression

!"# patient loss of consciousness

$eurologic deficits may be present

/: C% Scan

Should be admitted for continued obser&ation by a

neurosurgeon'
SB#ll base (rac"#re can no" always be
'e"ec"e' by R=rays, '#e "o "*e -ery basic
loca"ionE
Clinical signs "*a" *elp Diagnose A

)attle si"n 5 bl#e 9 ec*imosis in bacB o( ear,

#pper par" o( mas"oi' 6

Hemotipanum 5 membran "ympanic

blee'ing 6

?erior%ital ecch!mosis 5 blacB eyes

wi"*o#" 'irec" "ra#ma 6

Rhinorrhoe

Otorrhoe
8+S)1+/ @/+C$J/E
Anterior

/*inorr*ea

raccoon eye

+nosmia
Media

os pe"ros#m (rac"#re

O"orr*ea

Disr#p"ion o( & %)) an' %)))

?osterior

8ila"eral ba""leMs sign

More se-ere symp"oms

Decrease' o( consio#sness
Dia"nose

:alo "es" 9 be"a'ine "es" A cer"ain "*e CS@

C$ scan
@ompli.asi

:earing 'isr#p"ion

Parese perip*er o( &E%))

Meningi"is p#r#len"
45
:ema"oma Epi'#ral

Collec"ion o( bloo' be"ween "*e sB#ll

wi"* "*e '#ra ma"er 5Bnown wi"*
E4"ra'#ral *ema"oma6

massi-e *ema"oma '#e "o r#p"#re or

sin#s -enos#s me'ia aEmeningea

Clinical 'iagnos"ic sign A

1#ci' in"er-al 5N6

Decrease' o( consio#sness

1a"e *emiparese con"rala"eral lession

JeH#al p#pils

8abinsBy 5N6 con"rala"eral lession

$emporal (rac"#re
40
47
4?
:ema"oma epi'#ral

Epi'#ral *ema"ome (rom blee'ing -eins

less "*an "*e ar"eriesE

Generally "*is is ca#se' by a sin#s

lacera"ion by (rac"#re '#rama"ris occipi"al,
parie"al, or bone sp*enoi'E

Epi'#ral *ema"ome -eins loca"ion A

Pos"erior (ossa A sin#s sigmoi' or "rans-ers#s

lacera"ions

Me'ial (ossa A sp*enoparie"al sin#s in<#ry

Para Sagi"al A sagi"al s#perior sin#s "earing

49
Pa"*op*ysiology

)n<#ries ca#se' by lacera"ion

meningeal me'ia ar"ery, me'ia
meningeal -eins or sin#s '#ra, wi"* 9
wi"*o#" a sB#ll (rac"#reE

Epi'#ral *ema"oma compression,

s*i(", increase' )CPE
50
E4amina"ion

8rain C$=Scan an' M/) A looBs a

blee'ing layer blee'ing wi"*
len"iB#lar or bicon-e4 (ormE

Cerebral angiograp*y 5in-asi(e6

5!
Complica"ions

Primary complica"ions 'irec"

mec*anism

+4onal in<#ry

Early loss o( consio#sness 9 men"al s"a"e

'epression

Secon'ary complica"ions

1arge *ema"ome ne#rologic

'e"eriora"ion
5
Managemen"s

+8CD

&e#rologic 'e7ci" sign an' e-al#a"e

*ema"ome

Pos" op A p#" 'rainage 544 *o#rs6 "o

pre-en" secon'ary bloo' collec"ingE

GCS in"er-en"ion below ? 5in"#ba"ion6

Pre-en" secon'ary complica"ion

53

Depen's on progressi-i"y o(
in"racranial 'ecompensa"ion an'
commorbi' in"racranial lessions

Mor"ali"y 7=!5K 'an seH#ele in 5=

!0K o( case 5'#e "o commorbi'
in"racranial lession6E
Prognosis
:EM+$OM+ SJ8DJ/+1
Per'ara*an "er<a'i 'i an"ara
'#rama"er=araB*noi' aBiba"
robeBnya bridging vein
Ge<ala Blinis

$<' 30K Brn ce'era Bepala bera"E

Per#ba*an Besa'aran 5*ampir sem#a

Bas#s6E

&yeri Bepala, m#n"a*, le"argiE

:emiparesisE

)n"er-al l#si' sblm ge<ala ne#rogiB "ampaBE

SenisA

+B#" A in"er-al l#ci' 0=5 *ari

S#baB#"A in"er-al l#ci' 5 *ari T mingg#

KroniB A in"er-al l#ci' Q3 b#lan

*e'ala @linis
Acute
su%dural
Hemorrh
a"e
sering 'i*#b#ngBan 'engan ce'era o"aB besar 'an
ce'era ba"ang o"aBE
$an'a="an'a aBan ge<ala Blinis ber#pa
saBi" Bepala,
perasaan Ban"#B, 'an Bebing#ngan,
/espon yang lamba", 'an gelisa*E
Kea'aan Bri"is "erli*a" 'engan a'anya perlamba"an
reaBsi ipsila"eral p#pilE
Su%Acute
su%dural
Hemorrh
a"e
berBembang 7=!0 *ari se"ela* ce'era 'an 'i*#b#ngBan
'engan Bon"#sio serebri yang agaB bera"E $eBanan
serebral yang "er#s=mener#s menyebabBan pen#r#nan
"ingBa" Besa'aran yang 'alamE
Chronic
su%dural
Hemorrh
a"e
"er<a'i Barena l#Ba ringanE M#lanya per'ara*an Becil
memas#Bi r#ang s#b'#ralE 8eberapa mingg# Bem#'ian
men#mp#B 'i seBi"ar membran -asB#ler 'an pelan=pelan
mel#asE Ge<ala m#ngBin "i'aB "er<a'i 'alam beberapa
minggg# a"a# b#lanE Kea'aan ini pa'a proses yang lama
aBan "er<a'i pen#r#nan reaBsi p#pil 'an mo"oriBE
Pa"o7siologi

/obeBnya -ena peng*#b#ng an"ara

Bor"eBs serebri U 'rainase sin#s -ena
peningBa"an $)KE

Penyempi"an -en"riBel aBiba" -ol#me

beB#anE

J'em yg 'isebabBan ce'era o"aBE

Diagnosis

+namnesis 'i(oB#sBan p'

meBanisme ce'era U Bea'aan
ne#rologiB sblm U s"l* ce'eraE

$em#an ra'iogra7 'r C$ scan Bepala

"anpa Bon"ras B#mp#lan 'ara*
bMb"B b#lan sabi" an"ara o"aB U '#raE

:ilangnya s#lB#s U penyempi"an

-en"riBelE

Pergeseran garis "enga* aBiba"

-ol#me beB#an yg besarE
S#b'#ral *ema"oma
$erapi
)n"er-ensi be'a* sara( 'ini 54
<am6
)n"er-ensi GCS lb* ren'a* ?
5in"#basi seB#ens cepa"6E
Kranio"omi e-aB#asi *ema"om
secepa"nya 'gn irigasi -ia b#rr=
*ole
#9orang "#a G operasi Branio"omi
5'iban'ingBan 'gn b#rr=*ole sa<a6
Medicines1 )( s#rgery
canno" be 'oneA
9$ Diuretics1 #9V
pembengBaBan 'io"aB
'an 'p" aliran 'ara* yg
baiB
=$ Steroids1 V in3amasiE
:$ Anticonulsant
medicine1 "o con"rol
sei.#resE
@ompli.asi
!E :emiparese9*emiplegia
E
E Dis(asia9a(asia
3E EpilepsiE
4E :i'rosepal#sE
5E S#b'#ral empiema
?ro"nosis
!E Mor"ali"as pa'a s#b'#ral
*ema"om aB#" G 75K=?5K
E Pa'a s#b '#ral *ema"om
Bronis A
= Semb#* "anpa gangg#an
ne#rologi seBi"ar 50K=?0KE
= Semb#* 'engan gangg#an
ne#rologi seBi"ar 0K=50KE
3E Diperngar#*i a'anya ce'era
o"aB seB#n'er yg Berap
menyer"ainya
4E S#r-i-al lb* baiB <B e(eB
massa yg "er<a'i 'ie-aB#asi
O 4 <amE
S#barac*noi' :emorr*age

Ge<ala 'an "an'a BlinisA

BaB# B#'#B

nyeri Bepala

bisa "er'apa"
gangg#an Besa'aran

DiagnosisA

C$ Scan +'anya
per'ara*an 'i r#ang
s#baraBnoi'

2ani"a

Pen'ara*an spon"an biasanya 'iaBiba"Ban

'ari peca*nya secara "iba="iba aneurysm 'i
'alam ar"eri cerebralE

SeBi"ar 5K orang mengalami ge<ala=ge<ala

Ber#saBan pa'a bagian spesi7B pa'a o"aB,
seper"i beriB#" 'i bawa* ini A

Kelela*an a"a# l#mp#* pa'a sala* sa"#

bagian "#b#* 5paling sering "er<a'i6E

Ke*ilangan perasa pa'a sala* sa"#

bagian "#b#*E

Kes#li"an mema*ami 'an mengg#naBan

ba*asa 5aphasia6E
$an'a 'an Ge<ala

SaBi" Bepala, yang bisa "iba="iba "i'aB

seper"i biasanya 'an bera"
5Ba'angBala 'iseb#" saBi" Bepala
thunderclap6E

&yeri m#Ba a"a# ma"aE

Pengli*a"an gan'aE

Ke*ilangan pengli*a"an
seBelilingnyaE
Diagnosa

Merasa saBi" Bepala *eba" secara

men'a'aB 'an mencapai p#ncaB
'alam *i"#ngan 'e"iB

C$ scan

1P

Cerebral angiograp*y loBasi

ane#rism

Magne"ic resonance angiograp*y

C$ angiograp*y
Pena"alaBsanaan

+nalgesiB opioi' saBi" Bepala

Pelemb#" "in<a Bons"ipasi

&imo'ipine mencega* -asospasm

'an s"roBe isc*emic

Memasang s*#n" mengeringBan

cairan cerebrospinal, meng*ilangBan
"eBanan 'an mencega*
*y'rocep*al#s
KompliBasi

