TINJAUAN PUSTAKA
Indikasi Pembedahan pada Trauma Kapitis
Andika Surya Atmadja
Dokter Umum di Wilayah Pulomas, Jakarta Timur, Indonesia
ABSTRAK
5SBVNB NFSVQBLBO QFOZFCBC UFSCBOZBL LFNBUJBO QBEB VTJB EJ CBXBI UBIVO EBO MFCJI EBSJ NFSVQBLBO USBVNB LBQJUJT5SBVNB
LBQJUJT NFSVQBLBO TBMBI TBUV NBTBMBI LFTFIBUBO ZBOH EBQBU NFOZFCBCLBO HBOHHVBO GJTJL EBO NFOUBM ZBOH LPNQMFLT .FTLJQVO
EFNJLJBO
UJEBL TFNVB USBVNB LBQJUJT NFNFSMVLBO QFSBXBUBO EJ SVNBI TBLJU
QFODJUSBBO CT-scan
BUBVQVO UJOEBLBO QFNCFEBIBO 0MFI
LBSFOBJUV
EJQFSMVLBOQFOHFUBIVBONFOHFOBJJOEJLBTJCFEBIQBEBUSBVNBLBQJUJT
Kata kunci:*OEJLBTJCFEBI
LMBTJLBTJ
USBVNBLBQJUJT
ABSTRACT
5SBVNBJT UIFNPTUDPNNPODBVTFPG EFBUIGPSUIPTFVOEFSZFBSTPME
BOENPSFUIBOJTIFBEUSBVNB)FBEUSBVNBDBODBVTF
DPNQMFY QIZTJDBM BOE NFOUBM EJTUVSCBODFT
CVU OPU FWFSZ IFBE USBVNB OFFET IPTQJUBMJ[BUJPO
$5TDBO JNBHJOH OPS TVSHJDBM NBOBHFNFOU
5IFSFGPSF
JUhTOFDFTTBSZUPLOPXUIFJOEJDBUJPOTGPSTVSHFSZJOIFBEJOKVSZAndika Surya Atmadja. Surgical Indications in Head Trauma.
Keywords:)FBEUSBVNB
TVSHJDBMJOEJDBUJPOT
UZQFT
PENDAHULUAN %J MBJO QJIBL
UJEBL TFNVB USBVNB LFQBMB 4FCBHJBO CFTBS
QBTJFO USBVNB LBQJUJT
5SBVNB NFSVQBLBO QFOZFCBC UFSCBOZBL NFNFSMVLBO QFSBXBUBO EJ SVNBI TBLJU
NFNJMJLJ ($4
IBOZB TFLJUBS ZBOH
LFNBUJBO QBEB VTJB EJ CBXBI UBIVO QFODJUSBBO EFOHBO CT-scan BUBVQVO NFNJMJLJ ($4 4FLJUBS QBTJFO DFEFSB
EBO MFCJI EBSJ NFSVQBLBO USBVNB UJOEBLBO QFNCFEBIBO 5FSEBQBU JOEJLBTJ LFQBMB BLBO NFODBSJ QFSUPMPOHBO QFSUBNB
LBQJUJT 5SBVNB LFQBMB NFSVQBLBO TBMBI UFSUFOUV VOUVL EJMBLVLBO UJOEBLBOUJOEBLBO QBEB EPLUFS VNVN EBO IBOZB QBTJFO
TBUV NBTBMBI LFTFIBUBO ZBOH EBQBU UFSTFCVU ZBOHNFNCVUVILBOJOUFSWFOTJCFEBITBSBG
NFOZFCBCLBO HBOHHVBO TJL EBO NFOUBM
ZBOH LPNQMFLT EFGJTJU LPHOJUJG
QTJLJT
Klasifikasi Trauma Kapitis )BTJM TUVEJ UFSCBSV NFOHFOBJ USBVNB LBQJUJT
JOUFMFLUVBM
EBO MBJOMBJO
ZBOH EBQBU CFSTJGBU 5SBVNB LBQJUJT USBVNB LFQBMB
BEBMBI NFOVOKVLLBO CBIXB IJQPLTJB EBO IJQPUFOTJ
TFNFOUBSBBUBVQVONFOFUBQ USBVNB NFLBOJL UFSIBEBQ LFQBMB CBJL ZBOH UFSKBEJ TFTBBU TFUFMBI USBVNB EBQBU
