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LAPORAN KASUS SPINAL SYOK
BANGSAL BEDAH
PEMBIMBING
DR.RAHMAT, Sp.B
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I. IDENTITAS PASIEN
Nama : Tn. Dermawan
Umur : 3 !a"un
#en$% &e'am$n : La&$('a&$A)ama : I%'am
Pe&er*aan : Ku'$ +an)unan
N.-M : ./0.1Tan))a' ma%u& : Apr$' 21
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II. ANAMNESA
ALLOANAMNESA
Ke'u"an u!ama : &e'umpu"an mu'a$ 4ar$ +a!a% 4a4a
%ampa$ &e &a&$
R$wa5a! pen5a&$! %e&aran) : O% 4$+awa &e'uar)an5a 4en)an penurunan &e%a4aran. O% men)e'u"&an %e%a& 4an mu'a$ 4ar$ +a!a%4a4a %ampa$ &e &a&$ !$4a& +$%a 4$ )era&&an %e!e'a" !er&ena a'$ran'$%!r$& 4an !er*a!u" 4ar$ a!a% +an)unan %e!$n))$ 'e+$" &uran) me!er
pa4a %aa! +e&er*a. #a!u" 4en)an p%$%$ !er'en!an) 4an p$n)%an mua'6(7,mun!a"6(7. %e!e'a" 4$'a&u&an pemer$&%aan 4$ UGD % 4$ pu!u%&an%upa5a 4$rawa! $nap 4an men4apa! penan)anan 4ar$ +a)$an +e4a".
R$wa5a! pen5a&$! !er4a"u'u : H$per!en%$, a%ma, %a&$! *an!un),DM 4$%an)&a'.
R$wa5a! pema&a$an +a! : 6(7
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III. PEMERIKSAAN 8ISIK
Tan4a 9$!a'• Kea4aan umum : !ampa& %a&$! +era!
• Ke%a4aran umum : G-S E3M
•TD : /;< mmH)
• HR : 0 =;$
• RR : 3 =;$
• T : 3/>-
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1. KEPALA
• Ma!a : $&!er$& 6(;(7, anem$% 6(;(7
• Te'$n)a : !$4a& a4a per4ara"an
• Mu'u! : !$4a& a4a per4ara"an, mu&%a mu'u! 'em+a+
• H$4un) : %um+a!an *a'an na?a% 6(7, per4ara"an 6(7
• Le"er : pem+e%aran KGB 6(7
2. THORAK
• Da4a : %$me!r$%, %en%r$% 6(7, m!r$&6(7
• #an!un) : murmur 6(7, )a''p 6(7
• Paru : r"n&$ 6(7, w"e@$n) 6(7
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3. ABDOMEN
• Hepar: !$4a& !era+a
• L$mpa : !$4a& !era+a
• G$n*a' : !$4a& !era+a
• Sen%r$&6(7, M!r$& 6(7
• N5er$ !e&an 6(7, +$%$n) u%u%67
.ETREMITAS
a. E=!rem$!a% a!a%
4e=!ra 4an %$n$%!ra :
8'e=$ 67
E=!en%$ 67
A44u&%$ 67
A+4u&%$ 67
Ke&ua!an !! 67
Gra9$!a%$ 67 Ran)%an)an %u"u 67
Ran)%an)an n5er$ 67
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+.E=!rem$!a% +awa"
De=!ra 4an S$n$%!ra
8'e=$ 6(7
E=!en%$ 6(7
A44u&%$ 6(7
A+4u&%$ 6(7
Ke&ua!an !! 6(7
Gra9$!a%$ 6(7
Ran)%an)an %u"u 6(7
Ran)%an)an n5er$ 6(7
.GENETALIA
Terpa%an) &a!e!er
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PEMERIKSAAN PENUN#ANG