Hydrocephalus

Aasospasm

?ecahan .edua
Prognosis
35K meninggal
ane#rism
5 K meninggal 'alam
beberapa mingg#
pen'ara*an 'ari peca*an
Be'#a
Orang yang ber"a*an #n"#B
0 b#lan "e"api yang "i'aB
melaB#Ban operasi #n"#B
aneurysm memiliBi 3K
Bem#ngBinan mengalami
peca*an lainnya se"iap
"a*#nE
Gambaran perbe'aan per'ara*an
)n"raserebral 'an S#barac*noi'
CO7TUSIO CERE)RII

Pa'a contusio cerebri 5memar o"aB6 "er<a'i

per'ara*an=per'ara*an 'i 'alam <aringan o"aB
"anpa a'anya robeBan <aringan yang Basa" ma"a,
mesBip#n ne#ron=ne#ron mengalami Ber#saBan a"a#
"erp#"#sE

"er<a'inya lesi con"#sion a'anya aBselerasi Bepala

yang seBe"iBa pergeseran o"aB ser"a
pengembangan gaya Bompresi yang 'es"r#B"i(E

+Bselerasi yang B#a" berar"i p#la *ipereBs"ensi

Bepala memben"ang ba"ang o"aB "erlal# B#a"
menimb#lBan blocBa'e re-ersible "er*a'ap lin"asan
asen'ens re"iB#laris 'i(#s o"aB "i'aB men'apa"
inp#" a(eren Besa'aran *ilang selama blocBa'e
re-ersible berlangs#ngE
$imb#lnya lesi con"#sio 'i 'aera* WcoupX ,
WcontrecoupX ge<ala 'e7ci" ne#rologiB ber#pa
re3eBs babinsBy yang posi"i( 'an Bel#mp#*an JM&E

+Biba" gaya yang 'iBembangBan ole* meBanisme
yang beroperasi pa'a "ra#ma Bapi"is "erseb#" 'i
a"as a#"oreg#lasi pemb#l#* 'ara* cerebral
"ergangg# -asoparali"isE
*e'ala 1 $eBanan 'ara* ren'a*, na'i lamba"9cepa",
lema*, rasa m#al, m#n"a*, gangg#an perna(asan
bisa "imb#lE
?emeri.saan penun'an" 1 C$=Scan #n"#B
meli*a" le"aB lesi 'an Bem#ngBinan BompliBasi
<angBa pen'eBE
Terapi 1 an"iserebral e'ema, an"i per'ara*an,
simp"oma"iB, ne#ro"ropiB 'an perawa"an 7=!0 *ari

8er'asarBan a"as loBasi

ben"#ran, lesi 'ibe'aBan a"as

Ko#p Bon"#sio

1esi "er<a'i pa'a sisi ben"#ran, 'an

"empa" ben"#ran

Pa'a Bepala yang rela"i( 'iam

Kon"ra Bo#p

Kepala 'alam Bea'aan bebas

bergeraB aBan "er<a'i
2*en "*e *ea' s"riBes a 74e' ob<ec",
"*e co#p in<#ry occ#rs a" "*e si"e o(
impac" an' "*e con"reco#p in<#ry
occ#rs a" "*e opposi"e si'eE
Pengoba"an

Perawa"an Boma A
+"asi gangg#an pernapasan
Posisi "ren'elenb#rg 0
0
Pemberian O
Se'o" len'ir 9 m#n"a*
+"asi gangg#an sirB#lasi, per*a"iBan "an'a="an'a s*ocB 'an
awasi "ensi
+wasi in"aBe cairan U maBananE Pemberian cairan yang "i'aB
cerma" 'apa" "er<a'i 'e*i'rasi a"a# o-er*i'rasi 5<#mla*
cairan Bira=Bira !500 cc9*ari6
+wasi s#*#, bila s#*# meninggi *ar#s 'i"#r#nBanE
Pemberian an"ibio"iBa #n"#B cega* in(eBsi seB#n'erE
Cega* 'eB#bi"#s 'engan membaliB pen'eri"a "iap <amE

Pengoba"an e'ema serebri

O'ema serebri biasanya "imb#l 4 <am ses#'a*

"ra#ma Bapi"is 'an mencapai maBsimal pa'a *ari Be
T 3, maBa pengoba"an e'ema serebri ini 'i"#<#Ban
pa'a *ari=*ari per"ama 'ari Bon"#sio serebri, an"ara
lainA

Pemba"asan cairan yang mas#B, ? <am per"ama "aB

perl# 'ibericairan Bec#ali bila a'a s*ocB, selan<#"nya
cairan 'iberi an"ara !000 T !500 cc per 4 <amE
De*y'ra"ing agen" aE1E Mani"ol, glycerol, 'i#re"iBaE

Kor"iBos"eroi'

Simp"oma"is

Oba"=oba" yang memperbaiBi me"abolisme o"aB9oba"=

oba" #n"#B perB#a" 'in'ing pemb#l#* 'ara*E
Prognosa
$ergan"#ng 'ari l#asnya lesi 'an bera"nya Bon"#sioE
De7si" ne#rology #m#mnya semb#* semp#rnaE Pa'a laserasi
serebri 'e7si" ne#rology sering a'aE
8ila pengoba"an "i'aB a'eB#a" 5Bomosio serebri ma#p#n
Bon"#sio serebri6 bisa 'i'apa"Ban a'anya pos" "ra#ma"ic
sin'rom 'engan ge<ala ber#pa A
nyeri Bepala, p#sing, 'aya inga" berB#rang,Bonsen"rasi B#rangE
Ka'ang a'a per#ba*an wa"aB seper"i cepa" "ersingg#ng, m#'a*
mara*E Sin'rom ini 'i'apa"Ban 35 T 40K 'ari sel#r#* pen'eri"a
'engan "ra#ma Bapi"isE
Pengoba"an "er#"ama ber#pa simp"oma"is 'engan oba"=oba"
m#scle rela4an", "ranH#iliser, 7sio"erapi 5JKG, "raBsi le*er6E
HEMATOMA
I7TRACERE)RA#

per'ara*an parenB*im o"aB Barena peca*nya

ar"eri in"ra serebralmono a"a# m#l"iple,
per'ara*an 'alam cor"e4 cerebri yang berasal 'ari
ar"eri Bor"iBal U yang "erbanyaB pa'a lob#s
"emporalisE

Per'ara*an in"raserebral aBiba" "ra#ma Bapi"is

*ema"om yang *anya ber#pa per'ara*an Becil=
Becil sa<aE

SiBa pen'eri"a 'engan per'ara*an in"raserebral

l#p#" 'ari Bema"ian per'ara*annya aBan
'ireorganisasi 'engan pemben"#Ban gliosis 'an
Ba-i"asi menimb#lBan mani(es"asi ne#rologiB
ses#ai 'engan (#ngsi bagian o"aB yang "erBena
Conc#ssion
*""pA99wwwEbiap*Ecom9img9"obiEgi(
Concussion
mil' in<#ry or br#ise "o "*e
brain w*ic* may ca#se a s*or"
loss o( conscio#snessE ca#se
*ea'ac*es, na#sea, -omi"ing,
'i..iness, an' problems wi"*
memory an' concen"ra"ionE
*""pA99s"raig*""alBlawEcom9images9wiplas*E<pg
5hisplash In'ur!
Sering "er<a'i pa'a pengen'ara mobil
saa" mengalami BecelaBan
5"abraBan
6
Signs U Symp"oms
*""pA99wwwEcen"er(orbrain*eal"*Ene"9+ssessmen"K0Ser-ices9conc#ssionE*"ml

Conc#ssion M/)
Conc#ssion Gra'ing
Managemen"s
D)@@JSE +RO&+1 )&SJ/Y
5D+)6

DiD#se a4onal in<#ry a'ala* l#Ba yang menyebar

men#<# a4ons, bagian 'ari sel sara( pa'a o"aBE

Etiolo"i

Sa"#* U BecelaBaan Ben'araan bermo"orE

Sin'rom bayi berg#ncang 5s*aBen baby

syn'rome6 g#ncangan Beras seorang bayi
l#Ba o"aB Bema"ian sel o"aB, e'em o"aB,
$)KE

*e'ala dan tanda .linis1

Koma lama pasca "ra#ma Bapi"is

Dis(#ngsi sara( o"onom

Demam "inggi

Pen#n<ang 'iagnos"iB
D+) s#li" #n"#B men'e"eBsi Barena "i'aB
m#nc#l baiB pa'aC$ scana"a# 'engan
"eBniB penci"raan lain maBrosBopiB,
mesBip#n i"# m#nc#l miBrosBopisE&am#n,
a'a BaraB"eris"iB B*as 'ari D+) yang
m#ngBin a"a# m#ngBin "i'aB m#nc#l pa'a
C$ scan Ece'era 'i(#s "ela* ce'era lebi*
miBrosBopis 'ari ce'era maBrosBopiB 'an
s#li" #n"#B men'e"eBsi 'engan C$ 'an
M/), nam#n Be*a'irannya 'apa"
'isimp#lBan saa" pen'ara*an Becil "erli*a"
'alamcorp#s callos#ma"a#Bor"eBs
serebral
TRAUMA THORAB

$ra#ma "*ora4 a'ala* l#Ba a"a#

ce'era yang mengenai rongga
"*ora4 yang 'apa" menyebabBan
Ber#saBan pa'a 'in'ing "*ora4
a"a#p#n isi 'ari ca-#m "*ora4 yang
'isebabBan ole* ben'a "a<am a"a#
ben'a "#mp#l 'an 'apa"
menyebabBan Bea'aan gawa" "*ora4
aB#"E
$ra#ma "*ora4

Pasien 'engan ci'era 'a'a sering 'a"ang

'engan Bea'aan Bri"is 'iagnosa yang
cepa" 'an "erapi yang a'eB#a"E

$in'aBan awalA

PeriBsa 'an per*a"iBan +8C

1aB#Ban pemeriBsaan awal pa"ologi 'asar yg

seri#sA

Pne#mo"oraBs
$ension pne#mo"oraBs
Pne#mo"oraBs "erb#Ba

@lail c*es"
$ampona'e periBar'i#m
$ra#ma $oraBs

Dapa" ber#pa "ra#ma "#mp#l 9 "ra#ma "emb#s

ci'era ringan 9 mema"iBan
@raB"#r iga
@lail c*es"
Pne#mo"oraBs
:emo"oraBs
Kon"#sio par#
/#p"#r "raBea 9 bronB#s
/#p"#r 'ia(ragma
Ce'era aor"a U PD besar
Kon"#sio mioBar'i#m
$ampona'e <an"#ng
$ra#ma $oraBs

A &air+a!(C ) &%reathin"( dan C &circulation(

Anamnesis 1 2aB"# Be<a'ian, "empa" Be<a'ian, <enis "ra#ma

5"er"embaB, "er"#s#B, "erp#B#l, 'll6, ara* mas#B Bel#ar perl#Baan,
bagaiman Bea'aan pen'eri"a selama 'alam per<alanan

?emeri.saan fsi.