TFDBSB MBOHTVOH NBVQVO UJEBL MBOHTVOH NFOHBLJCBULBO LFSVTBLBO PUBL TFLVOEFS
%J *OEPOFTJB
UJEBL UFSEBQBU EBUB OBTJPOBM ZBOH NFOZFCBCLBO HBOHHVBO GVOHTJ 6OUVL NFODFHBI IBM UFSTFCVU
TBOHBU EJ
NFOHFOBJ USBVNB LFQBMB 1BEB UBIVO
OFVSPMPHJT
ZBJUV HBOHHVBO TJL
LPHOJUJG
QFSMVLBOQFOBOHBOBOBXBMZBOHUFQBU
EJ 34$. UFSEBQBU QBTJFO USBVNB LFQBMB GVOHTJ QTJLPTPTJBM CBJL UFNQPSFS NBVQVO
SJOHBO
QBTJFO USBVNB LFQBMB TFEBOH
QFSNBOFO 1BEB USBVNB LBQJUJT QFSMV Pemeriksaan Awal pada Trauma Kapitis
EBO QBTJFO USBVNB LFQBMB CFSBU %J EJQFSIBUJLBO BEBOZB QFSVCBIBO LFTBEBSBO 5JEBL TFNVB USBVNB LBQJUJT QFSMV EJCBXB LF
3VNBI 4BLJU 4JMPBN QBEB UBIVO UFS TFUFMBI USBVNB ,FTBEBSBO EBQBU EJOJMBJ SVNBI TBLJU VOUVL QFNFSJLTBBO MFCJI MBOKVU
EBQBU LBTVT USBVNB LFQBMB %J 3VNBI NFOHHVOBLBO Glasgow Coma Scale ($4
*OEJLBTJLFSVNBITBLJUBEBMBI
4BLJU "UNB +BZB QBEB UBIVO
KVNMBI 5BCFM
"UBT EBTBS OJMBJ UFSTFCVU
USBVNB /JMBJ ($4 QBEB QFNFSJLTBBO BXBM
QBTJFO USBVNB LFQBMB NFODBQBJ PSBOH LBQJUJT EBQBU EJLMBTJLBTJLBO NFOKBEJ USBVNB KJLB EJEVHB LBSFOB BMLPIPM
PCTFSWBTJ
EBSJQBTJFOSBXBUJOBQCBHJBOTBSBG LBQJUJT NJOJNBM
SJOHBO
TFEBOH
EBO CFSBU TFMBNB KBN EBO CBXB LF SVNBI TBLJU
5BCFM
,MBTJLBTJ USBVNB LBQJUJT TFMBJO CJMBOJMBJ($4UFUBQ
4BMBI TBUV DBSB VOUVL NFOHVSBOHJ LFNBUJBO CFEBTBSLBO ($4
KVHB EBSJ HBNCBSBO LMJOJT 5FSEBQBUpost-traumatic seizure
BEBMBI UJOEBLBO CFEBI %J "NFSJLB
TFUJBQ EBOIBTJMCT - scan PUBL
5FSEBQBUUBOEBUBOEBEFTJUOFVSPMPHJ
UBIVOOZB UFSEBQBU QBTJFO ZBOH 5FSEBQBU UBOEB GSBLUVS UFOHLPSBL BEBOZB
NFNFSMVLBO UJOEBLBO PQFSBTJ TFCBHBJ +JLB QBEB CT-scan PUBL UFSMJIBU BCOPSNBMJUBT DBJSBO TFSFCSPTQJOBM EBSJ IJEVOH BUBV
QFOBUBMBLTBOBBO post-traumatic intracranial CFSVQB QFSEBSBIBO JOUSBLSBOJBM
QFOEFSJUB UFMJOHB
IFNPUJNQBOJ
NFNBS EJ CFMBLBOH
hematoma
EJHPMPOHLBOEBMBNUSBVNBLBQJUJTCFSBU BVSJLVMB
NFNBSEJQFSJPSCJUBM
Alamat korespondensi email: [email protected]
CDK-236/ vol. 43 no. 1, th. 2016 29
TINJAUAN PUSTAKA
Tabel 1.Glasgow Coma Scale UVMBOH UFOHLPSBL EBO EVSBNBUFS 4VNCFS
