Asuhan Keperawatan pada Klien dengan Cidera Kepala Berat pada kasus gawat darurat dan kritis (ventilator)

1. CKB
Disampaikan pada pemantapan profesi KGD:
Ns. Arcellia Farosyah P., S.Kep., MSc

2. Hukum Monroe Kelly
¡ Darah
¡ Cairan serebrospinal
¡ Parenkim Otak

4. PENINGKATAN TIK

5. PO2 & PCO2
¡ PCO2 tinggi:
vasodilatasi
¡ Asidemia: aliran darah ke
otak meningkat
¡ PCO2 rendah:
vasokonstriksi
¡ Alkalemia: aliran darah ke
otak berkurang

6. CPP = MAP - ICP
CPP : Cerebral Perfusion Pressure
MAP : Mean Arterial Pressure
ICP : Intra Cranial Pressure
CPP < 70 mmHg Iskemik Otak

7. Case 1
Mr. A is brought to A&E
Department via EMS with full C-
spine precaution. The patient
was state in multiple fracture
due to highway accident.
GCS: 8 with raccoon eyes sign;
BP: 160/90 mmHg; HR: 100x/m;
RR: 35x/m. Blood running from
his nose.
Source: Huizenga et al., 2009

8. Pengkajian (IGD)
¡ A
¡ B
¡ C
¡ D
Dx. Penunjang?

9. Protokol Khusus:
Resusitasi Otak
1. IV: Normovolume
2. Hiperventilasi
3. Manitol 20%, 1 gr/kgBB
4. Furosemide, 0.3-0.5 mg/kgBB
5. Antikonvulsan

10. Indikasi Masuk ICU
1. Tipes 1: Hypoxemia <50%
2. Tipes 2: Hypercapnia >50%

11. Ventilator Settings
1. RR 4-20x/m
2. Tidal Volume 5-15cc/KgBB
3. FiO2% 40-100%
4. I:E Ratio 1:2 / 1:1.5

12. INDIKASI MASUK ICU
Mr. A has been on the ventilator for
24 hours after post craniotomy
surgery. You volunteered to care for
him today, since you know him from
the intubation yesterday.
The settings: PCMV 14, VT 700, PEEP 5
mmHg, FIO2 60%, I:E 1:2. Since 07:00,
RR 20x/m. On drugs. SaO2: 100%.
High pressure alarm (The time is now
11:00). Patient look uncomfortable
Source: Plambex, 2009

13. Drugs
1. Sedatives: propofol
2. Analgesics
3. Paralytics / NMBs (Neuromuscular
Blocking agents: Norcuron
4. Neuroleptics: Haldol

14. Pengkajian (ICU)
¡ A
¡ B
¡ C
¡ D
Dx. Penunjang?

15. ABG
¡ PaCO2 is 28, the pH is 7.48, and the
PaO2 is 120
¡ (normals: PaCO2 35-45 mm Hg, pH
7.35-7.45 mm Hg, PaO2 80-100 mm
Hg).

16. ¡ Based on the ABG, the
pulmonologist changes the
vent settings to SIMV, rate 10,
PS 10, FIO2 40%. The VT remains
700, RR 24. How will these new
settings help Mr. Hill?

17. Weaning criteria
1. TV: at least 5ml/Kg
2. MV: less than 10l/m
3. RR: less than 25x/m
4. ABG
5. Klinis

18. GOODLUCK!!