Inspe.si "en"#Ban l#Ba mas#B a"a# l#Ba Bel#ar, per*a"iBan

Besime"risan geraB 'an posisi pa'a aB*ir 'ari inspirasi 'an eBspirasi

?alpasi raba a'a "i'aBnya Brepi"asi, nyeri "eBan an"eropos"erior

'an la"erola"eral, ser"a ban'ingBan (remi"#s Biri 'an Banan

?er.usi per*a"iBan a'anya b#nyi perB#si sonor, "impani 'an

*ipersonor, ser"a a'anya peBaB 'an ba"as an"ara yang peBaB 'an
sonor, seper"i garis l#r#s a"a# garis miring

Aus.ultasi ban'ingBan bising napas Biri 'an Banan, apaBa*

melema* a"a# meng*ilang, ba"asnya, a"a# a'anya bising abnormal

@eadaan sta%il pemeri.saan radiolo"i &foto ?A(

Penanganan Jm#m

Jm#mA
&yeri 'apa" memba"asi pernapasan 'p"
menyebabBan pne#monia
8ila m#l"ipel 3ail c*es"
@raB"#r pa'a iga ! U ce'era PD besar
@raB"#r iga bawa* ce'era limpa, *epar, a"a# gin<al

DiagnosisA
Mengalami nyeri "eBan pa'a palpasi
Mengel#* nyeri ber"amba* Be"iBa ba"#B, bernapas
'alam, a"a# bergeraB
@o"o "oraBs 'engan gambaran iga yang rinci
'iagnosis
@raB"#r )ga

$erapiA
+nalge"iB oral
8loB ner-#s in"erBos"alis
Sab#B iga yang m#'a* 'ilepas, 'iBai"Ban 'engan
-elcro
Per*a"iBan (aB"or 5rawa"6A

Jsia

PenyE Kar'io=respirasi yg s'* a'a sebel#mnya

Ci'era penyer"a

@raB"#r m#l"iple

Gas 'ara* abnormal

+'anya BompliBasi
@raB"#r )ga

Jm#mA

8eberapa iga mengalami (raB"#r pa'a sisi

'a'a "i'aB s"abil 53ail c*es"6

Segmen 'in'ing yg "'B "er"opang bergeraB

para'oBsal 5bergeraB mas#B Be"iBa "eBanan
in"ra"oraBs nega"i( sas" inspirasi U Bel#ar saa"
eBspirasi6 -ol#me "i'al men#r#n pira#
5s*#n"6 Banan Be Biri (#ngsional U *ipoBsiaE

DiagnosisA

Dengan obser-asi 9 palpasi geraBan

para'oBsal
@lail C*es"

$erapiA

S"abilBan segmen yang mengambang

Ci'era "erBai" 5pne#mo"oraBs U

*emo"oraBs6 'i"erapi 'engan
"oraBos"omi slang

8loB ner-#s in"erBos"alis menga"asi

nyeri
@lail C*es"
M#l"iple le(" rib (rac"#res, p#lmonary
con"#sion, an' *emo"*ora4 in an el'erly
man a("er a mo"or -e*icle acci'en"E
1e(" *emo"*ora4 in a pa"ien"
wi"* rib (rac"#resE
a4ial comp#"e' "omograp*y image o( "*e c*es" in a pa"ien" wi"* le(" pos"erior
rib (rac"#resE E $*e le(" pne#mo"*ora4 5 white arrows 6 is associa"e' wi"* a
'isplace' pos"erior le(" rib (rac"#re 5 black arrow 6E Secon'ary eDec"s on "*e
le(" l#ng incl#'e a p#lmonary con"#sion an' -ol#me lossE

Pne#mo"oraBs se'er*ana

Par# 'i sisi ci'era Bolaps 'an oBsigenasi "ergangg#

$ension pne#mo"oraBs

J'ara yang mas#B lebi* banyaB 'ari pa'a yang

Bel#ar "eBanan in"raple#ra "er#s meningBa"
"eBanan sanga" "inggi se*ingga me'ias"in#m
"er'orong Be sisi yang erlawanan aliran 'ara*
sirB#lasi sen"ral men#r#n *ipo"ensi ar"erial U
syoB

Mer#paBan Bea'aan 'ar#ra" mema"iBan 'lm

bbrp meni"

Pne#mo"oraBs "erb#Ba
Pne#mo"oraBs

DiagnosisA

Ge<alaA 'ispnea U nyeri 'a'a ple#ri"iB

@o"o "oraBsA

$erpisa*nya perm#Baan ple#ra -iseral 'ari parie"al

1aB#Ban (o"o 'alam Bea'aan eBspirasi 'an "egaB

$erapiA

Pemasangan ala" berBa"#p sa"# ara* melal#i

'in'ing 'a'a #n"#B yang Becil

$oraBos"omi slang 'engan penye'o" Bon"in#

#n"#B yg se'ang sampai besar
Pne#mo"oraBs
?7EUMOTORA@S
TERTUTU?

Dapa" "er<a'i Barena (ragmen (raB"#r iga merobeB

par#, nam#n 'apa" p#la "er<a'i "anpa a'anya
(raB"#r iga, 'imana "r#ma "er<a'i pa'a (ase
inspirasi 'engan glo"is "er"#"#p 'an 'aya "a*an
al-eoli "erlampa#iE

Pne#mo"oraBs "er"#"#p 'engan a'anya

meBanisme pen"il aBan menyebabBan #'ara
"erperangBap pa'a rongga ple#ra se= *ingga
"eBanan rongga ple#ra aBan lebi* besar 'ari
#'ara a"= mos7r 'an 'iseb#" sebagai
pne#mo"oraBs 'esaBan (tension pneumothora!"

Pne#mo"oraBs 'esaBan 'apa" menyebabBan

pen'orongan me'ias"in#m Be ara* Bon"rala"eral
yang 'apa" mengaBiba"Ban "er<epi"nya -enaca-a
se*ingga 'apa" menggangg# -eno#s return
<an"#ng
?enatala.sanaan 1

Pemasangan water seal drainage pa'a pen'eri"a

pen#mo"oraBs bergan"#ng Bepa'a A

8era"nya gangg#an perna(asan

Diser"ai pne#mo"oraBs 'esaBan

Pne#mo"oraBs bila"eral

Diser"ai *emo"oraBs

Selama obser-asi pne#mo"oraBs ber"amba*

l#as

8ila 'iperl#Ban pemaBaian -en"ila"or

8ila 'iperl#Ban anes"esi #m#m

?7EUMOTORA@S TER)U@A

DisebabBan ole* "ra#ma "#mp#l ma#p#n "ra#ma

"a<am, rongga ple#ra memp#nyai "eBanan yang
sama 'engan #'ara a"mos7r 'an 'ari l#bang l#Ba
pa'a 'in'ing 'a'a aBan "er'engar s#ara *isapan
#'ara selama (ase inspirasi yang 'iseb#" sebagai
sucking chest wound"
Manifestasi A

+'anya mediastinal Dutter 'an l#Ba meng*isap

Pa'a Bea'aan ini <#ga aBan "er'apa" respirasi

yang pen'ell#(, Barena selama (ase inspirasi par#
ipsila"eral aBan B#ncup 'an selama (ase
eBspirasi par# aBan se'iBi" mengembang, *al ini
menan'aBan ba*wa selama (ase eBspirasi #'ara
'ari par# Bon= "rala"eral mas#B Be par# ipsila"eral
?enatala.sanaan 1

8eriBan oBsigenasi 'an -en"ilasi yang

a'eB#a"

$#"#p 'e(eB 'engan Bassa s"eril,

'engan mereBa"Ban 'i 3 sisi #n"#B
meng*asilBan e(eB [#utter$valve%"

Sangan mereBa"Ban pa'a Beempa"

sisi Barena 'apa" menyebabBan
tension pneumothora"

Kem#'ian laB#Ban insersi chest tube"

TE7SIO7
?7EUMOTORA@S

Pne#mo"oraBs yang progresi( 'an cepa"

memba*ayaBan <iwa pasien 'alam waB"# yang
singBa"

J'ara yang Bel#ar par# mas#B Be rongga ple#ra 'an

"i'aB 'apa" Bel#ar lagi "eBanan ple#ra "er#s
meningBa"
Manifestasi 1

$er<a'i sesaB napas yang progresi( 'an bera"

Pasien "ampaB sianosis, Bec#ali s#'a* "er<a'i

Be*ilangan 'ara* yang banyaB

$er'apa" Bolaps 'engan p#ls#s Becil 'an *ipo"ensi

bera" sebagai aBiba" gangg#an pa'a <an"#ng 'an
"er*alangnya aliran baliB -ena Be <an"#ng

$an'a pergeseran me'ias"in#m "erli*a"