VUBNB QFSEBSBIBO IFNBUPNB FQJEVSBM
Fungsi Respons Skor
BEBMBI SVQUVSOZB BSUFSJ NFOJOHFB NFEJB
.BUB
#VLBTQPOUBO -PLBTJ QFSEBSBIBO FQJEVSBM ZBOH QBMJOH
#VLBKJLBEJQFSJOUBI TFSJOH BEBMBI EBFSBI UFNQPSPQBSJFUBM EBO
#VLBEFOHBOSBOHTBOHOZFSJ EBFSBI UFNQPSBM
QBEB QBTJFO EBQBU
5JEBLBEBSFTQPOT UFSKBEJ CJMBUFSBM 1VODBL JOTJEFOT BEBMBI
#JDBSB
/PSNBM BOUBSB VTJB TBNQBJ UBIVO
4FLJUBS
#JOHVOH QBTJFO EFOHBO IFNBUPNB FQJEVSBM
,BUBLBUBLBDBV
EJCBXB LF SVNBI TBLJU EBMBN LFBEBBO UJEBL
TBEBS
4VBSBUJEBLNFOFOUV
5JEBLBEBSFTQPOT
(FKBMB LMJOJT IFNBUPNB FQJEVSBM TFCBHBJ
.PUPSJL
%BQBUNFOHJLVUJQFSJOUBI
CFSJLVU
%BQBUNFOVOKVLUFNQBUOZFSJ Lucid interval
, BXBMOZB QBTJFO UJEBL
%BQBUNFOHIJOEBSJOZFSJ TBEBS
LFNVEJBO TBEBS EBO LFNCBMJ UJEBL
%FLPSUJLBTJ TBEBS
%FTFSFCSBTJ ,FTBEBSBONBLJONFOVSVO
5JEBLBEBSFTQPOT Late IFNJQBSFTJT
1VQJMBOJTPLPS
Tabel 2.,MBTJLBTJUSBVNBLFQBMB 3FFLT#BCJOTLJ
TBUVTJTJ
'SBLUVSEJEBFSBIUFNQPSBM
Kategori GCS Gambaran Klinik CT-scan Otak
1BEB TBBU QBTJFO TBEBS
EBQBU EJUFNVL BO
.JOJNBM 1JOHTBO
EFTJUOFVSPMPHJ
/PSNBM
HFKBMB EFTJU GPLBM EFTFSFCSBTJ
LFKBOH
3JOHBO 1JOHTBO NFOJU
EFTJUOFVSPMPHJ
/PSNBM BGBTJB
4FEBOH 1JOHTBO NFOJUmKBN
EFTJUOFVSPMPHJ
"COPSNBM /ZFSJLFQBMBQSPHSFTJG
#FSBU 1JOHTBO KBN
EFTJUOFVSPMPHJ
"COPSNBM 4BBU QBTJFO LFNCBMJ UJEBL TBEBS
TFSJOH
UFSKBEJTQBTUJTJUBTUVOHLBJCJMBUFSBM
1FOVSVOBOLFTBEBSBO KBN TFUFMBI EJPCTFSWBTJ BUBVQVO ,BEBOH EJUFNVLBO CSBEJLBSEJ
3BTBCBBMQBEBUVCVI KBNTFUFMBIUSBVNB YNFOJU
LFOBJLBO UFLBOBO EBSBI
/ZFSJLFQBMBCFSBUEBOQFSTJTUFO 5FSEBQBU GSBLUVS BUBV EFQSFTJ QBEB TJTUPMJL
.VOUBICFSVMBOH LBMJ
EBTBS UFOHLPSBL BUBV USBVNB
"EBOZB BNOFTJB QPTUUSBVNBUJL QFOFUSBTJ )BTJM CT-scan PUBL QBEB QBTJFO IFNBUPNB
NFOJU
5FSEBQBU QFOVSVOBO LFTBEBSBO BUBV FQJEVSBM BEBMBI HBNCBSBO IJQFSEFOT
5FSEBQBUBNOFTJBSFUSPHBSE NFOJU
UBOEBEFTJUOFVSPMPHJCBSV QFSEBSBIBO
CJLPOWFLT EJ UVMBOH UFOHLPSBL
.FLBOJTNF USBVNB ZBOH CFSJTJLP CFTBS
,FTBEBSBO QFOVI ($4
UBOQB EBO EVSB
VNVNOZB EJ EBFSBI UFNQPSBM
TFQFSUJ LFDFMBLBBO MBMV MJOUBT