• EKG
• DL
• GDS,-HOLESTROL,SGPT;OT,-REATININ
• PHOTO : THORA-O LUMBAL AP;LATERAL
• PHOTO : LUMBO SA-RAL AP;LATERAL
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EKG : DALAM BATAS NORMAL
GDS : /C m);4'
-HOLESTROL : 1< m);4' SGPT : 1 U;L
SGOT : 2< U;L
-REATININ : ,00 m);4'
Dara" 'en)&ap
B- : C,C.1 6.(1.7 NORMAL
RB- : ,02 6 NF .(.7 HIGH
PLT : 1.1 6NF1(7 NORMAL
HBG : 1, )r;4'
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I. DIAGNOSA KER#A
SPINAL -ORD IN#URY DENGAN 8R.THORAAL I
. PENAGANAN IGD
O2 : ( Lpm
RL : 2(2 Tpm
Nra)e% : 1amp;0*am
Neur!am : 1)r;0*am
Aran : 1amp;12*am
-e?!r$a=ne : 1amp;12 *am
Me+a'am$n : 1mp';0*am
Parae!am' : 1)r;0*am
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. RESUME
Seran) pa%$en 'a&$('a&$, Tn.Dermawan umur 3
!a"un 4a!an) &e RS 4$an!ar &e'uar)an5a 4en)an&e'u"an !er*a4$ &e'umpu"an mu'a$ 4ar$ +a!a% 4a4a%ampa$ &e &a&$ %e!e'a" !er*a!u" 4ar$ &e!$n))$an m%aa! +e&er*a. Se!e'a" 4$'a&u&an pemer$&%aan ?$%$& 4an
pemer$&%aan penun*an) 5an) men4u&un)4$%$mpu'&an +a"wa Tn.D 4$ 4$a)n%a SPINAL -ORDIN#URI 4en)an 8R.ETEBRA THORAAL 1
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• 8OLLO UP TANGGAL APRIL 21 S : %e%a& 67, mua' 6(7, mun!a"6(7
O : TD 11;< mm"), HR : 0=;$, RR : 3 =;$ A : SPINAL -ORD IN#URY
THERAPY
O2 : 3( Lpm
IN8US RL : 2Tpm
In*.Me!$' pre4n$%'n : 39$a'; *am %e'ama 2 *am
In*. Parae!am' : amp;0*am
In*. -e?!r$a=ne : amp; 12*am
In*.Me+a'am$n : amp;0*am
In*.P$rae!am : 3)r;0*am
BED REST TOTAL
POSISI LURUS ALAS KERAS
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• 8OLLO UP TANGGAL C APRIL 21
S : Se%a& 67, mua' 4an mun!a"6(7, pu%$n)6(7, BAK67, BAB6(7 O : TD : 12;/=;$, HR :0=;I, RR : 20=;$
A : SPINAL -ORD IN#URY
T"erap5 :
O2 : 3( Lpm U8D RL : 2 Tpm
In*.Me!$' pre4n$%'n 29$a' : 2 !pm;)an!$ a$ran
In*.e?!r$a=ne :1)r;0*am
In*.p$rae!am : 3)r;0*am
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TIN#AUAN PUSTAKA
SPINAL -ORD IN#URY
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Ana!m$ ?$%$')$% 9er!e+ra
1. K'umna 9er!e+ra'$% a4a'a" %e+ua" %!ru&!ur 'en!ur 5an)
4$+en!u& 'e" %e*um'a" !u'an) 5an) 4$%e+u! 9er!e+ra a!au rua%
!u'an) +e'a&an). D$an!ara !$ap 4ua rua% !u'an) pa4a !u'an)
+e'a&an) !er4apa! +an!a'an !u'an) rawan.