PerB#si "impani, m#ngBin p#la re'#p Barena

peng#rangan ge"aran pa'a 'in'ing "oraBs
?enatala.sanaan 1

Desin(eBsi B#li" 'i sela iga Be 'ari garis

mi'Bla-iB#ler yang "erBena

Dengan <ar#m s#n"iB s"eril p#ngsi 'an 'ibiarBan

"erb#Ba

1aB#Ban "#be "oraBos"omi "ension

pne#mo"oraBs ber#lang lagi ses#'a* par#
mengembang
This picture sho+s a chest radio"raph +ith = a%normalities
&9( tension pneumothora3
&=( potentiall! life0sain" interention dela!ed +hile +aitin" for 30ra! results$
Tension pneumotora.s de.ompresi 'arum munculC dan terapi tida. %oleh
ditunda untu. .onfrmasi 30ra!$

Jm#mA
Mer#paBan peng#mp#lan 'ara* 'i 'alam rongga ple#ra
Dapa" menyebabBan syoB *ipo-olemiB U *ipoBsia
aBiba" gangg#an pa'a eBspansi par#

DiagnosisA
Ge<alaA

&yeri 'a'a ple#ri"iB

Dispnea
PE 7siBA

8#nyi pernapasan mere'#p

PeBaB pa'a perB#si 5Bec#ali a'a pne#mo"oraBs6

@o"o "oraBsA

Cairan "erli*a" 'i bawa* basis par# pa'a (o"o "egaB

Pa'a (o"o "elen"ang berBab#" pa'a sisi yang saBi"

:emo"oraBs

$erapiA

DialirBan melal#i slang "oraBos"omi yang

'i*#b#ngBan 'engan seBa" air 'ara*
'i b#ang

Pem#li*an -ol#m 'ara* 'engan )% line

:emo"oraBs

$imb#l pa'a 7 <am per"ama se"ela*

"ra#ma

Di"an'ai 'engan 'ispnea, pen#r#nan

PO ar"eri, ronBi 'an in7l"ra" pa'a
(o"o "oraBs

Dapa" 'iiB#"i 'engan seBre"

"raBeobronBial, *emop"isis, 'an
e'ema par#

$erapiA in"#basi E$
Kon"#sio par#
CEDERA TRA@EA dan )RO7@US

Sarang, "e"api m#ngBin 'isebabBan ole* "ra#ma

"#mp#l a"a# "ra#ma menemb#s
Manifestasi .linis 1 $an'a T "an'a yang "imb#l
biasanya 'rama"is, 'engan *emop"isis bermaBna,
*emopne#mo"oraBs, Brepi"asi s#bB#"an 'an
gawa" napas, em7sema me'ias"inal 'an ser-iBal
'alam, a"a# pne#mo"oraBs 'engan Bebocoran
#'ara masi(
?enatala.sanaan 1

Pemasangan pipa en'o"raBea 'i l#ar ce'era

#n"#B mem#ngBinBan -en"ilasi 'an mencega*
aspirasi 'ara*

Pipa "oraBos"omi 'iperl#Ban #n"#B *ema"o"oraBs

a"a# pen#mo"oraBs
RU?TUR ESO,A*US

1ebi* sering "er<a'i pa's "ra#ma "a<am 'iban'ing "ra#ma

"#mp#l "oraBs, 'an loBasi r#p"#ra ole* Barena "ra#ma
"#mp#l paling sering pa'a !93 bagian bawa* eso(ag#s
+Biba" r#p"#ra eso(ag#s aBan "er<a'i Bon"aminasi rongga
me'ias"in#m ole* cairan sal#ran pencernaan bagian
a"as se*ingga "er<a'i me'ias"ini"is yang aBan
memperb#r#B Bea'aan pen'eri"anyaE
Pa'a (o"o "oraBs A pne#mome'ias"in#m 'an *i'ro"oraBs,
yang paling sering a'ala* *i'ro"oraBs Biri

Pena"alaBsanaan A PemeriBsaan (o"o "oraBs 'engan

b#b#r bari#m a"a# 'engan memperg#naBan
eso(agosBopi 'apa" menge"a*#i loBasi 'ari r#p"#ra
eso(ag#s ini, 'an 'ilaB#Ban "oraBo"omi #n"#B reparasi
opera"i(E
@O7TUSIO MIO@ARD
P#B#lan langs#ng pa'a s"ern#m 'engan 'iiB#"i memar
<an"#ng
Manifestasi .linis 1

8er-ariasi A pe"eBie epiBar'ial s#per7sial = Ber#saBan

"ransm#ral

Disri"mia "ersering
?emeri.saan penun'an"

)soen.im CPK spesi7B

EKG per#ba*an gel $=S$ yang nonspesi7B a"a# 'isri"mia

?enatala.sanaan 1

Segera 'ilaB#Ban periBar'iosin"esis #n"#B meng#rangi

"ampona'e 'an 'iiB#"i "oraBo"omi #n"#B mencari ser"a meng=
*en"iBan s#mber per'ara*anE

$ra#ma "a<am 'aera* preBor'ial, paras"emal Biri 'an Banan

*ar#s 'ic#rigai mengenai <an"#ng 'an segera 'ilaB#Ban
eBsplorasi "oraBo"omi sebel#m Bea'aan pen'eri"a memb#r#B
TAM?O7ADE EA7TU7*

Perembesan 'ara* 'ari <an"#ng Be 'alam r#ang

periBar'ial Bompresi yang progresi( pa'a <an"#ng 'an
obs"r#Bsi pa'a -ena T -ena besar

Ge<ala "imb#l Barena peneBanan 'ara* yang Bembali Be

a"ri#m Banan 'an Biri
Manifestasi .linis 1

+'anya <e<as "ra#ma "a<am 'i 'aera* periBar'i#m a"a#

yang 'iperBiraBan menemb#s <an"#ng, gelisa*, p#ca",
Beringa" 'ingin, peninggian "eBanan -ena <#g#laris,
peBaB <an"#ng melebar, 'an p#ls#s para'oBs#s

$rias BlasiB 8ecB A 'is"ensi -ena le*er, b#nyi <an"#ng

melema*, 'an *ipo"ensi

EKG low -ol"age sel#r#* lea'

?enatala.sanaan 1 p#ngsi r#ang periBar'i#m 'an
"oraBo"omi
RU?TUR AORTA

Ce'era mema"iBan pa'a "ra#ma "#mp#l 'a'a

Manifestasi .linis 1

/asa nyeri

@alse ane#rism yang membesar 'engan cepa",

rasa nyeri pa'a 'a'a ber"amba*, pernapasan
'angBal, s#li" menelan, 'an "er<a'i *emop"isis
?enatala.sanaan 1

@o"o ron"gen 'a'a 'ar#ra" me'is"in#m melebar

'an a'a aor"ic Bnob 'engan ba"as Bab#r
aor"ogra7 'ar#ra"

1e(" *ear" by pass a"a# pin"as eBs"erna

perbaiBan 'engan pembe'a*an
TRAUMATIC DIA,RA*MATIC RU?TURE
Indi.ator 1

Dis"ress na(as yang persis"en a"a# progresi(

8ising #s#s pa'a 'a'a

*am%aran CBR

%ag#e 'an bayang 'ia(ragma"iB yang "i'aB 'apa"

'ibe'aBan

:erniasi organ ab'ominal Be 'alam ca-i"as 'a'a

Displacemen" &G$ Be 'alam ca-i"as 'a'a lebi* sering

"er<a'i 'i sisi Biri
?enatala.sanaan 1

sem#a pen'eri"a *ar#s 'ir#<#B pa'a be'a* #m#m

#n"#B laparo"omi
TRAUMA A)DOMI7A#
De7nisi U E"iologi
$ra#ma per#" 'gn
pene"rasi Be 'lm rongga
perine#mE
1#Ba "#s#B 505K6
1#Ba "embaB
$emb
#s
$ra#ma per#" "anpa
pene"rasi Be 'lm rongga
perine#mE
50K 'isebabBan
BecelaBaan lal# lin"asE
P#B#lan
8en"#ran
1e'aBan
Deselerasi
Kompresi
Sab#B pengaman 5sea"=
bel"6
$#mp
#l
TI?E CEDERA

8er'asarBan organ yang "erBena

'apa" 'ibagi '#aA

Pa'a or"an padat ge<ala #"ama

perdarahan, seper"iA

:epar

1impa

Pa'a or"an %eron""a ge<ala #"ama

peritonitis, seper"iA

Js#s

Sal#ran empe'#
Mani(es"asi Klinis
Trauma tem%us &trauma perut
den"an penetrasi .edalam
ron""a peritonium( 1

:ilangnya sel#r#*
a"a# sebagian
(#ngsi organ

/espon s"res
simpa"is

Per'ara*an 'an
pembeB#an 'ara*

Kon"aminasi baB"eri

Kema"ian sel
Trauma tumpul &trauma
perut tanpa penetrasi
.edalam ron""a peritonium($

Ke*ilangan 'ara*E

Memar9<e<as pa'a
'in'ing per#"E

Ker#saBan organ=
organE

&yeri "eBan, nyeri

Be"oB, nyeri lepas
'an BeBaB#an
5rigi'i"y6 'in'ing
per#"E

)ri"asi cairan #s#s

$an'a yang men#n<#Ban ce'era
in"ra ab'omen
Trauma Tem%us
A%domen

Pasien 'engan "ra#ma "emb#s ab'omen seringBali

'a"ang 'engan sa"# 'ari "iga sBenario Blinis beriB#"A
:ampir a"a# <elas mengalami *en"i <an"#ngE
:ipo"ensi bera" a"a# peri"oni"is yang 'iser"ai "aBiBar'iaE
$aBipnea a"a# s"abili"as *emo'inamiB 'engan nyeri "eBan
pa'a ab'omen minimal sampai "i'aB a'aE

Js#s mer#paBan organ yang paling sering terkena

pa'a l#Ba "emb#s ab'omen #s#s mengisi
sebagian besar rongga ab'omenE

1#Ba "#s#B li-er 540K6, #s#s *al#s 530K6,

'ia(ragma 50K6, Bolon 5!5K6

1#Ba "embaB #s#s *al#s 550K6, Bolon 540K6, li-er

530K6, s"r#B"#r -asB#ler in"raab'omen 55K6
DIA*7OSIS

Diagnosis "ra#ma "emb#s ab'omen biasanya

'i"egaBBan ber'asarBan anamnesis 'an
pemeriksaan &sik, 'engan l#as ce'era *anya
"ampaB se"ela* pengg#naan mo'ali"as diagnostik
lain sepertiA

