LAPORAN SKENARIO 1 BLOK XX SEMESTER 7

KEGAWATDARURATAN MEDIK
KELOMPOK V
KETUA : JHOSIA FRIDHO 133307010077
SEKRETARIS : ALFYANI SAHR 133307010136
NOTULEN : RONI DWINDRA 133307010123
ANGGOTA : MARIO HERBET 133307010142
SERGIUS SITANGGANG 133307010168
STEFANIE PUTRI 133307010143
YULIA VALENTINA 133307010124
RICHO BARUS 133307010125
ANTONIUS F 133307010139
FITRI NIRWANA 133307010167
ZAKIUL IFKAR H 133307010169
JULI SARI G 133307010122
AGNES CHYNTIA SILABAN 133307010126

FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
TAHUN AKADEMIK 2016/2017
 SCENARIO
A man of 17 years have a hobby of
motorcycle racing wildly. Was taken to hospital
due to a fall from a motorcycle. Head suffered
concussion. He always moaned, when told the
doctor to open the eyes should be the stimulation
and avoid painful stimuli. On examination found:
TD 90/50 mmHg, HR 80x / min, 17x RR / min,
and found marks raccoon eye, otorrhea,
rhinorrhea. What happened to this man and what
actions should be done?
1. Clarification of Terms
a. Raccoon eye: the buildup of blood in the eye orbit marked with red
and blue.
b. Otorrhea: secret is out of the ear are white.
c. Rhinorrea: watery secretion from the nose ulcers.
2. Establish Problems
a. Male 17 years old was taken to hospital due to a fall from a
motorcycle. Head suffered concussion.
b. He always moaned, when told the doctor to open the eyes should be
the stimulation and avoid painful stimuli.
c. On examination found: TD 90/50 mmHg and found signs raccoon eye,
otorrhea, rhinorrhea.
3. Analyze Issues
a. - Chances are he did not understand the traffic regulations.
- Chances are he was not wearing a helmet so that high-risk head
trauma.
b. GCS: 8 (by weight).
c. The possibility of intra-cranial hemorrhage.
4. Conclusion While
A man of 17 years experienced a head injury.
5. Learning Objective (LO)
1. Definition, Etiology and Classification of head injury
2. Pathophysiology and Clinical symptoms of head injury
3. Explain GCS
4. Early Trauma Treatment capitis
 A. DEFINITION, ETIOLOGY AND
CLASSIFICATION HEAD INJURY
Definitions :

Head injury is mechanical trauma to the head, either directly or indirectly cause neurological
function disorders are physical disorders, cognitive, psychosocial functioning either temporary or
permanent.

Etiology :

1. Traffic accidents

2. Dropped

3. blunt force trauma

4. Accidents

5. Domestic violence

6. Accidents Sports

7. Trauma due to gunshot or an explosion on the battlefield

Classification

1. Mechanism Head Injury

2. Weighing Head Injury

LIGHT Lightweight Loss of consciousness <20 min.

Post traumatic amnesia <24 hours.
GCS = 13-15.
MEDIUM Loss of consciousness is being 20 min and 36 hours.
Post traumatic amnesia 24 hours and 7 days.
GCS = 9-12.
WEIGHT Loss of consciousness> 36 hours.
Post traumatic amnesia> 7 days.
Weight GCS = 3-8.