• 8un)%$ rua% !u'an) +e'a&an) :
a. Mena"an &epa'a 4an a'a!(a'a! !u+u" 5an) 'a$n
+. Me'$n4un)$ a'a! "a'u% 5an) a4a 4$4a'amn5a 6%um%um !u'an)
+e'a&an)7
. Tempa! 'e&a!n5a !u'an) $)a 4an !u'an) pan))u'
4. Menen!u&an %$&ap !u+u".
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Menuru! S5a$?u4$n 61//<7, +a)$an(+a)$an 4ar$ rua% !u'an) +e'a&an) !er4$r$
4ar$ :
a. er!e+ra %er9$&a'$% < rua%, mempun5a$ +a4an rua% &e$' 4an 'u+an) rua%n5a
+e%ar. Pa4a !a*u %a5apn5a !er4apa! 'u+an) !empa! 'a'un5a %ara? 5an) 4$%e+u!?ramen !ran%9er%a'$%. Rua% per!ama %er9$&a'$% 4$%e+u! pr%e%u% 4n!$4
6a&%$%7 5an) memun)&$n&an &epa'a +erpu!ar &e &$r$ 4an &e &anan.
+. er!e+ra !ra&a'$% 6!u'an) pun))un)7 !er4$r$ 4ar$ rua%. Ba4an rua%n5a
+e%ar 4an &ua!, !a*u 4ur$n5a pan*an) 4an me'en)&un).
. er!e+ra 'um+a'$% 6!u'an) pn))an)7 !er4$r$ 4ar$ rua%. Ba4an rua%n5a +e%ar,!e+a' 4an &ua!, !a*u 4ur$n5a a)a& p$a&. Ba)$an rua% 4ar$ &e a)a&
menn*' 4$%e+u! prmn!r$um.
4. er!e+ra %a&ra'$% 6!u'an) &e'an)&an)7 !er4$r$ 4ar$ rua%. Rua%(rua%n5a
men*a4$ 1, %e"$n))a men5erupa$ %e+ua" !u'an), 4$%amp$n) &$r$;&anan5a
!er4apa! 'u+an)('u+an) &e$' +ua" 5an) 4$%e+u! ?ramen %a&ra'$%.
e. er!e+ra &&%$)$a'$% 6!u'an) e&r7 !er4$r$ 4ar$ rua%, rua%(rua%n5a &e$' 4an
men*a4$ %e+ua" !u'an) 5an) 4$%e+u! *u)a %.&&%$)$a'$%. Dapa! +er)era&
%e4$&$! 4an mem+en!u& %a&rum.
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2. Me4u'a %p$na'$% +er?un)%$ %e+a)a$ pu%a! re?'e&% %p$na' 4an *u)a %e+a)a$ *ara%(*ara% &n4u&%$ $mpu'% 4ar$ a!au &e !a&. Ter4$r$ 4ar$ :
a. Su+%!an!$a a'+a 6%era+u! %ara? +erm$e'$n7 5an) +er?un)%$ %e+a)a$ *ara%
&n4u&%$ $mpu'% a?eren 4an e?eren an!ara +er+a)a$ !$n)&a! me4u'a %p$na'$%4an !a&
+. Su+!an!$a )r$%ea 6*ar$n)an %ara? !a& +erm$e'$n7 merupa&an !empa! $n!e)ra%$re?'e&%(re?'e&% %p$na'
Da'am me4u'a %p$na'$% a4a 31 pa%an) %ara?, !er4$r$ 4ar$ : %er9$&a' 0 pa%an),
!ra&a' 12 pa%an), 'um+a' pa%an), %a&ra' pa%an), &&%$)ea' 1 pa%an).
Se+ua" $r$%an me'$n!an), %u+%!an!$a )r$%ea !ampa& men5erupa$ "uru? H&ap$!a'. Kana'$% %p$na'$% +er$&u! $%$n5a 5a$!u a$ran %ere+r%p$na', me'$n!a%
per%$% 4$ !en)a"(!e)a" "uru? H !er%e+u!. Ke4ua &a&$ "uru? H men*u'ur &e
+a)$an !u+u" 4$%e+u! &rnu an!er$r a!au &rnu 9en!ra'$%. Se4an)&an &a&$ +e'a&an) 4$nama&an &rnu p%!er$!, a!au &rnu 4r%a'$%. Sum(%um !u'an) +e'a&an) 4$+un)&u% 'e" 3 %e'apu! 5a$!u 4urame!er, ara&"n$4, 4an p$ame!er. D$an!ara 4urame!er 4an ara&"n$4 !er4apa! 'u+an) 4$%e+u!&an4un) 4urame!er.