KBUVI EBSJ GSBLUVS
UFUBQJ OZFSJ LFQBMB CFSBU EBO (BNCBS
LFUJOHHJBO QFSTJTUFO
UFSEBQBU TFUJEBLOZB LBMJ
NVOUBI QBEB TFMBOH XBLUV ZBOH Hematoma Subdural
1FNFSJLTBBO QFOVOKBOH QBEB USBVNB CFSCFEB )FNBUPNB TVCEVSBM BEBMBI IFNBUPNB
LBQJUJTBOUBSBMBJO "EB SJXBZBU HBOHHVBO QFNCFLVBO BLJCBU SPCFLOZB WFOB EJ BOUBSB EVSBNBUFS
'PUP QPMPT LFQBMB 'PUP QPMPT LFQBMB EBSBI TFQFSUJ NFOHHVOBLBO PCBU EBO QBSFOLJN PUBL bridging vein
)FNBUPNB
NFNJMJLJ TFOTJUJWJUBT EBO TQFTJTJUBT BOUJLPBHVMBO
EBO QFOVSVOBO TVCEVSBM EBQBU BLVU UFSEJBHOPTJT
SFOEBI EBMBN NFOEFUFLTJ QFSEBSBIBO LFTBEBSBO
BNOFTJB
EBO UBNQBL IBSJ TFUFMBI USBVNB
EBO LSPOJL IBSJ
JOUSBLSBOJBM PMFI LBSFOB JUV
TFKBL EJ HFKBMBEFTJUOFVSPMPHJ TFUFMBI USBVNB
1BEB MBOKVU VTJB EBQBU
UFNVLBOOZB CT-scan
GPUP QPMPT LFQBMB Magnetic resonance imaging .3*
UJEBL CFSLBJUBOEFOHBOUSBVNBBUBVEFOHBO
TVEBINVMBJEJUJOHHBMLBO LFQBMB 5FLOJL QFODJUSBBO JOJ MFCJI USBVNB SJOHBO 4FLJUBS QBTJFO
CT-scan LFQBMB CT-scan LFQBMB NFSVQBLBO TFOTJUJG EJCBOEJOHLBO CT-scan
OBNVO IFNBUPNB TVCEVSBM NFNQVOZBJ OJMBJ ($4
TUBOEBS CBLV VOUVL NFOEFUFLTJ QFNFSJLTBBO .3* NFNCVUVILBO XBLUV
QFSEBSBIBO JOUSBLSBOJBM 4FNVB QBTJFO MFCJIMBNBEJCBOEJOHLBOCT-scan
EFOHBO ($4 TFCBJLOZB NFOKBMBOJ (FKBMB LMJOJT IFNBUPNB TVCEVSBM BEBMBI OZFSJ
QFNFSJLTBBOCT-scan*OEJLBTJCT-scan
DIAGNOSIS YANG MEMERLUKAN LFQBMB
EBQBU UFSKBEJ QFOVSVOBO LFTBEBSBO
.BUB IBOZB NFNCVLB CJMB BEB TINDAKAN BEDAH EBOEFTJUOFVSPMPHJT
SBOHTBOHTBLJU OJMBJ($4
Hematoma Epidural
5FSEBQBU QFOVSVOBO LFTBEBSBO OJMBJ )FNBUPNB FQJEVSBM BEBMBI TVBUV %JBHOPTJT IFNBUPNB TVCEVSBM EJUFHBLLBO
($4
EBO UJEBL NFNCBJL EBMBN IFNBUPNB ZBOH UFSBLVNVMBTJ EJ BOUBSB EFOHBO CT-scan LFQBMB. )BTJM CT-scan BLBO
30 CDK-236/ vol. 43 no. 1, th. 2016
TINJAUAN PUSTAKA
NFNQFSMJIBULBO HBNCBSBO IJQFSEFOT TINDAKAN BEDAH CT-scanEFOHBO($4CFSBQBQVO
QFSEBSBIBO
EJ BOUBSB EVSBNBUFS EBO 5FSBQJ QFNCFEBIBO QBEB USBVNB LBQJUJT 1BEB QBTJFO EFOHBO ($4
IBSVT
BSBLOPJE
UBNQBL TFQFSUJ CVMBO TBCJU NFNFSMVLBO CFCFSBQB QFSUJNCBOHBO EBO EJMBLVLBO FWBLVBTJ QFNCFEBIBO TF
