LAPORAN PENDAHULUAN Nama : Eka Novita Sari NIM : 113115007 113115007
A. MASALAH KESEHAT KESEHATAN : INTRAERE!RAL INTRAERE!RAL HEMAT HEMATOMA "IH# "IH# !. PEN$ PEN$ER ERT TIAN IAN P%r&ar P%r&ara'a( a'a( i(tra) i(tra)%r% %r%*ra *ra++ a&a+a' a&a+a' ,%r&ar ,%r&ara'a( a'a( -a( -a( t%r/a& t%r/a&ii ,a&a ,a&a /ari( /ari(a( a( otak otak *iaa(-a aki*at ro*%ka( ,%m*+' &ara' -a( a&a &a+am /ari(a( otak. S%)ara k+i(i &ita(&ai &%(a( a&a(-a ,%(r(a( k%a&ara( -a( ka&a(2ka&a( &i%rtai +at%ra+iai ,a&a ,%m%rikaa( T S)a( &i&a,atka( a&a(-a &a%ra' 'i,%r&%( -a( i(&ikai &i+akka( & i+akka( o,%rai /ika Si(+% Diam%t%r +%*i' &ari 3 )m P%ri4%r A&a(-a ,%r%%ra( ari t%(a' S%)ara k+i(i k+i(i '%matom t%r%*t &a,at m%(-%*a*ka( m%(-%*a*ka( a(a( a(a( (%ro+oi (%ro+oi+at%r +at%ra+ia a+iai. i. O,%ra O,%raii -a( -a( &i+ak &i+akka( ka( *iaa(*iaa(-aa a&a+a' a&a+a' %vaka %vakai i '%mato '%matom m &i%rt &i%rtai ai &%kom,r &%kom,r%i %i &ari t+a( t+a( k%,a+a. 6aktor24akto 6aktor24aktorr -a( m%(%(tka( ,ro(o%(-a 'am,ir ama &%(a( 4aktor2 4aktor -a( m%(%(tka( ,ro(o% ,%r&ara'a( *&ra+. "Pa+a 008# I(tra %r%*ra+ H%matom a&a+a' ,%r&ara'a( k%&a+am *ta(i otak .H%morrai i(i *iaa(-a t%r/a&i &ima(a t%ka(a( m%(&%ak k%,a+a am,ai &a%ra' k%)i+ &a,at &a,a t t%r/a&i ,a&a +ka t%m*ak )i&%ra tm,+. "S'ar-a(to 008# I(tra %)%r%*ra+ %)%r%*ra+ '%matom a&a+a' ,%(&ara'a( ,%(&ara'a( &a+am /ari(a( otak it %(&iri. %(&iri. Ha+ i(i &a,at tim*+ tim*+ ,a&a )i&%ra k%,a+a t%rtt, t%rtt, -a( *%rat ata ata )i&%ra )i&%ra k%,a+a k%,a+a t%r*ka t%r*ka .i(tra%r%*ra+ '%matom &a,at tim*+ ,a&a ,%(&%rita trok% '%morik aki*at m%+%*ar(-a ,%m*+' (a&i. "or9i( 008#
. ETIOLO$I Etio+oi &ari I(tra %r%*ra+ H%matom m%(rt S-o(o "011# a&a+a' : a. K%)%+a K%)%+akaa kaa( ( -a( -a( m%(-%* m%(-%*a*k a*ka( a( tra trama ma k%,a+ k%,a+aa *. 6raktr &%,r%i t+a( t%(korak ). $%rak $%rak ak%+%r ak%+%rai ai &a( &a( &%%+% &%%+%ra raii ti*a2t ti*a2ti*a i*a &. %&% %&%ra ra ,%(%t ,%(%tra rai i ,%+r ,%+r %. at' 4. K%)% K%)%+a +aka kaa( a( k%(& k%(&ar araa( aa( *%rm *%rmot otor or . Hi,%rt%(i '. Ma+4or Ma+4orma mai i Art%r Art%rii ;% ;%(oa (oa i. A(%rima /. Ditraia &ara' k. O*at +. M%rokok 1