C$ scan

Jl"rasonogra7 ab'omen

1a-ase peri"oneal 'iagnos"iB

'ksplorasi operati( adalah standar emas untuk

mendiagnosis cedera intraperitonealE
@OM?#I@ASI @#I7IS

in(eBsi a"a# "erben"#Bnya abses

sin'rom Bompar"emen ab'omen

per'ara*an in"ra=ab'omen a"a#

re"roperi"oneal

e'ema -iseralE
TATA #A@SA7A
)emua kasus yang meliba"Ban trauma tembus abdomen harus
'i"angani 'engan mengkonsultasikannya bersama ahli bedah trauma
sambil menerapBan protokol bantuan hidup trauma lan*ut 5+$1S,
+'-ance' $ra#ma 1i(e S#ppor"6E
)n'iBasi #n"#B "a"a laBsana opera"i( melip#"iA
Kegagalan memperbaiBi Bea'aan secara Blinis se"ela* res#si"asi
cairanE
+'anya "an'a="an'a rangsang peri"oneal yang men#n<#BBan
laserasi *a"i a"a# limpaE
$erli*a" cairan peri"oneal bebas pa'a C$ scan a"a# #l"rasonogra7E
+asien yang stabil perl# 'ipan"a# secara Be"a" "er*a'ap per#ba*an
"an'a="an'a -i"al 'an "er*a'ap "imb#lnya "an'a="an'a rangsang
peri"oneal 'an yang 'inilai 'engan pemeriBsaan ab'omen serialE
)emua pasien cedera tembus abdomen harus menerima antibiotik
dan pro&laksis tetanusE
TRAUMA TUM?U#
A)DOME7

MeBanisme "er<a'inya "ra#ma pa'a "ra#ma

"#mp#l 'isebabBan a'anyaA

Deselerasi cepa"

+'anya organ=organ yang "i'aB memp#nyai

Belen"#ran 5noncomplian" organ6 seper"iA

:a"i

1impa

PanBreas

Gin<al

$ra#ma "#mp#l lim(a 540=55K6, li-er 535=45K6,

#s#s *al#s 55=!0K6
S#r-ei seB#n'er

)nspeBsi

+#sB#l"asi

Palpasi

PerB#si
)nspeBsi
PeriBsa ab'omen #n"#B menem#Ban a'anya "an'a
eBs"ernal 'ari ci'era \ &o"e pa""erns o( abrasion an'9or
ecc*ymo"ic areasE
Per*a"iBan pola 'ari l#Ba #n"#B mempre'iBsi a'anya
"ra#ma in"ra ab'omen 5eg, lap bel" abrasions, s"eering
w*eelTs*ape' con"#sions6E
Per*a"iBan pola perna(asan Barena perna(asan ab'omen
mengin'iBasiBan spinal cor' in<#ry \ &o"e ab'ominal
'is"en"ion an' any 'iscolora"ionE
8ra'ycar'ia m#ngBin mengin'iBasiBan a'anya 'ara* bebas
'i in"raperi"oneal
$*e C#llen sign 5ie, peri#mbilical ecc*ymosis6 m#ngBin
mengin'iBasiBan per'ara*an re"roperi"oneal
@lanB br#ising 'an pembengBaBan meningBa"Ban
Bec#rigaan a'anya ce'era re"roperi"oneal
)nspeBsi 'aera* geni"al 'an perine#m #n"#B ce'era
<aringan l#naB, per'ara*an 'an *ema"om
Aus.ultasi ?er.usi

+b'ominal br#i"
m#ngBin
mengin'iBasiBan
penyaBi" -asc#lar
a"a# "ra#ma"ic
ar"erio-eno#s
7s"#la

PerB#si "en'erness
mer#paBan "an'a
peri"oneal
Palpasi
Palpasi sel#r#* ab'omen 'engan *a"i sambil meper*a"iBan respon 'ari
pasienE Per*a"iBan a'anya masa abnormal , "en'erness, 'an 'e(ormi"as
@#llness an' 'o#g*y consis"ency mengin'iBasiBan per'ara*an in"ra=
ab'ominalE Krepi"asi a"a# ins"abili"as B#ba* "*oraB bagian bawa*
Bem#ngBinan ce'era limpa 'an *a"i aBiba" ce'era "#lang r#s#B bawa*
)ns"abili"as pel-icce'era sal Bemi* bagian bawa* ser"a *ema"oma
pel-ic 'an re"roperi"onealE @raB"#r "erb#Ba pel-ic M/Q 50
1aB#Ban pemeriBsaan rec"al an' biman#al -aginal pel-ic #n"#B
mengi'en"i7Basi Bem#ngBinan ce'era 'an per'ara*an
1aB#Ban pemeriBsaan sensoriB 'i 'a'a 'an ab'omen #n"#B menge-al#asi
a'anya spinal cor' in<#ryE Spinal cor' in<#ry 'apa" mempengar#*i
BaeaB#ra"an peme ab'omen Barena men#r#nnya a"a# "i'aB a'anya
persepsi nyeri
Di"ensi ab'omen bisa "er<a'i seB#n'er aBiba" 'ila"asi lamb#ng Barena
-en"ilasi a"a# menelan #'ara
$an'a peri"oni"is 5eg, in-ol#n"ary g#ar'ing, rigi'i"y6 segera se"ela*
ce'era aBiba" Bebocoran isi 'ari #s#sE
Peri"oni"is Barena per'ara*an in"ra ab'omen bar# m#nc#l se"ela*
beberapa <am 'e-elopE
Mani(es"asi Klinis

+'anya 'ara* a"a# cairan #s#s aBan menimb#lBan

rangsangan peri"one#m \ nyeri tekan, nyeri ketok
dan nyeri lepas

+'anya 'ara* 'apa" 'i"en"#Ban 'gn \ shi(ting

dullness

+'anya #'ara bebas 'p" 'iBe"a*#i 'gn \ hilang

atau beran*aknya pekak hati

-ising usus biasanya melemah atau menghilang

/angsangan peri"one#m 'p" p#la ber#pa nyeri alih

di daerah bahu terutama sebelah kiri
?ATO,ISIO#O*I

$ra#ma "#mp#l ab'omen a'ala* penyebab

utama morbiditas dan mortalitas yang
'isebabBan ole* "ra#ma pa'a sem#a
BelompoB #siaE

Ce'era in"ra=ab'omen biasanya

'isebabBan ole* kekuatan kompresi( atau
deselerasiE

.impa merupakan organ yang paling

sering terkena cedera, 'iiB#"i *a"i 'an #s#s
Becil 'an besarE
PemeriBsaan Pen#n<ang
PemElab A

:emoglobin

:ema"oBri"

1e#Bosi"

+nalisis #rin
PemEra'iogis A (o"o polos ab'omen 3 posisi
)%P a"a# sis"ogram \ bila 'ic#rigai a'anya "ra#ma p'
salEBencing
#l"rasonograp*y 5re(erre' "o as @+S$ T (oc#se' ab'ominal
sonograp*y (or "ra#ma6,
C$ scan
1a-ase peri"oneal 'iagnos"iB \ #9 menge"a*#i a'anya cairan
in"raab'omen 'an <enisnya
DP1 %sE @+S$ %sE C$=Scan pa'a "ra#ma
"#mp#l ab'omen
DP1 @+S$ C$=Scan
)n'iBasi Men#n<#BBan
'ara* bila
*ipo"ensi(
Men#n<#BBan
cairan bila
*ipo"ensi(
Men#n<#BBan
Ber#saBan
organ bila "ensi
normal
Ke#n"#ngan De"eBsi 'ini
Sem#a pasien
Cepa"
9?K sensi"i-e
De"eBsi ce'era
#s#s
$ranspor" A "i'aB
De"eBsi 'ini
Sem#a pasien
&on=in-asi(e
Cepa" A 'apa"
'i#lang
?0=97K aB#ra"
$ranspor" A
"i'aB
1ebi* spesi7B
#n"#B ce'era
Sensi"i-e 9=
9?K aB#ra"
Ker#gian )n-asi-e
Spesi7"as ren'a*
$ra#ma 'ia(ragma
'an re"ro
peri"one#m l#p#s
:asil
bergan"#ng
opera"or
Dis"orsi Barena
#'ara #s#s
$ra#ma
'ia(ragma #s#s,
'an ce'era
pancreas
] ma*al 'an
memaBan
waB"#
$ra#ma
'ia(ragma, #s#
'an ce'era
panBreas
$ranspor" A
'ib#"#*Ban
/0)T1 /ocused 0bdominal
)onography (or Trauma

Jn"#B mengi'en"i7Basi cairan 'iA

MorrisonMs 5*epa"orenal6 po#c* in "*e

rig*" #pper H#a'ran"

splenorenal recess in "*e le(" #pper

H#a'ran"

pel-is

pericar'ial sac

Kec#ali 'i pericar'ial sac, *ar#s

minimal 300 m1
Diagnos"ic Peri"oneal 1a-age

)n'iBasi #n"#B melaB#Ban DP1 sbbEA

&yeri ab'omen yang "i'aB bisa 'i"erangBan

sebabnya

$ra#ma pa'a bagian bawa* 'ari 'a'a

:ipo"ensi, *ema"oBri" "#r#n "anpa alasan yang

<elas

Pasien ce'era ab'ominal 'engan gangg#an

Besa'aran 5oba",alBo*ol, ce'era o"aB6

Pasien ce'era ab'ominal 'an ce'era me'#la

spinalis 5s#ms#m "#lang belaBang6

Pa"a* "#lang pel-is

Kon"ra in'iBasi rela"i( melaB#Ban DP1 sbbEA

:amil

Perna* operasi ab'ominal

Opera"or "i'aB berpengalaman

8ila *asilnya "i'aB aBan mer#ba*

pena"alaBsanaan
DIA*7OSIS
+namnesis 'an pemeriBsaan 7siB
Ultrasono"raf "ela* "erse'ia 'i sebagian besar p#sa"
"ra#ma #"ama
PemeriBsaannya cepa"
$i'aB in-asi(
Dapa" 'ilaB#Ban selama res#si"asi
MemiliBi sensi"i-i"as 73=??K
Spesi7si"as 9?=!00K
CT den"an .ontras oral dan intraena a'ala*
mo'ali"as ra'iogra7B yang lebi* baiB pa'a pasien s"abil
yang mengalami "ra#ma "#mp#l ab'omenE
PemeriBsaan ini memiliBi sensi"i-i"as 9=97,0K
Spesi7si"as 9?,7K
1a-ase peri"oneal 'iagnos"iB sering 'ig#naBan 'i masa lal#
"e"api secara lamba" "ela* 'igan"iBan ole* #l"rasonogra7
'an C$ Barena "i'aB a'anya spesi7si"as 'an "i'aB mamp#
menilai re"roperi"one#mE
DIA*7OSIS