(BNCBS
CFSCFEBQBEBTFUJBQKFOJTUSBVNBLBQJUJT DFQBUOZB
)FNBUPNBFQJEVSBMZBOHQSPHSFTJG
Fraktur Kranial Terdepresi dan Fraktur 1BEB VNVNOZB
QFNCFEBIBO VOUVL
Basis Kranii FWBLVBTJ IFNBUPNB QFSMV EJQFSUJNCBOH #JMB WPMVNF IFNBUPNB DN
LFUFCBMBO
1BEB LBTVT GSBLUVS LSBOJBM UFSEFQSFTJ
QFSMV LBO BQBCJMB EJUFNVLBO IFNBUPNB EFOHBO NN
EBO midline shift NN QBEB
UFSBQJ BHSFTJG NFOHJOHBU SJTJLP JOGFLTJ
LFKBOH
WPMVNF NFMFCJIJ DN QBEB IBTJM CT-scan QBTJFO EFOHBO ($4 EBO UBOQB EFTJU
EBO EFGPSNJUBT LPTNFUJL 1FOFMJUJBO .FTLJQVO EFNJLJBO
JOEJLBTJ QFNCFEBIBO OFVSPMPHJ
EBQBU EJUFSBQJ LPOTFSWBUJG EF
QBEB QBTJFO GSBLUVS LSBOJBM UFSCVLB QBEB DFEFSB LFQBMB UJEBL IBOZB CFSEBTBSLBO OHBO QFNFSJLTBBO CT-scan TFSJBM :BOH QFSMV
NFOEBQBULBO
LFKBEJBO JOGFLTJ IBTJM CT-scan TBKB
UFUBQJ KVHB BEBOZB EJQFSIBUJLBO BEBMBI SJTJLP QFNCFTBSBO MFTJ
JOUSBLSBOJBM *OGFLTJ NFOJOHLBULBO LFKBEJBO QFSCVSVLBOLMJOJTEBOMPLBTJMFTJ CT-scan VOUVL follow up QBEB QBTJFO ZBOH
EFTJU OFVSPMPHJ QFSTJTUFO
LFKBOH TBNQBJ UJEBL EJPQFSBTJ
IBSVT EJMBLVLBO EBMBN
MFCJI EBSJ NJOHHV TFUFMBI USBVNB TFSUB 4FNVB MVLB QFOFUSBTJUFNCVT NFSVQBLBO KBN
4FLJUBS LBTVT IFNBUPNB FQJEVSBM
LFNBUJBO JOEJLBTJQFNCFEBIBO
NFOHBMBNJ QFNCFTBSBO
QBMJOH TFSJOH
EBMBN KBN TFUFMBI USBVNB 1FNCFTBSBO
1BEB GSBLUVS CBTJT LSBOJJ
HFKBMB LMJOJT TFTVBJ Hematoma Epidural UJEBLUFSKBEJMBHJKBNTFUFMBIUSBVNB
EFOHBOMPLBTJOZB *OEJLBTJ CFEBI QBEB IFNBUPNB FQJEVSBM
BEBMBI )BTJM PQFSBTJ CJBTBOZB CBJL
LFDVBMJ QBEB
1BEB GSBLUVS CBHJBO BOUFSJPS
HFKBMB EBO 7PMVNF IFNBUPNB DN QBEB IBTJM GSBLUVS ZBOH QBOKBOH EBO MBTFSBTJ TJOVT
UBOEBLMJOJTOZBBEBMBI WFOPTVT 1SFWBMFOTJ IFNBUPNB FQJEVSBM
,FMVBSOZB DBJSBO MJLVPS NFMBMVJ IJEVOH CJMBUFSBM BEBMBI 1BEB QBTJFO LPNB
rhinorrhea CJBTBOZB UFSEBQBU SFFLT #BCJOTLJ CJMBUFSBM
1FSEBSBIBO
ecchymosis QFSJPSCJUBM TQBTUJTJUBT
SJHJEJUBT
NFOVOKVLLBO LPNQSFTJ
CJMBUFSBMraccoon eye NFTFOTFGBMPO
EBO QSPHOPTJTOZB CVSVL 1BEB
"OPTNJB QBTJFO TFQFSUJ JOJ
QFNCFEBIBO UJEBL CPMFI
EJUVOEB
1BEB GSBLUVS CBHJBO NFEJB