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Derma!m 4an m5!m
• Derma!m a4a'a" 4aera" pa4a &u'$! 5an) 4$per%ara?$ 'e" a&%n %en%r$% 4$4a'am
ra4$&% %ara? %e)men!a'. Le9e' %en%r$% a4a'a" 4erma!m 4en)an ?un)%$ %en%r$% 5an)
nrma' 4an 4apa! 4$+e4a&an pa4a &e4ua %$%$ !u+u".
&un$ un!u& menen!u&an !$!$& %en%a%$ a4a'a" :
1. - : area 4$a!a% 4e'!$4
2. -C : *emp' !an)an
3. -< : *ar$ !en)a" !an)an
. -0 : &e'$n)&$n)
. T : pap$''a mamae
C. T0 : =$p"$%!ernum
<. T1 : um+$'$u%
0. T12 : %$mp"$%$% pu+$%
/. L : +a)$an me4$a' +e!$%
1. L : ruan) an!ara *ar$ &a&$ per!ama(&e4ua
11. S1 : +a!a% 'a!era' pe4$%
12. S3 : 4aera" !u+er%$!a% $%"$$
13. S( : 4aera" per$ana'
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• M5!m
%e!$ap %ara? %e)men!a' 6ra4$&%7 memper%ara?$ 'e+$" 4ar$ 1 !! 4an
&e+an5a&an !! 4$per%ara?$ 'e" 'e+$" 4ar$ %a!u %ara?. Un!u& memu4a"&an,
+e+erap !! a!au &e'mp& !! 4$$4en!$?$&a%$ %e+a)a$ %a!u %e)men %ara"
%p$na'.
O!! !! 5an) !erpen!$n) a4a'a" :
1. -( : 4e'!$4
2. -(C : e&%!en%r per)e'an)an !an)an3. -(< : e&%!en%r %$&u
. -(0 : ?'e&%r *ar$(*ar$ !an)an 1(3
. T(1 : a+4u&!r *ar$ &e'$n)&$n)
C. L(2 : 8'e&%r pan))u'
<. L(3 : e&%!en%r 'u!u!
0. L( : 4r%?'e&%$ per)e'an)an &a&$
/. L( : e&%!en%r *ar$ &a&$ II
1.S(1 : ?'e&%$ per)e'an)an &a&$
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Se!$ap !! 4$'a&u&an )ra4$a%$ men*a4$ C !$n)&a!;4era*a! &e&ua!an !!.D&umen!a%$ &e&ua!an &e'mp& !! &un$ un!u& mem+an!u men)e!a"u$
per+a$&an a!au mem+uru&n5a &ea4aan neur')$%!.
Dera*a! &e&ua!an !! :
: &e'umpu"an !!a'
1 : !era+a a!au !era%an5a &n!ra&%$
2 : )era&an !anpa mena"an
3 : )era&an me'awan )a5a +era!
: )era&an &e %e)a'a ara", !ap$ &e&ua!an &uran)
: &e&ua!an nrma'
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S5& %p$na'
• -e4era !u'an) +e'a&an) a4a'a" e4era men)ena$ er9$&a'$%, 9er!e+ra'$%, 4an
'um+a'$% a&$+a! !rauma *a!u" 4ar$ &e!$n))$an, &ee'a&aan 'a'u '$n!a%,
&ee'a&aan 'a'u '$n!a% 6S*am%u"$4a5a!, 1//<7.
• Sp$na' r4 $n*ur5 6S-I7 a4a'a" %ua!u &eru%a&an ?un)%$ neur')$% 5an)
%er$n) &a'$ 4$%e+a+&an 'e" &ee'a&aan 'a'u '$n!a%. E?e& 4ar$ %p$na' r4
$n*ur5 !er)an!un) pa4a *en$% 'u&a 4an !$n)&a! 4ar$ e4era. A&$+a! 5an)
4$!$m+u'&an &arena e4era S-I +er9ar$a%$, 4an 5an) !erpara" +$%a %ampa$
men)a&$+a!&an "$'an)n5a ?un)%$ m!r$& 4an %en%r$& %er!a &e"$'an)an
?un)%$ 4e?e&a%$ 4an +er&em$" 68ran%$%a, 207.