Tanda0tanda adan!a trauma tumpulA

&yeri "eBan ab'omen

+brasi

EBimosis

Se<as se"ir a"a# sab#B pengaman

Pena"alaBsanaan

+8C

Segera pasang pipa lamb#ng \ selain #"B 'iagnos"iB,

#9 mencega* "er<a'inya aspirasi bila "er<' m#n"a*

Ka"e"er \ #9 mengosongBan Ban'#ng Bemi* 'an

menilai #rin

$in'aBan laparo"omi \ #9 menge"a*#i organ yg

mengalami Ber#saBan

8ila "er'apa" per'ara*an \ peng*en"ian per'ara*an

P' organ berongga, penanganan Ber#saBan berBisar

'r pen#"#pan se'er*ana sampai reseBsi sebagian
Mana<emen Periopera"i(
O%serasi ?re0O?
8#Ban *anya "an'a="an'a
-i"al 5$&/S6 sa<a, JSG, @+S$,
#rine, C$=Scan, GCS,
labora"ori#m 'apa" 'ig#naBan
#n"#B obser-asi
$i'aB *anya beberapa Bali
sa<a, nam#n secara Bon"in#
Pasien s"abil, "i'aB selal#
*ar#s normal, ole* Barena i"#
*ar#s 'i obser-asi perio'iB
Pasien "i'aB s"abil perl#
obser-asi Be"a", <iBa perl#
se"iap saa"
O%serasi ?asca0O?
Kea'aan #m#m 5Besa'aran,
"an'a -i"al6
Cairan 5balance, in"aBe,
o#"p#"6
)n"aBe A )n(#s, &G$, oral
O#"p#"A Jrine, (eses, &G$, 'rain,
)21
Pos" OP=blee'ing 5insicion
si"e, 'rain6
1#Ba OP 5blee'ing, p#s6
&#"risi 5oral, en"eral,
paren"eral6
Oba"=oba"an
S"age' 1apara"omy

Operasi ber"a*ap

Pa'a "ra#ma ab'omen A #m#mnya Barena

operasi "i'aB bole* 'ilaB#Ban "erlal# lama
5ba"as waB"# operasi A ! <am6

$a*ap awalA 'amage con"rol \ primary

s#r-ey lapara"omi 5a"asi per'ara*an6

$#n'a 'e7ni"i-e s#rgery se"ela*

pemeriBsaan s"abil

/e=operasi 4=4? <am Bem#'ian <iBa

pemeriBsaan s"abil \ moni"oring 'i )CJ
1aparo"omy
+1GO/)$M+ 81J&$ +8DOM)&+1
$/+JM+
+1GO/)$M+ PE&E$/+$)&G +8DOM)&+1
$/+JM+
@OM?#I@ASI @#I7IS

Per'ara*an "er#s=mener#s

)n(eBsi

Gagal organ

Kema"ian
$ra#ma Dia(ragma

$er<a'i seB#n'er 'ari "ra#ma

"#mp#l a"a# "emb#sE

/#p"#r "er<a'i pa'a sisi sebela*

BiriE

PemeriBsaan A C$ scan 'an

laparosBopiE

Ke"erlamba"an 'alam
menen"#Ban 'iagnosis 'apa"
menigBa"Ban morbi'i"as 'an
mor"ali"asE
$ra#ma PanBreas

Sarang, sering "erli*a" se"ela*

"er<a'i "ra#ma "#mp#lE

Pasien merasa nyeri pa'a

epigas"ric a"a# p#ngg#ngE

Ser#m en.im pancrease "i'aB

spesi7BE

PemeriBsaan A C$ scanE
$ra#ma Kan'#ng Kemi*

$er<a'i pa'a pasien yang

mengalami (raB"#r pel-isE

:ema"#riaE

PemeriBsaan A re"rogra'e
cys"ogram 'an C$ scanE
$ra#ma Pangg#l

8ersamaan 'engan "ra#ma pa'a

gin<alE

PemeriBsaan A C$ scan

/e"roperi"oneal *ema"oma
m#ngBin bisa (alse posi"i( pa'a
DP1 or JSGE
$/+JM+ G)&S+1

Pen'a*#l#anA

$ra#ma gin<alA "ersering pa'a "rE Jrinari#s

$ra#ma pene"rasi "ra#ma parenBim Becil

#m#mnyaA 'ebri'emen, primary repair, 'rainase

$ra#ma l#as 'apa" perl# ne(reB"omi parsial9"o"al c"*A

"ra#ma pa'a *il#m
?0K "ra#ma pene"ran gin<al 5N6 "ra#ma in"ra=ab'
lain

$ra#ma "#mp#l minor 5?5K6 U mayor

MinorA con"#sio, biasanya 'i"* Bonser-a"i(

MayorA laserasi Bor"eBs 'alam 'g e4"ra-asasi,

*ema"oma perine(riB besar, "ra#ma "*' -asB#larisasi
DE/+S+$
5++S$6
M+&)@ES$+S) K1)&)S U
PEME/)KS++&
/iwaya" N nyeri N <e<as 9 l#Ba pa'a area Bos"o-er"ebra
8ila 5N6 syoB yg 5=6 'apa" 'ia"asi 9 ber#lang perl#
laparo"omi segera
Palpasi nyeri "eBan U Be"egangan o"o"
Massa <arang "eraba
SiBa "eraba massa re"roperi"oneal oB *ema"oma a"a#
#rinoma
5N6 "an'a iri"asi peri"one#m
$E# <iBa 5N6 imbibisi 'ara* Be in"raperi"oneal
Sering 'iser"aiA (raB"#r iga "erbawa*, ceBA apaBa* a'a
pne#mo9*emo"*ora4, r#p"#r limpa
:ema"#ria miBro 9 maBrosBopiB
$ra#ma "#mp#l 'g *ema"#ria miBro 5=6 "an'a syoB 5=6
perl# penci"raan Q lan<#" BecE N6 "ra#ma in"raab', a"a#
"ra#ma 'eselerasi cepa"
$ra#ma "a<am 'g sem#a *ema"#ria perl# penci"raan
SiBa 5=6 *ema"#ria Bem#ngBinan ce'era bera" "e"ap
a'a
KOMP1)K+S) U D)+G&OS)S

KompliBasiA
Dini 54mgg pe! se"ela* "ra#ma6A per'ara*an, e4"ra-asasi
#rin, abses, sepsis, 7s"el #rin U :$
1an<#"A :$, 7s"el ar"erio-ena, *i'rone(rosis, #roli"iasis,
pielone(ri"is BroniB

DiagnosisA
)%PA pili*an pe!E lain^A C$ scan, ar"eriogra7
GambaranA eBsresi Bon"ras V, garis psoas 9 Bon"#r gin<al O
<elas, sBoliosis men<a#*i sisi "erBena, 5=6 a'a eBsBresi 5c"*A
a-#lsi9oBl#si pE', ce'era pe'iBel6, a'a bagE Gin<al 5=6 "erli*a"
5c"*A laserasi 'alam, a-#lsi6
)%P & 'apa" oB "ra#ma ringan
Gin<al Bon"rala"eral perl# 'inilai #9 per"imbangan ne(reB"omi
$+$+1+KS+&+ Oc" Ui-pQ

$ra#ma "a<am 5cen'er#ng agresi(6,

"ra#ma "#mp#l 5cen'er#ng
Bonser-a"i(6

$* Bonser-a"i( 5c"*A #9 "ra#ma "#mp#l

minor6A

)s"ira*a", analgesiB, obser-asi s"a"#s

gin<al 5pemE 1oBal, :b, :", en'apan #rin6

$ra#ma "#mp#l mayor 5laserasi

Bor"e4 'g e4"ra-asasi, *ema"oma
perine(riB besar, "ra#ma pE'6
e4plorasi
+1GO/)$M+ 5"anpa C$ Scan6
$ra#ma
"emb#s
:ema"#ria
5Q591P86
S"abil 5=6
s"abil
1aparo"omi
E4plorasi
)%P
+bnormal 9
5=6
)n(orma"i(
&ormal
E4ploras
i
Obser-a
si
:ema"oma
re"roperi"onea
l
l#as9ber'eny#
"
:ema"oma 5=6
l#as
Obser-a
si
E4ploras
i
+1GO/)$M+ 5"anpa C$ Scan6
$ra#ma "#mp#l
:ema"#ria
MiBosBopiB
Gross *ema"#ria 9
*ema"#ria miBro
NsyoB
5=6 perl#
penci"raan, BecA
5N6 "ra#ma
penyer"a,
"ra#ma
'eselerasi cepa"
s"abil 5=6
s"abil
1aparo"om
i E4plorasi
)%P
:ema"oma
re"roperi"onea
lA
1#as e4plor
5=6 l#as obs
& obser-asi
+bn e4plorasi
5=6 in(orma"i(
_ 5N6 "ra#ma lainA
e4plor
_ 5=6 "ra#ma lainA obs
$/+JM+ 1)MP+