HFKBMB EBO UBOEB
LMJOJTOZBBEBMBI .PSUBMJUBT PQFSBTJ FWBLVBTJ IFNBUPNB
,FMVBSOZB DBJSBO MJLVPS NFMBMVJ UFMJOHB FQJEVSBM BEBMBI %BUB QFSCBOEJOHBO
otorrhea BOUBSB UFSBQJ PQFSBUJG EBO OPOPQFSBUJG QBEB
(BOHHVBO/7**EBO7*** FQJEVSBMIFNBUPNBCFMVNBEB
1BEB GSBLUVS CBHJBO QPTUFSJPS
HFKBMB EBO Hematoma Subdural
UBOEB LMJOJTOZB BEBMBI ecchymosis NBTUPJE *OEJLBTJ QFNCFEBIBO QBEB IFNBUPNB
CJMBUFSBMBattle sign TVCEVSBMBEBMBI
Gambar 1.CT-scan VOUVLNFMJIBUmidline shift. 1BEB IBTJM CT-scan EJUFNVLBO LFUFCBMBO
Hematoma Intraserebral ,FUKJLB# "EJEVHBUFSKBEJmidline shift IFNBUPNB NN BUBV midline shift
)FNBUPNB JOUSBTFSFCSBM BEBMBI QFSEBSBIBO
QBSFOLJN PUBL BLJCBU QFDBIOZB BSUFSJ
JOUSBTFSFCSBM
CJBTBOZB LBSFOB DFEFSB LFQBMB
CFSBU $JSJ LIBT IFNBUPNB JOUSBTFSFCSBM
BEBMBI IJMBOH LFTBEBSBO EBO OZFSJ LFQBMB
CFSBUKJLBQBTJFOTBEBSLFNCBMJ
Perdarahan Subaraknoid
1FSEBSBIBO EJ SVBOH TVCBSBLOPJE CJBTBOZB
EJTFSUBJ IJMBOHOZB LFTBEBSBO
OZFSJ LFQBMB
CFSBU
EBO QFSVCBIBO TUBUVT NFOUBM ZBOH
DFQBU (FKBMB LMJOJT QFSEBSBIBO TVCBSBLOPJE
BEBMBI LBLV LVEVL
OZFSJ LFQBMB
EBO CJTB
EJEBQBUJ HBOHHVBO LFTBEBSBO )BTJM CT-
scan BEBMBI BEBOZB HBNCBSBO QFSEBSBIBO
IJQFSEFOT
EJ SVBOH TVCBSBLOPJE (BNCBS
Gambar 2.)FNBUPNBFQJEVSBM Gambar 3.)FNBUPNBTVCEVSBM
CDK-236/ vol. 43 no. 1, th. 2016 31
TINJAUAN PUSTAKA
NNEFOHBOOJMBJ($4CFSBQBQVO - Cushing reflex IJQFSUFOTJ
CSBEJLBSEJ
1BEB OJMBJ ($4
QFSMV monitoring UBOEBUBOEBHBOHHVBOOBQBT
UFLBOBO JOUSBLSBOJBM TFDBSB IBUJIBUJ #JMB /JMBJ ($4 EFOHBO LPOUVTJP DN
UFLBOBO JOUSBLSBOJBM NFMFCJIJ NN)H EJ EBFSBI GSPOUBM BUBV UFNQPSBM EFOHBO
BUBV QVQJM BOJTPLPS BUBV UFSEJMBUBTJ midline shift NN EBO VLVSBO MFTJ
UFUBQ
EJQFSMVLBOQFNCFEBIBO DN
1BEBQBTJFOEFOHBOOJMBJ($4 EFOHBO
LFUFCBMBO IFNBUPNB NN EBO 1BTJFO EFOHBO MFTJ NBTTB QBSFOLJN UFUBQJ
midline shift NN
IBSVT EJMBLVLBO UJEBL NFNQFSMJIBULBO UBOEBUBOEB EFTJU
QFNCFEBIBO FWBLVBTJ IFNBUPNB CJMB OFVSPMPHJT
UFLBOBO JOUSBLSBOJBM UFSLPOUSPM
OJMBJ ($4 UVSVO TFUJEBLOZB OJMBJ EBSJ EBO UJEBL EJUFNVLBO LFMBJOBO QBEB CT-scan,