• -e4era me4u'a %p$na'$% a4a'a" %ua!u &eru%a&an ?un)%$ neur')$% 5an)
4$%e+a+&an 'e" +en!uran pa4a me4u'a %p$na'$% 6Brunner J Su44ar!, 217
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E!$')$
• Se*a& !a"un 2 e!$')$ u!ama -MS an!ara 'a$n &ee'a&aan 'a'u '$n!a%
63/,27, *a!u" 620,37, &e&era%an 6'u&a !em+a& 1,C7, 'a"ra)a
6!eru!ama 4$9$n), 0,27, a&$+a! 'a$nn5a 4ar$ mena&up /,<.
• E!$')$ nn!rauma!$&, an!ara 'a$n )an))uan 9a%&u'ar, au!$mun,
4e)enera!$?, $n?e&%$, $a!r)en$&, 4an 'e%$ n&)en$&.
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Tan4a 4an Ge*a'aMenuru! #ne% J 8$= 62/7 a4a +e+erapa !an4a 4an )e*a'a 4ar$ S-I, an!ara
'a$n:
• Pa4a awa'n5a %5& %p$na': para'$%$% ?'a&%$4 4en)an penurunan a!au !$4a&a4an5a a&!$9$!a% re?'e&%.
• H$'an)n5a ?un)%$ m!r$& %e+a)$an;par%$a' 4$ +awa" 'e9e' S-I 6!erma%u&
per)era&an 9'un!er J per)era&an me'awan )ra9$!a%$ a!au !a"anan7.
• Ke"$'an)an ?un)%$ %en%r$ %e+a)$an a!au !!a' 4$ +awa" 'e9e' S-I 6!erma%u&
%en!u"an, %u"u, n5er$.
• Pa4a awa'n5a pen$n)&a!an HR +ra4$&ar4$a pa4a awa'n5a pen$n)&a!an
TD penurunan TD.
• N5er$ a&u! 4$ pan))u' a!au 'e"er, 4apa! men*a'ar 4$ %epan*an) %ara?.
• Re?'e&% !en4n 4a'am 4an a&!$9$!a% re?'e&% per$ana' a+nrma'.
• H$'an)n5a &er$n)a!
• H$'an)n5a re?'e&%(re?'e&% %en%r$&, m!r$& 4an !en4n 4a'am 4$ +awa"
'e9e' e4era.
• Re!en%$ %e&re%$ paru, menurun &apa%$!a% 9$!a', pen$n)&a!an Pa-O2,
penurunan O2 )a)a' na?a% 4an e4ema pu'mna'.
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K'a%$?$&a%$
-e4era me4u''a %p$na'$% 4apa! 4$&'a%$?$&a%$&an +er4a%ar&an '&a%$ e4era,
5a$!u1. -e4era %er9$&a'
Le%$ -1(-
Pa4a 'e%$ -1 -, !! !rape@$u%, %!ernma%!$4eu% 4an !! p'a%ma ma%$"
+er?un)%$. O!! 4$a?ra)ma 4an $n!er&%!a' men)a'am$ para'$%$% 4an !$4a&
a4a )era&an $n9'un!er 6+a$& %eara ?$%$& maupun ?un)%$na'7. D$+awa"!ran%e&%$ %p$na' !er%e+u!, &e"$'an)an %en%r$ pa4a !$n)&a! -1 -3 me'$pu!$
&%$p$!a', !e'$n)a 4an +e+erapa 4aera" wa*a".