D. MANI6ESTASI KLINIK I(tra)%r%*ra+ '%morr'a% m+ai &%(a( ti*a2ti*a. Da+am %kitar %t%(a' ora( 'a+ it &ia9a+i &%(a( akit k%,a+a *%rat %ri(ka+i %+ama akti4ita. M%ki,( *%it ,a&a ora( ta akit k%,a+a k%m(ki(a( ri(a( ata ti&ak a&a. Daa( %/a+a t%r*%(tk(-a &i4(i otak &a( m%(/a&i m%m*rk %*aaima(a ,%+aa( ,%(&ara'aa(. !%*%ra,a %/a+a %,%rti +%ma' +m,' k%'i+a(a( ,%raa &a( mati raa %ri(ka+i m%m,%(ar'i 'a(-a a+a' at *aia( t*'. ora( k%m(ki(a( ti&ak *ia *%r*i)ara ata m%(/a&i ,i(. P%(+i'ata( k%m(ki(a( t%ra( ata 'i+a(. Mata *ia &i /( ,%ri(ta' -a( *%r*%&a ata m%(/a&i +m,'. P,i+ *ia m%(/a&i ti&ak (orma+ *%ar ata k%)i+. Ma+ m(ta' %ra(a( &a( k%'i+a(a( k%a&ara( a&a+a' *iaa &a( *ia t%r/a&i &i &a+am 'it(a( &%tik am,ai m%(it. M%(rt or9i( "008# ma(i4%tai k+i(ik &ari &ari I(tra )%r%*ra+ H%matom -ait : a. K%a&ara( m(ki( aka( %%ra 'i+a( ata *%rta'a, %iri( &%(a( m%m*%ar(-a *. ). &. %.
'%matom. Po+a ,%r(a,aaa( &a,at %)ara ,ror%i4 m%(/a&i a*(orma+. R%,o( ,,i+ m(ki( +%(-a, ata m%(/a&i a*(orma+. Da,at tim*+ m(ta'2m(ta' aki*at ,%(i(kata( t%ka(a( i(tra )ra(im. P%r*a'a( ,%ri+ak ko(iti4 &a( ,%r*a'a( 4iik ,a&a *%r*i)ara &a( %raka( motorik
&a,at tim*+ %%ra ata %)ara +am*at. 4. N-%ri k%,a+a &a,at m()+ %%ra ata *%rta'a, %iri( &%(a( ,%(i(kata( t%ka(a( i(tra )ra(im.
E. PATO6ISIOLO$I P%r&ara'a( i(tra%r%*ra+ i(i &a,at &i%*a*ka( o+%' kar%(a r,tr art%ria %r%*ri -a( &a,at &i,%rm&a' &%(a( a&a(-a 'i,%rt%(i. K%+ar(-a &ara' &ari ,%m*+' &ara' &i&a+am otak *%raki*at ,a&a /ari(a( &i%kitar(-a ata &i&%kat(-a %'i(a /ari(a( -a( a&a &i%kitar(-a aka( *%r%%r &a( t%rt%ka(. Dara' -a( k%+ar &ari ,%m*+' &ara' a(at m%(iritai otak %'i(a m%(aki*atka( voo,am% ,a&a art%ri &i%kitar ,%r&ara'a( ,am% i(i &a,at m%(-%*ar k%%+r' '%mi4%r otak &a( +i(kara( 9i++ii ,%r&ara'a( a(%orima2a(%orima i(i m%r,aka( +%kka(2+%kka( *%r&i(&i( ti,i -a( m%(o(/o+ ,a&a art%ri ,a&a t%m,at -a( +%ma'. Maki( +ama a(%orim% maki( *%ar &a( ka&a(2ka&a( ,%)a' aat m%+akka( aktivita. Da+am k%a&aa( 4iio+oi ,a&a ora( &%9aa /m+a' &ara' -a( m%(a+ir k% otak 5< m+m%(it ,%r 100 r /ari(a( otak. !i+a 2