TBBU LFKBEJBO TBNQBJ UJCB EJ SVNBI EBQBU EJUFSBQJ TFDBSB OPOPQFSBUJG EBO
TBLJU EFOHBOmonitoringQFODJUSBBOTFSJBM
.PSUBMJUBT QBTJFO IFNBUPNB TVCEVSBM 4BMBI TBUV JOEJLBTJ VUBNB QFNCFEBIBO
ZBOH NFNFSMVLBO UJOEBLBO QFNCFEBIBO QBEB IFNBUPNB JOUSBTFSFCSBM BEBMBI
BEBMBI .PSUBMJUBT QBTJFO LPNB VOUVL NFOVSVOLBO UFLBOBO JOUSBLSBOJBM
ZBOH EJPQFSBTJ BEBMBI 5JOHHJOZB 8BMBVQVO CFMVN BEB EBUB QFSCBOEJOHBO
NPSUBMJUBT JOJ LBSFOB TFCBHJBO CFTBS LBTVT NPSUBMJUBT BOUBSB QBTJFO ZBOH EJPQFSBTJ EBO
IFNBUPNB TVCEVSBM CFSLBJUBO EFOHBO UJEBL
CFCFSBQB QFOFMJUJBO NFOVOKVLLBO
DFEFSB KBSJOHBO JOUSBLSBOJBM BUBVQVO QFOVSVOBO UFLBOBO JOUSBLSBOJBM ZBOH
FLTUSBLSBOJBM ,FMBJOBO JOUSBLSBOJBM ZBOH QB TJHOJLBO QBTDBPQFSBTJ 0QFSBTJ QBEB
MJOH TFSJOH EJUFNVJ BEBMBI LPOUVTJP TFSFCSJ KBN QFSUBNB KVHB NFOVOKVLLBO QFSCFEBBO
EBO IFNBUPNB JOUSBTFSFCSBM ,FMBJOBO IBTJM ZBOH TJHOJLBO EJCBOEJOHLBO EFOHBO
FLTUSBLSBOJBM ZBOH QBMJOH TFSJOH BEBMBI PQFSBTJ ZBOH EJMBLVLBO MFCJI EBSJ KBN
GSBLUVS GBTJBM
FLTUSFNJUBT
EBEB
EBO USBVNB TFUFMBI USBVNB )BTJM MFCJI CVSVL EJEBQBULBO
BCEPNFO 1FSCBOEJOHBO BOHLB NPSUBMJUBT
LBMJ MFCJI CBOZBL QBEB QBTJFO ZBOH
QBTJFO ZBOH EJPQFSBTJ EFOHBO ZBOH UJEBL Gambar 4.'SBLUVSLSBOJBMUFSEFQSFTJ IBOZB NFOEBQBULBO UFSBQJ PCBUPCBUBO
NBTJI CFMVN UFSTFEJB LBSFOB LFCBOZBLBO EJCBOEJOHLBOEFOHBOZBOHEJPQFSBTJ
QBTJFO BLIJSOZB NFNFSMVLBO UJOEBLBO BLBO NFOJOHLBULBO JOTJEFOT JOGFLTJ TFCFTBS
PQFSBTJ
Perdarahan Subaraknoid
1FSEBSBIBO TVCBSBLOPJE OPOUSBVNBUJL
Faktur Kranial Terdepresi Hematoma Intraserebral TFSJOH UFSKBEJ QBEB NBMGPSNBTJ BSUFSJWFOB
'SBLUVS LSBOJBM UFSEFQSFTJ UFSCVLB ZBOH *OEJLBTJ PQFSBTJ QBEB MFTJ QBSFOLJN PUBL /BNVO
QFSEBSBIBO TVCBSBLOPJE USBVNBUJL
NFMFCJIJ LFUFCBMBO LSBOJVN IBSVT EJPQFSBTJ BLJCBUUSBVNBBEBMBI UFSKBEJ QBEB TFLJUBS QBTJFO EFOHBO
VOUVL NFODFHBI JOGFLTJ 4FUJBQ UJOEBLBO 5FSEBQBU EFTJU OFVSPMPHJT ZBOH DFEFSB LFQBMB 1FSEBSBIBO USBVNBUJL
VOUVL NFOHBUBTJ GSBLUVS LSBOJBM UFSEFQSFTJ QSPHSFTJG TVCBSBLOPJE USBVNBUJL CJBTBOZB UFSKBEJ CFS
