98279904 fraktur basis cranii
TRANSCRIPT
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Roihatul Zahroh, S.Kep.Ns., M.Ked
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Kulit kepala Tulang tengkorak Meningen Otak Cairan serebrospinalis Tentorium
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Tabula externa Diploe Tabula interna
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Konveksitas (kubah tengkorak)
Basis cranii (dasar tengkorak)
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Fraktur yg terjadi pd tulang yg membentuk dasar tengkorak.
Terbagi atas; fossa anterior, fossa media dan fossa posterior
Fraktur pd masing2 fossa akan memberikan manifestasi yg berbeda
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Dibatasi oleh; os.spenoid, procesus clinoidalis anterior, dan jagum spenoidalis.
Manifestasi / tanda gejalanya terjadi perlahan 12-24 jam
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Ekimosis periorbital (Racoon Eyes/brill hematome),
Tidak disertai cedera lokal), Hematome subconjungtiva;
anosmia (Gg. N.olfactorius), Rhinorea (Kebocoran CSS) dg tanda pemeriksaan trdpt
`Halo - sign` pd kertas tissue Gangguan Visus
(Gg.N.optikus)
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Dibatasi oleh; os.temporalis, procesus clinoidalis posterior, dan dorsum sella.
Tanda-gejala; echymosis mastoid (battle sign), othorrea, hematompanum, sakit kepala, Gg.visus dan gerak bola mata.
25% Gg.N.VII, N.VIII.
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Merupakan dasar kompartemen infratentorial
Sering tidak disertai tanda yg jelas namun segera menimbulkan kematian
Penekanan batang otak
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Bila perdarahan di kepala (lbh brbahaya di daerah atas telinga dan belakang kepala)
Hentikan perdarahan dengan menekan pd pembuluh darah di kepala (menggunakan tiga jari; dua jari dipembuluh darah yg luka dan ibu jari pada nadi di leher/sblh jakun)
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Tes; Halo sign CT Scan kepala Mri (magnetik resonance imaging) ECG
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Observasi adanya kebocoran CSS (biasanya membaik spontan)
Kolaborasi tim medis (untuk TIDAK memberikan obat anti biotik)
Hindari resisten obat Jangan memberikan irigasi terhdp
otorhea (mempermudah terjadinya infeksi)
Jangan melakukan pemasangan NGT pd Fr.fossa anterior(mempermudah infeksi intrakranial)
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Monitor patensi jalan napas, usaha napas dan ABG
Monitor tanda-tanda vital Monitor CSS, jika 2 minggu kebocoran CSS
blm berhenti
Operasi (bedah saraf)
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Umur penderita, waktu dan mekanisme cedera
Status respiratorik dan kardiovaskuler (terutama tekanan darah)
Pemeriksaan neurologis,terdiri dari GCS terutama nilai respon motorik dan reaksi cahaya pupil
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