3. Morphology

a. cranium fracture

b. Intra Cranial Lesions

 B. Pathophysiology and Clinical
Symptoms Trauma Capitis
1. Clinical symptoms
a. Clinical symptoms that may aid in the diagnosis are:
- Battle sign (blue or ekhimosis behind the ear over mastoid os)
- Hemotipanum (bleeding in the area of tympanic ear menbran)
- Periorbital ecchymosis (black eye without direct trauma)
- Rhinorrhoe (serobrospinal fluid out of the nose)
- Otorrhoe (serobrospinal fluid out of the ear)
b. Clinical symptoms for mild head trauma:
- Headache persistent or prolonged
- Nausea or vomiting
- Sleep disorders and appetite decreased
c. Clinical symptoms of the severe head trauma;
- Symptoms or signs cardinal which showed an increase in the brain is
decreased or increased.
- Changes in pupil size (anisokoria).
- Triad Cushing (decreased heart rate, hypertension, respiratory
depression)
 C. GLASGOW COMA SCALE
Parameter Patients Response Score
Best Eye Spontaneous eye opening 4
Response Eye opening to voice stimuli 3
Eye opening to pain stimuli 2
None 1
Best Verbal Conversant and oriented 5
Response Confused and disoriented 4
Utters inappropriate words 3
Makes incomprehensible sounds 2
Makes no sounds 1
Best Motor Obeys commands 6
Response Localizes to pain 5
Withdraws to pain 4
Abnormal Flexion (decorticate response) 3
Extensor posturing (decerebrate response) 2
No movement 1
 D. BEGINNING OF MANAGEMENT
HEAD INJURY
A. The patient was conscious (GCS = 15)
1. Simple head injury (SHI)
2. Awareness interrupted momentarily
B. Patients with decreased consciousness
1. Mild head injury / minor head injury (GCS
= 13-15)
2. moderate head injury (GCS = 9-12)
3. severe head injury (CGS = 3-8)
Measures In Emergency Room
1. Resuscitation with action A = Airway, Breathing =B
and C = Circulation
2. Physical examination
3. Radiological examination
4. Laboratory tests
Hb, leukocytes, cell differentiation
random blood sugar (GDS)
Urea and Creatinine
Blood gases
Electrolytes (Na, K, and Cl)
Serum albumin (day 1)
Platelets, PT, aPTT, fibrinogen
5. Management of intracranial pressure (ICT)
6. Nutrition
7. Neurorestorasi / rehabilitation
 FINAL CONCLUSION
A man of 17 years have a hobby of motorcycle racing wildly. Was taken to hospital due to a fall from a
motorcycle. Head suffered concussion. He always moaned, when told the doctor to open the eyes should
be the stimulation and avoid painful stimuli. On examination dijumpi: TD: 90/50 mmHg, HR: 80x / min,
RR: 17x / minute, and found marks raccoon eye, otorrhoea, rhinorrhea.
Based on history and physical examination of male patients 17 years capitis severely traumatized. With

GCS examination:
The opening of the eyes (eye): E2 (open eyes should be stimulation)
Voice response (verbal): V2 (Moaning in pain)
Movement (movement): M4 (Avoiding painful stimuli)
Number of GCS score: 8 (by weight)

Initial management is:

a. Airway (Airway)
The airway was released from the tongue that fell backward with the head extension. If you need to install the pipe
or pipe endotracheal oropharynx. Clean the rest of vomit, blood, mucus or dentures. If vomiting, the patient was
placed askew. Gastric contents emptied through a nasogastric tube to avoid aspiration of vomit.
b. b. Breathing (Breathing)
Respiratory disorders may be caused by disease of the central or peripheral. The disorder is caused by central
respiratory depression characterized by Cheyne Stokes breathing pattern, central neurogenic hyperventilation, or
ataxic. Peripheral abnormalities caused by aspiration, chest trauma, pulmonary edema, pulmonary embolism, or
infection.
Governance:
Oxygen high doses, 10-15 liters / minute, intermittent
Find and treat the causative factor
If you need to use a ventilator
c. Circulation (Circulation)
Hypotension can occur as a result of brain injury. Hypotension with systolic
blood pressure <90 mm Hg happens only once alone can increase the risk of
death and disability. Hypotension occurs mostly due to extracranial factors,
such as hypovolemia due to external bleeding or rupture in the tool, chest
trauma with cardiac tamponade / pneumothorax, or septic shock. Tata
laksananya by stopping the source of bleeding, improved heart function,
replace blood lost, or temporarily with 0.9% NaCl isotonic fluids.
After resuscitation ABC, conducted a physical examination that includes
awareness, blood pressure, pulse, respiration patterns and frequency, the
pupil (large, shapes and light reaction), deficits of focal cerebral and
extracranial injuries.
- Need to do a CT-scan of the head to establish a definitive diagnosis.
- Laboratory examination
Hb, leukocytes, cell differentiation
random blood sugar (GDS)
Urea and Creatinine
Blood gases
Electrolytes (Na, K, and Cl)
Serum albumin (day 1)
Platelets, PT, aPTT, fibrinogen
After that we refer the patient to a specialist neurosurgery.