UFSCVLB IBSVT EJCFSJ BOUJCJPUJL 'SBLUVS 5FSEBQBU QFOJOHLBUBO UFLBOBO JOUSB TBNBBO EFOHBO QFSEBSBIBO JOUSBLSBOJBM
LSBOJBM UFSEFQSFTJ UFSCVLB NBTJI EBQBU LSBOJBMZBOHSFGSBLUFS MBJOOZB TFQFSUJ IFNBUPNB FQJEVSBM
EJUFSBQJ UBOQB PQFSBTJ CJMB CBJL LMJOJT
NBVQVO SBEJPMPHJ UJEBL NFOVOKVLLBO
BEBOZB QFOFUSBTJ EVSBNBUFS
IFNBUPNB
JOUSBLSBOJBM
LFUFSMJCBUBO TJOVT GSPOUBMJT
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MVLBJOGFLTJ
'SBLUVS LSBOJBM UFSEFQSFTJ UFSUVUVQ UJEBL
NFNFSMVLBOUJOEBLBOPQFSBTJ
4FKVNMBI
LFKBEJBO JOGFLTJ CFS
IVCVOHBO EFOHBO EFTJU OFVSPMPHJ ZBOH
MFCJI CBOZBL EBO QFSTJTUFO
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epilepsy LFKBOH UFSKBEJ NJOHHV TFUFMBI
USBVNB
EBO LFNBUJBO 5JOEBLBO PQFSBUJG
VOUVL EFCSJEFNFO NFOVSVOLBO LFKBEJBO
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EJUVOEB MFCJI EBSJ KBN TFUFMBI USBVNB Gambar 5.1FSEBSBIBOJOUSBTFSFCSBM Gambar 6.1FSEBSBIBOTVCBSBLOPJE
32 CDK-236/ vol. 43 no. 1, th. 2016
TINJAUAN PUSTAKA
IFNBUPNB TVCEVSBM
BUBVQVO IFNBUPNB MFCJI CVSVL KJLB EJTFSUBJ EFOHBO QFSEBSBIBO Glasgow Coma Scale VOUVL NFOFOUVLBO
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PQFSBTJ QBEB QFSEBSBIBO TVCBSBLOPJE USBVNB LBQJUJT QFSMV EJSBXBU JOBQ EJ SVNBI
USBVNBUJL NFOHJLVUJ JOEJLBTJ PQFSBTJ QBEB SIMPULAN TBLJU
EJMBLVLBO QFNFSJLTBBO CT-scan
BUBV
QFSEBSBIBO JOUSBLSBOJBM MBJOOZB ZBOH UFSKBEJ 5SBVNB NFSVQBLBO QFOZFCBC UFSUJOHHJ QVO EJPQFSBTJ 5FSEBQBU LSJUFSJB UFSUFOUV
)BOZBTBKB
QSPHOPTJTQFSEBSBIBOJOUSBLSBOJBM LFNBUJBO QBEB VTJB EJ CBXBI UBIVO EBO VOUVL UJOEBLBO PQFSBTJ NBTJOHNBTJOH
MBJOOZB TFQFSUJ IFNBUPNB FQJEVSBM
MFCJI EBSJ USBVNB NFSVQBLBO USBVNB KFOJT USBVNB LBQJUJT *OEJLBTJ QFNCFEBIBO
IFNBUPNB TVCEVSBM
EBO IFNBUPNB LBQJUJT 5SBVNB LBQJUJT EJLMBTJLBTJLBO NFO EJUFOUVLBO CFSEBTBSLBO QFNFSJLTBBO LMJOJT
JOUSBTFSFCSBM BLBO NFNQVOZBJ IBTJM ZBOH KBEJ SJOHBO
TFEBOH
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DAFTAR PUSTAKA
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CDK-236/ vol. 43 no. 1, th. 2016 33