Dapa" oB "ra#ma "a<am, "#mp#l, ia"rogeniB, U

r#p"#r spon"an 5<arang6
$ra#ma "a<amA
biasanya organ lain iB#" "erl#Ba 5seringA par#, lamb#ngC lain^A
panBreas, gin<al Biri, pE' mesen"eri#m6

1impa mEp organ yg paling sering "erl#Ba pa'a "ra#ma

"#mp#l ab'omen a"a# "ra#ma "oraBs Biri=bawa*E
Dapa" 'iser"ai "ra#ma organ lain
/#p"#r spon"an 5pa'a splenomegali6 c"*A
gg *ema"ologiB, monon#Bleosis, malaria BroniB, sarBoi'osis,
splenomegali Bonges"i( oB :$ por"al

D4 biasanya 'g C$scan 5ps s"abil6, laparo"omi

e4plorasi 5ps 5=6 s"abil6
DE/+S+$ $/+JM+ 1)MP+
M+&)@ES$+S) K1)&)S U
PEME/)KS++&

Pen"ingA pemE +b' ber#lang^ o9 pemeriBsa sama

#"B meman"a#A

Ge<ala #m#m 5s*oB, anemia6, loBal 5cairan, iri"asi

peri"one#m6

/#p"#r 'apa" onse" lamba"A

8brp *ari ` mgg 5biasanya O7*r6

OB e(eB "ampona'e pa'a laserasi Becil, a"a#
*ema"oma s#bBaps#lar
8iasanya ps '"g 'g Bea'aan s*oB N "an'a per'ara*an
in"raab' a"a# seper"i a'a "#mor ab' Biri a"as

5N6 nyeri "eBan, U anemia seB#n'er

Mani(es"asi Blinis U PemeriBsaan @isiBA

&yeri per#" bagE +"asE !93 Bas#s Biri a"as, p#ngg#ng Biri
&yeri 'apa" re(erre' Be ba*# 5"an'a Ke*r6 5O a Bas#s6
Massa Biri a"asC s*i("ing '#llness 5N6
PerB#siA peBaB oB *ema"om 5$an'a 8allance6

PemeriBsaan pen#n<angA
:ema"oBri"C labA biasanya 5N6 le#Bosi"osis
@o"o roA pa"a* "#lang iga Biri 5mgB6, peninggian 'ia(ragma
Biri, bayangan limpa membesar, 'esaBan lamb#ng Be
garis "enga*
PemE +b' serial U *ema"oBri" biasanya 'ilaB#Ban "E# 4?=7
<am pe!

Ps 5awal6 'apa" 'iceB JSG, <iBa 5N6 cairan U ps s"abil

C$ scan #9 menge"a*#iA
S#mber per'ara*an, e4"ra-asasi Bon"ras, gra'ing U "ra#ma
organ lain yg memb#"#*Ban op
Penem#an e4"ra-asasi 9 con"ras" bl#s* per'ara*an
mene"ap
Kon"ro-ersi an"ara "in'aBan op a"a# angiograp*ic emboli.a"ion
:asil semen"araA Bon'isi ini bBn ) m#"laB #9 op

Ps biasanya )CJ #"B be' res" U &G$A

4?=7<amA pemE +b' serial U :"
Q 4?=7<am in"erme'ia"e care #ni" la"i*an ber<alan U
m#lai maBan 'imoni"or

C$ scan 'apa" 'i#lang pa'a Bea'aan :" V, *ipo"ensi,

ile#s persis"en

Peng#langan C$ scan sebel#m ps 'ip#langBan 5=6 "ll

'iperl#Ban
$+$+1+KS+&+

Opera"i( U non opera"i(A

SeBarangA non opera"i( 570K6 'g "ingBa" s#Bses Q 90K
Opera"i( 5c"*A spleneB"omi6 @/ OPS)

OPS) 5o-erw*elming pos"splenec"omy in(ec"ion6

meningi"is, sepsis, pne#monia
E"ioA pne#moBoB#sE 1ainA *E in3#en.a, e coli,
s"a79s"rep"oBoB#s
Onse" cepa" U mema"iBan 5!=!?<am6, biasanya 'iser"ai
'g peny#li" 5s*oB, gg eleB"roli", *ipogliBemi, D)C, 'll6

+n<#ran #9 -aBsin pne#moBoB#s sebel#m ps p#lang, U +b

pro7laBsis 5c"*A amoBsilin6 #9 'emam Q 3?E5C
Bee(eB"i(an Be cara ini m4 bel#m <elas

Kri"eria BlasiB #9 "* non opera"i(A

S"abil *emo'inamiB, nega"i( ab' e4am,

e4"ra-asasi 5=6, "ra#ma limpa 'era<a" !=3

in'iBasi #9 laparo"omi 5=6 a"a# 5=6 a'a "ra#ma

lain yg b#"#* in"er-ensi op,

5=6 a'a @/ per'ara*an QQ 5coag#lopa"*y, gg

*a"i, an"iBoag#lan, 'e( (B Boag#lan6,

S"#'iA ps Q 55"*n, *emoperi"one#m besar,

'era<a" 4=5 b#Ban lagi ) m#"laB #9 "* op

Per#ba*an 'alam (ail#re ra"e 5=6 signi7Ban

$* Opera"i(A splenora7, spleneB"omi

Splenora7A op #9 memper"a*anBan limpa (#ngsional

5baiB oB "ra#ma "#mp#l9"a<am6A
Memb#ang <arE &on -i"al, mengiBa" pE' "erb#Ba, men<a*i
Baps#l limpa yg "erl#Ba

SpleneB"omi 5"o"al6A
5=6 m#'a* oB splenomegali @/ perleBa"an 'g 'ia(ragma
DilaB#Ban <iBa splenora7, spleneB"omi parsial 5=6 ber*asil
SpleneB"omi parsial eBsisi !segmen 'ilaB#Ban <iBa
r#p"#r 5=6 Bena *il#s U bagE Yg 5=6 ce'era m4 -i"al
$o"al *ar#s 'iiB#"i 'g a#"o"ransplan"asi 'g *arapan limpa
aBan "#mb#* U (#ngsional
KompliBasiA OPSS, a"eleB"asis lob#s par# bawa* Biri,
"rombosi"osis
$/+JM+ :+$)

Sering baiB oB "ra#ma "#mp#l a"a# pene"ran

:emos"asis spon"an sering 550K pa'a laserasi Becil

saa" 'ilaparo"omi6

8anyaB "ra#ma *a"i *anya perl# pengawasan, U 5=6 'rainase

PrognosisA

Mor"ali"asA ?=!0K "ergan"#ng 'era<a" U penyaBi" penyer"a

Gra'e !=3A mor"ali"as biasanya oB penyaBi" penyer"a

Gambaran Blinis U pemeriBsaanA

&yeri U nyeri "eBan Banan a"as, 'apa" re(er Be ba*# Banan

Dapa" 'a"ang 'g Bea'aan s*oB *ipo-olemiB 5*ipo"ensi, V#rin

o#"p#", VC%P6, Ba'ang 'g 'is"ensi ab'ominal

1abA le#Bosi"osis 5biasanya Q!50006 sering pa'a oB "ra#ma

"#mp#l
DE/+S+$ $/+JM+ :+$)
$+$+1+KS+&+

$a"alaBsana #m#mA

Kon"rol per'ara*an, pengangBa"an <arE &on -i"al, 'rainase

1aserasi 'angBal simple s#"#re, a"a# pengg#naan agen^

*emos"a"ic

1esi Q para* "in'aBan^ "amba*an 5c"*A 'eep ma""ress s#"#res,

pacBing, 'bbri'emen", resec"ion, mes* *epa"orr*ap*y, 'll6

1aserasi simpel 5=6 pM'ara*an biasanya 5=6 'ilaB#Ban s#"#re, 5=6

'rainase 5BecE $'p lesi 'alam parenBim oB @/ biliary 7s"#la pos"=op6

S#bcaps#lar *ema"oma 'apa" 'i obs a"a# 'i e-aB#asi s#rgiBal

5<iBa 5=6 a'a lesi parenBim66

1aserasi yg "er#s ber'ara* wala# s#'a* 'iBon"rol scr loBal

$rac"o"omy memb#Ba lesi #9 mencari s#mber pE' lal# 'iligasi

Se"ela* 'iligasi m4 ber'ara* coba pringleMs mane#-erc

PringleMs Mane#-er #9 menge"a*#i s#mber pE'
Se"ela* 'iclamp 'ara* ber*en"i s#mber 'ari cabang aE*epa"iBa
a"a# -Epor"a
Se"ela* 'iclamp m4 pM'ara*an s#mber 'ari cabang -E*epa"iBa a"a#
-EBa-a
Mane#-er ini <g 'apa" #9 -is#alisasi 5saa" melaB#Ban s#"#re6
:a"i e(eB oBl#si pE' "E# pa'a ps *ipo"ermi biasanya !5=0mn", bbrp
laporanA oBl#si `!<am 'g s"eroi' 'ilaporBan aman

$* Bonser-a"i(, non=op 'ian<#rBan "E# #9A

Ps "ra#ma *a"i "#mp#l 'g *emo'inamiB s"abil "anpa in'iBasi #9

e4plorasi

8iasanya ps ini 'ie-al#asi 'g JSG <iBa 5N6 +b&

C$scan 'g Bon"ras 5=6 e4"ra-asasi biasanya "* non=
op

Kri"eria BlasiB #9 "* non=opA

:emo'inamiB s"abil, s"a"#s men"al &, 5=6 a'a in'iBasi #9

laparo"omi 5c"*A peri"oneal sign, "ra#ma gra'e !=3, Beb#"#*an
"rans(#si O #ni"6

Kri"eria ini seBarang semaBin lebar

@ang, 'BB Blasi7Basi in'iBasi "* op ber'asar C$=scanA

$ipe!A 5N6 e4"ra-asasi Be ca-i"as peri"oneal "* op

$ipe A *emoperi"one#m, N e4"ra-asasi Bon"ras Be parenBim

angiograp*y emboli.a"ion a"a# 'apa" "* op

$ipe 3A 5=6 *emoperi"one#m, N e4"ra-asasi Bon"ras Be parenBim

angiograp*y emboli.a"ion

Moni"or psA biasanya 'g $an'a^ -i"al, :"