a+ira( &ara' k% otak tr( m%(/a&i 1< m+m%(it ,%r 100 r /ari(a( otak aka( m%(/a&i ,%('%(tia( akti4ita +itrik ,a&a (%ro( t%ta,i trktr %+ mai' *aik %'i(a %/a+a i(i mai' r%v%i*%+. Oki%( a(at &i*t'ka( o+%' otak %&a(ka( O &i,%ro+%' &ari &ara' otak %(&iri 'am,ir ti&ak a&a )a&a(a( O &%(a( &%mikia( otak a(at t%ra(t( ,a&a k%a&aa( a+ira( &ara' %tia, aat. !i+a ,+a- O t%r,t <210 &%tik aka( t%r/a&i a(a( 4(i otak *i+a +%*i' +ama &ari =2< m%(it aka( t%/a&i /%+a+%i -a( ti&ak ,ti' +ai "ir%v%ri*%+# &a( k%m&ia( k%matia(. P%r&ara'a( &a,at m%(i(ika( t%ka(a( i(trakra(ia+ &a( m%(-%*a*ka( i)'%mi &i&a%ra' +ai( -a( ti&ak ,%r&ara'a( %'i(a &a,at *%raki*at m%(ra((-a a+ira( &ara' k% otak *aik %)ara mm ma,( +oka+. Tim*+(-a ,%(-akit i(i a(at )%,at &a( ko(ta( &a,at *%r+a(( *%*%ra,a m%(it /am *a'ka( *%*%ra,a 'ari. "or9i( 008#
6. PATH>A?S Trama k%,a+a 6raktr &%,r%i t+a( t%(korak Hi,%rt%(i Ma+4ormai Art%ri ;%(oa A(%rima Ditraia &ara' O*at M%rokok P%)a'(-a ,%m*+' &ara' otak ",%r&ara'a( i(tra)ra(ia+# Dara' mak k% &a+am /ari(a( otak P%(ata+aka(aa( : Kra(iotomi Lka i(ii ,%m*%&a'a(
Port &@%(tri Mikroora(im%
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"or9i( 008# $. PEMERIKSAAN PENUNAN$ P%m%rikaa( ,%((/a( &ari I(tra %r%*ra+ H%matom m%(rt S&o-o "00=# a&a+a' %*aai *%rikt : a. A(iora4i *. t )a((i( ). Lm*a+ ,(i &. MRI %. T'ora ,'oto 4. La*oratorim . EK$ H. PENATALAKSANAAN P%(&ara'a( i(tra)%r%*ra+ +%*i' m(ki( m%(/a&i 4ata+ &i*a(&i(ka( trok% i)'%mi). P%(&ara'a( t%r%*t *iaa(-a *%ar &a( )atatro,'i) k'(-a ,a&a ora( -a( m%(a+ami t%ka(a( &ara' ti(i -a( kro(i. L%*i' &ari %t%(a' ora( -a( m%(a+ami ,%(&ara'a( *%ar m%(i(a+ &a+am *%*%ra,a 'ari. M%r%ka -a( *%rta'a( 'i&, *iaa(-a k%m*a+i a&ar &a( *%*%ra,a 4(i otak *%ramaa( &%(a( 9akt. M%ki,( *%it k%*a(-aka( ti&ak %m*' %+r'(-a 4(i otak -a( 'i+a(.
4
P%(o*ata( ,a&a ,%(&ara'a( i(tra)%r%*ra+ *%r*%&a &ari trok% i)'%mi). A(ti)oa+a(t "%,%rti '%,ari( &a( 9ar4ari(# o*at2o*ata( trom*o+itik &a( o*at2o*ata( a(ti,+at%+%t "%,%rti a,iri(# ti&ak &i*%rika( kar%(a m%m*at ,%(&ara'a( maki( *rk. ika ora( -a( m%((aka( a(tikoa+a( m%(a+ami trok% -a( m%(%+arka( &ara' m%r%ka *ia m%m%r+ka( ,%(o*ata( -a( m%m*a(t ,%(m,a+a( &ara' %,%rti : a. ;itami( K *iaa(-a &i*%rika( %)ara i(4%. *. Tra(4i ata ,+at%+%t. Tra(4i &ara' -a( t%+a' m%m,(-ai %+ &ara' &a( ,%(a(kata( ,+at%+%t ",+ama %ar -a( &i*%kka(#. ). P%m*%ria( i(4 ,a&a ,ro&k i(t%ti -a( %r,a ,a&a ,rot%i( &i &a+am &ara' -a( m%m*a(t &ara' (tk m%(m,a+ "4aktor ,%(m,a+a(#. O,%rai (tk m%(a(kat ,%(m,ka( &ara' &a( m%('i+a(ka( t%ka(a( &i &a+am t%(korak *a'ka( /ika 'a+ it *ia m%(-%+amatka( 'i&, /ara( &i+akka( kar%(a o,%rai it %(&iri *ia m%rak otak. a ,%(a(kata( ,%(m,ka( &ara' *ia m%mi) ,%(&ara'a( +%*i' +%*i' +a(/t k%raka( otak m%(im*+ka( k%)a)ata( -a( ,ara'. M%ki,( *%it o,%rai i(i k%m(ki(a( %4%kti4 (tk ,%(&ara'a( ,a&a k%+%(/ar ,ititar- ata ,a&a )%r%*%++m. Pa&a *%*%ra,a ka k%%m*'a( -a( *aik a&a+a' m(ki(. M%(rt or9i( "008# m%(-%*tka( ,%(ata+aka(aa( (tk I(tra %r%*ra+ H%matom a&a+a' %*aai *%rikt : a. O*%rvai &a( tira' *ari( t%r+a+ +ama. *. M(ki( &i,%r+ka( +iai ,%m*+' -a( ,%)a' &a( %vakai '%matom %)ara *%&a'. ). M(ki( &i,%r+ka( v%(ti+ai m%ka(i. &. U(tk )%&%ra t%r*ka &i,%r+ka( a(ti*iotiok. %. M%to&%2m%to&% (tk m%(r(ka( t%ka(a( i(tra kra(im t%rmak ,%m*%ria( &ir%tik &a( o*at a(ti i(4+amai. 4. P%m%rikaa( La*oratorim %,%rti : T2S)a( T'ora 4oto &a( +a*oratorim +ai((-a -a( m%((/a(.
I. PRIMAR? SUR;E? "A!DE# 1. Air9a-. Ta(&a2ta(&a o*/%kti42m*ata( Air9aa. Look "+i'at# a,aka' ,%(&%rita m%(a+ami aitai ata k%a&ara((-a m%(r(. Aitai m%m*%ri k%a( a&a(-a 'i,okia &a( ,%(r(a( k%a&ara( m%m*%ri k%a( a&a(-a 'i,%rkar*ia. Sia(oi m%((/kka( 'i,ok%mia -a( &i%*a*ka( o+%' kra((-a oki%(ai &a( &a,at &i+i'at &%(a( m%+i'at ,a&a kk2kk &a( k+it %kitar m+t. Li'at a&a(-a r%traki &a( ,%((aa( otot2otot (a,a 5
tam*a'a( -a( a,a*i+a a&a m%r,aka( *kti tam*a'a( a&a(-a a(a( air9a-. Air9a- "/a+a( (a,a# -ait m%m*%ri'ka( /a+a( (a,a &%(a( m%m,%r'atika( ko(tro+ %rvika+ ,aa( %rvika+ ko++ar (tk immo*i+iai %rvika+ am,ai t%r*kti ti&ak a&a )%&%ra %rvika+ *%ri'ka( /a+a( (a,a &ari %a+a m*ata( *%(&a ai( &ara' &ari 4raktr maki+o4aia+ ii -a( ,ata' &a( +ai(2+ai(. Lakka( i(t*ai "orotrak%a+ t*%# /ika a,(%a $S "$+ao9 oma S)a+%# B < ,%rtim*a(a( /a (tk $S 8 &a( 10 /ika atrai oki%( ti&ak m%()a,ai 80C. *. Lit%( "&%(ar# a&a(-a ara2ara a*(orma+. P%r(a,aa( -a( *%r*(-i "ara (a,a tam*a'a(# a&a+a' ,%r(a,aa( -a( t%rm*at. ). 6%%+ "ra*a# . !r%at'i(. Ta(&a2ta(&a o*/%kti42v%(ti+ai -a( ti&ak a&%kat a. Look "+i'at# (aik tr((-a &a&a -a( im%tri &a( ,%r%raka( &i(&i( &a&a -a( a&%kat. Aim%tri m%((/kka( ,%m*%+ata( " splinting # ata flail chest &a( tia, ,%r(a,aa( -a( &i+akka( &%(a( a' "labored breathing # %*aik(-a 'ar &ia(a, %*aai a()ama( t%r'a&a, oki%(ai ,%(&%rita &a( 'ar %%ra &i %va+ai. Eva+ai t%r%*t m%+i,ti i(,%ki t%r'a&a, *%(tk &a( ,%r%raka( &a&a ,a+,ai t%r'a&a, k%+ai(a( &i(&i( &a&a -a( m(ki( m%(a( v%(ti+ai ,%rki (tk m%(%(tka( a&a(-a &ara' ata &ara k% &a+am ,ar. *.