)nila* Benapa s"a"#s men"al in"aB 5=6 sine H#e non #9 "* non=op

+ngiograp*ic emboli.a"ion bbrp s#mber s#'a*

men<a'iBannya pro"oBol "* non=op

Ps biasanya )CJ U 'imoni"orE 8iasanya Q4?<am s#'a*

bisa in"erme'ia"e care #ni" 'apa" m#lai 'ie" oral

$ira* baring "e"ap 'i"er#sBan *ingga *ari Be 5

+B"i-i"as 7siB & biasanya 'apa" 'ilaB#Ban Q 3b#lan

$ingBa" Beber*asilan "* non=opA

Gra'e !=3 5`95K6, gra'e 4=5 575=?0K6

&am#n "* non op *a"i "erlewa"nya "ra#ma 9 po"ensi

"ra#ma lain 5"E# *ollow -isc#s per(ora"ion6
$ra#ma :a"i U SeBi"arnyaEE

$ra#ma "ria' por"al 50E07K6

8iasanya oB "ra#ma pene"ran

$ra#ma eBl#si( "*' "ria' por"al sg" <arang, biasanya 5N6 "ra#maA
*epar, '#o'en#m, gas"er, colon, U pE' lain

Mor"ali"as 50=?0K

KompliBasiA 7s"#la bilier, por"al -ein "*rombosis, *epa"ic isc*emia

$ra#ma '#cE Kom#nis

Minor a"a# parsial 5O50K circ#m(erence6 primary repair, $=$#be

Mayor c*ole'oen"eric anas"omosis @/ s"riB"#r OO

$ra#ma empe'# sanga" <arang

$*A Bolesis"eB"omi

8iasanya 'ilaB#Ban 'rainase "M"#"#p oB @/ biliary 7s"#la

KOMP1)K+S) Pos"=Opera"i-e

KompliBasi^ pasca "ra#ma *a"iA

P#lmo, coag#lopa"*y, biliary 7s"#la,

*emobilia, abses in"raparenBim a"a#
s#b'ia(ragma

Pos"opera"i-e blee'ing 5O!0K6A

Dapa" oB *emos"asis 5=6 baiB, a"a#

pos"op coag#lopa"*y, a"a# nya

SiBa ps 5=6 *ipo"ermiB T coag#lopa"*ic T

aci'o"ic re=e4plorasi "rac"o"omy
a"a# pacBing N re=e4plorasi #lang 5<iBa
pM'ara*an 'i(#s6

+bses in"ra T ab'ominalA

@/A s*oB lama, gg parenBim l#as, 5N6 "ra#ma *ollow -isc#s, isBemi
*epar oB ligasi pE' mayor, U 'rainase "Mb#Ba, 5N6 <ar non -i"al

8eberapa s"#'i Bri"iB pengg#naan 'rainase oB @/ in(eBsi

in"raperi"oneal

Dera<a" != 5biasanya 5=6 prl#6, 'era<a" Q para* 5wala#p#n

Bon"ro-ersial6 sering 'ilaB#Ban 'rainase

C$ scan #9 'e"eBsi abses

$*A perc#"aneo#s 'rainage, "api <iBaA ps 'g "an'a peri"oneal,

'emam persis"en a"a# abses m#l"ipel ree4plorasi

8iliary 7s"#la 57=!0K6A

@/A "ra#ma 'era<a" QG3, ps yg 'ilaB#Ban reseBsi, a"a# 'ebri'emen

l#as

8iasanya 7s"#la men#"#p spon"an =4mgg pasca 'rainase "M"#"#p

:emobilia 5<arang6A

8iasanya oB "ra#ma "#mp#l, 'i'4 'g en'oscopy #pper G)

Kel#*anA <a#n'ice, nyeri /Jd, malaise, melena

$*A angiograp*ic emboli.a"ion

$/+JM+ JSJS KEC)1

)nsi'enA

8agE Yg paling sering "erBena oB "ra#ma pene"ran

5=0K pa'a "ra#ma "#mp#l

Gambaran Klinis U PemE @isiBA

Wsea" bel" signX c#riga "ra#ma en"eric U

mesen"eric

KebanyaBan "ra#ma "#mp#l 5N6 "an'a peri"oneal,

nam#n laserasi Becil 'apa" 5=6 "an'a peri"oneal

SiBa ps 'g 5N6 "an'a peri"oneal, a"a# *emo'inamiB 5=6

s"abil laparo"omi, '4 'i"egaBan in"ra=opera"i-e

:ollow -isc#s in<#ries biasanya '4 sering "ela" "E#

oB "ra#ma "#mp#l *a"i^
PemeriBsaan Pen#n<angA
@o"o polos, DP1, C$ nam#n DP1 U C$ 5=6 "ll B*as
DP1 #9 #EBecil sering (alse nega"i-e oB pM'ara*an min
SiBa C$ *asil 5=6 5=6 c#B#p #9 r#le o#" ba*wa ps ini 5=6 a'a "ra#ma
#EBecil

8eberapa gambaran yg mgB memban"#A

5N6 (ree 3#i' "anpa "ra#ma organ pa'a", 5N6 (ree air 5<arang6,
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M e n i l a i a ' a n y a * e m a " # r i a U e - a l # a s i p e r ( # s i g i n < a l ' e n g a n

m e m a n " a # p r o ' # B s i # r i n
0EPemasangan
Ba"e"er #rin
PemeriBsaa
n
Sasmani

Kecepa"an aliran berban'ing l#r#s 'engan

empa" Bali ra'i#s Ban#l 'an berban'ing "erbaliB
'engan pan<angnyaE

+la"A Ba"e"er )% #B#ran besar

$empa" A

Orang 'ewasa A
PD lengan bawa* PD sen"ral 5-ena
(emoralis, <#g#laris, s#bcla-ia6

+naB A
in"ra=osse#s

Ka"e"er "erpasang ambil 'ara* U crossma"c*,

p4 lab, "oBsiBologi, +GD, (o"o "ora4E
+Bses
Pemb#l#*
Dara*
Cairan yang mengan'#ng Bomponen
'ara*
2*ole bloo',
re' pacBe' cells,
o4ygen carrying capaci"y
Koloi' +lb#min,
s"rac*,
gela"in,
'e4"ran
Kris"aloi' /1, &aCl 0E9K
Cairan *anga" U
"e"esan cepa"
5bol#s6
!= 1
'ewasa
0m19Bg
pa'a anaB
[3 (or ! r#leM
/espon Pen'eri"a
$erapi
+wal
Cairan
E-al#asi
/es#si"a
si U
Per(#si
Organ
E-al#asi
/es#si"a
si U
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Organ
!E
/espon
pen'eri"a
!E
/espon
pen'eri"a
E
Pro'#Bsi
#rine
E
Pro'#Bsi
#rine
3E
Keseimban
gan asam=
basa
3E
Keseimban
gan asam=
basa
/espon cepa" /espon semen"ara $anpa respon
$an'a -i"al & PerbaiBan
semen"ara
Bembali men#r#n
$e"ap abnormal
D#gaan Be*ilngan
'ara*
Minimal
5!0=0K6
Se'ang, ms* a'a
50=40K6
8era" 5Q40K6
Keb#"#*an
Bris"aloi'
Se'iBi" 8anyaB 8anyaB
Keb#"#*an 'ara* Se'iBi" Se'ang=banyaB Segera
Persiapan 'ara* $ype spesi7c U
crossma"c*
$ype spesi7c Emergensi
Operasi M#ngBin Sanga" m#ngBin :ampir pas"i
Ke*a'iran 'ini a*li
be'a*
Perl# Perl# Perl#
!E
/espon
pen'eri"a
E4amina"ion
$*ro#g* *eal"* *is"ory
Descrip"ion o( e-en"s
prece'ing an'9or ca#sing
onse" o( symp"oms
Comple"e p*ysical e4am,
incl#'ing rec"al e4am, "o
'e"ermine s*ocB ca"egory
&asogas"ric "#beA
@or #n'iDeren"ia"e' *ypo-olemic
s*ocB "o r#le o#" G) *emorr*age
8loo' "ype an' cross=ma"c*
:emoglobin an' *ema"ocri"
le-els
)nser" @oley ca"*e"erA
Moni"or #rine o#"p#"E
Coag#la"ion s"#'iesA
Pro"*rombin "ime
Par"ial "*romboplas"in
"ime
)n"erna"ional normali.e'
ra"io

O"*er meas#res o( s*ocB

an' "iss#e
*ypoper(#sionA
+r"erial bloo' gas
8ase 'e7ci"
Ser#m lac"a"e le-el
Ser#m elec"roly"es
Essen"ial 2orB#p labora"ori#m
E4amina"ion
C*es" ra'iograp*A
:emo"*ora4A
8l#n" c*es" in<#ries
$*oracic ar"erio-eno#s mal(orma"ion
Pel-ic ra'iograp*A
Pel-ic (rac"#re
@oc#se' +b'ominal Sonograp*y
(or $ra#ma 5@+S$ e4am6A
+b'ominal "ra#ma
Possible ab'ominal aor"ic ane#rysmA
Per(orm be'si'e e-al#a"ionE
&on"ra#ma"ic in"raperi"oneal
*emorr*age
@l#i' in Morisongs po#c* implies
signi7can" *emorr*age or asci"esE
&ega"i-e 7n'ings 'o no" r#le o#"
in"raperi"oneal *emorr*ageE

En'o-aginal #l"raso#n'A
Posi"i-e pregnancy "es"
@l#i' in "*e c#l='e=sac
Ec"opic pregnancy

+b'ominal C$ scanA
De"ec"s bo"*
in"raperi"oneal an'
re"roperi"oneal
*emorr*age
Per(orme' once "*e
pa"ien" *as been s"abili.e'
+b'ominal aor"ic
ane#rysm
)maging
KompliBasi

Ker#saBan organ A
-
SSP
-
:a"i
-
Gin<al Gagal gin<al a'ala*
BompliBasi yg pen"ing pa'a syoB
*ipo-olemiB