Lit%( "&%(ar# a&a(-a ,%r%raka( &ara ,a&a k%&a ii &a&a. P%(r(a( ata ti&ak t%r&%(ar(-a ara (a,a ,a&a at ata '%mitorak m%r,aka( ta(&a aka( a&a(-a )%&%ra &a&a. Hati2'ati t%r'a&a, a&a(-a +a/
,%r(a,aa( -a( )%,at2taki,(% m(ki( m%((/kka( k%kra(a( oki%(. ). $(aka( pulse oxymeter . A+at i(i mam, m%m*%rika( i(4ormai t%(ta( atrai oki%( &a( ,%r4i ,%ri4%r ,%(&%rita t%ta,i ti&ak m%matika( a&a(-a v%(ti+ai -a( a&%kat 3. ir)+atio( &%(a( ko(tro+ ,%r&ara'a( a. R%,o( a9a+ t*' t%r'a&a, ,%r&ara'a( a&a+a' takikar&i (tk m%m,%rta'a(ka( )ar&ia) ot,t 9a+a,( trok% vo+m m%(r( *. S%+a(/t(-a aka( &iikti o+%' ,%(r(a( t%ka(a( (a&i "t%ka(a( ito+ik2t%ka(a( &iato+ik# ). ika a+ira( &ara' k% ora( vita+ &a' &a,at &i,%rta'a(ka( +ai maka tim*++a' 'i,ot%(i
6
&. P%r&ara'a( -a( tam,ak &ari +ar 'ar %%ra &i'%(tika( &%(a( *a+t t%ka( ,a&a &a%ra' t%r%*t %. I(at k' (tk otorr'aia -a( ti&ak m%m*%k /a(a( m,a+ MAE "M%at Aktik Ekt%r(# &%(a( ka,a ata kai( kaa *iarka( )aira( ata &ara' m%(a+ir k%+ar kar%(a 'a+ i(i m%m*a(t m%(ra(i TTIK "T%ka(a( Ti(i I(tra Kra(ia+# 4. S%ma )aira( -a( &i*%rika( 'ar &i'a(atka( (tk m%('i(&ari t%r/a&i(-a koa+o,ati &a( a(a( irama /a(t(. . Dia*i+ita. $S %t%+a' r%itai *. !%(tk kra( &a( r%4+%k )a'a-a ,,i+ ). Ni+ai kat motorik kiri &a( ka(a( a,aka' a&a ,ar%% ata ti&ak 5. E,or% &%(a( m%('i(&ari 'i,ot%rmia. S%ma ,akaia( -a( m%(t,i t*' ,%(&%rita 'ar &i+%,a aar ti&ak a&a )%&%ra t%r+%9atka( %+ama ,%m%rikaa(. P%m%rikaa( *aia( ,(( 'ar &i+akka( %)ara +o2ro++i( &%(a( 'ar m%('i(&ari t%r/a&i(-a 'i,ot%rmi "Am%ri)a o++%% o4 Sr%o( ATLS# a. S%)o(&ar- Srv%1# K%,a+a &a( +%'%r K%,a+a. I(,%ki "k%im%tria( mka &a( t%(korak 9ar(a &a( &itri*i ram*t k+it k%,a+a# ,a+,ai "k%a&aa( ram*t t%(korak k+it k%,a+a maa ,%m*%(kaka( (-%ri t%ka( 4o(ta(%+a ",a&a *a-i##. L%'%r. I(,%ki "*%(tk k+it "9ar(a ,%m*%(kaka( /ari(a( ,art maa# tiroi&# ,a+,ai "k%+%(/ar +im,% k%+%(/ar tiroi& trak%a# mo*i+ita +%'%r. # Da&a &a( ,ar I(,%ki. Da&a &ii(,%ki t%rtama m%(%(ai ,otr *%(tk
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k%im%tria( %k,a(i %rta k%a&aa( k+it. I(,%ki &a&a &ik%r/aka( *aik ,a&a aat &a&a *%r%rak ata ,a&a aat &i%m t%rtama %9akt &i+akka( ,%(amata( ,%r%raka( ,%r(a,aa(. P%(amata( &a&a aat *%r%rak &i+akka( &%(a( t/a( (tk m%(%ta'i 4r%k%(i i4at &a( ritm%irama ,%r(a,aa(. Pa+,ai. Di+akka( &%(a( t/a( (tk m%(ka/i k%a&aa( k+it ,a&a &i(&i( &a&a (-%ri t%ka( maa ,%ra&a(a( k%im%tria( %k,a(i &a( ta)ti+ vr%mit "vi*rai -a( &a,at t%ra*a -a( &i'a(tarka( m%+a+i it%m *ro(ko,+mo(a+ %+ama %%ora( *%r*i)ara# P%rki. P%r'atika( a&a(-a 'i,%ro(or ata F&++F -a( m%((/kka( &ara ",(%motorak# ata )aira( "'%motorak# -a( t%r&a,at ,a&a ro(a ,+%ra. 7
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*%ra(kta( a(tara +ai( : a# %&%ra ,%m*+' &ara'. *# 6raktr &i %kitar %(&i +tt &a( %(&i ik. )# r' i(/r-. &# Si(&roma kom,art%m%(. %# Di+okai %(&i ,a(+. K%a&aa( ik%mik i(i aka( &ita(&ai &%(a( : a# Pai art%ri ti&ak t%ra*a. *# P)at ",a++or#. )# Di(i( ")oo+(%#. &# Hi+a((-a 4(i %(orik &a( motorik. %# Ka&a(2ka&a( &i%rtai '%matoma F*rit &a( t'ri++F. 6ikai 4raktr k'(-a ,a&a ,%(&%rita &%(a( )%&%ra k%,a+a %&a,at m(ki( &i+aka(aka( %)%,at(-a. S%*a* 4ikai -a( t%rt(&a &a,at m%(i(katka( r%iko ARDS "A&+t R%,irator- Ditr% S-(&rom# am,ai 5 ka+i +i,at. 6ikai &i(i ,a&a 4raktr t+a( ,a(/a( -a( m%(-%rtai )%&%ra k%,a+a &a,at m%(r(ka( i(i&%(i ARDS.
. DIA$NOSA KEPERA>ATAN a. K%ti&ak%4%kti4a( ,%r4i /ari(a( )%r%*ra+ *.& Ta'a(a( ,%m*+' &ara' i(4ark *. N-%ri k%,a+a akt *.& ,%(i(kata( t%ka(a( i(tra)ra(ia+ "TIK#
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). R%iko: K%ti&ak%im*a(a( k%*t'a( (trii kra( &ari k%*t'a( t*' *.& a(or%kia &. K%raka( mo*i+ita 4iik *.& K%+%ma'a( (%tro(mit%r %. $a(a( ,%m%('a( k%*t'a( ADL *.& k%+%ma'a( 4iik. 4. R%iko ti(i t%r'a&a, i(4%ki *%r'*(a( &%(a( i(vai MO.
DAFTAR PUSTAKA
or9i( E+iGa*%t' . 008. Buku Saku Patofisologi edisi 3. E$ : akarta S&o-o A %t a+. Buku Ajar Ilmu Penyakit Dalam. akarta : 6KUI 00=.
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