Pa%$en pa4a u4r$p'e)$a -1, -2, 4an -3 mem+u!u"&an per"a!$an penu"
&arena &e!er)an!un)an pa4a;!er"a4ap 9en!$'a!r me&an$%. Pa%$en $n$ *u)a
&e!er)an!un)an %emua &e+u!u"an %e"ar$("ar$n5a. ua4r$p'e)$a pa4a -mun)&$n *u)a mem+u!u"&an 9en!$'a!r me&an$% !e!ap$ 4apa! 4$'epa%. #a4$
pen))unaann5a %eara $n!erm$!!en %a*a.
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Le%$ -
B$'a %e)men - me4u''a %p$na'$% men)a'am$ &eru%a&an, ?un)%$ 4$a?ra)ma
ru%a& %e&un4er !er"a4ap pa%a !rauma a&u!. Para'$%$% $n!er!$na' 4an 4$'a!a%$
'am+un) 4apa! 4$%er!a$ 4en)an 4epre%$ perna?%an. ua4r$p'e)$a pa4a - +$a%an5a men)a'am$ &e!er)an!un)an 4a'am me'a&u&an a&!$9$!a% %eper!$
man4$, men5$%$r ram+u!, menu&ur !eap$ pa%$en mempun5a$ &4$na%$
!an)an 4an mu'u! 5an) +a$&.
Le%$ -C
Pa4a 'e%$ %e)men -C, 4$%!re%% perna?a%an 4apa! !er*a4$ &arena para'$%$%
$n!e%!$na' 4an e4ema a%en4en 4ar$ me4u''a %p$na'$%. B$a%an5aa&an !er*a4$
)an))uan pa4a !! +$%ep, !r$ep, 4e'!$4 4an pemu'$"ann5a !er)an!un) pa4a
per+a$&an p%$%$ 'en)an. Umumn5a pa%$en ma%$" 4apa! me'a&u&an
a&!$9$!a% "$)$ene %eara man4$r$, +a"&an ma%$" 4apa! mema&a$ 4an
me'epa%&an +a*u.
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Le%$ -<
Le%$ me4u''a pa4a !$n)&a! -< memun)&$n&an !! 4$a?ra)ma 4an a&%e%r$%
un!u& men)&mpen%a%$ !! a+4men 4an $n!er&%!a'. 8'e&%$ *ar$ !an)an
+$a%an5a +er'e+$"an &e!$&a &er*a re?'e&% &em+a'$. ua4r$p'e)$a -<
mempun5a$ p!en%$ "$4up man4$r$ !anpa perawa!an4an per"a!$an &"u%u%.
Pem$n4a"an man4$r$, %eper!$ +erpa&a$an 4an me'epa% pa&a$an me'a'u$
e&%!r$m$!a% a!a% 4an +awa", ma&an, man4$, pe&er*aan ruma" 5an) r$n)an
4an mema%a&.
Le%$ -0
p%$%$ a+nrma' 4ar$ e&%!rem$!a% a!a% !$4a& !er*a4$ pa4a 'e%$ -0 &arena
a44u&!r 4an r!a!r $n!erna' mampu men$a4a&an an!a)n$%. O!! 'a!$%$mu%
4r%$ 4an !rape@$u% u&up &ua! un!u& men5&&n) p%$%$ 4u4u&. H$p!e+%$
p%!ura' 4apa! !er*a4$ +$'a pa%$en 4$!$n))$&an pa4a p%$%$ 4u4u& &arena
&e"$'an)an &n!r' 9a%m!r. H$p!en%$ $n$ 4apa! 4$m$n$ma'&an 4en)an
pa%$en +eru+a" %eara +er!a"ap 4ar$ +er+ar$n) &e p%$%$ 4u4u&. #ar$ !an)an
pa%$en +$a%an5a pa4a p%$%$ menen)&ram.
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2. -e4era T"ra&a'
Le%$ T1 T
Le%$ pa4a re)$n T1(T 4apa! men5e+a+&an perna?a%an 4en)an4$a?ra)ma!$&. 8un)%$ $n%p$ra%$ paru men$n)&a! %e%ua$ !$n)&a! penurunan
'e%$ pa4a !ra&%. H$p!en%$ p%!ura' +$a%an5a munu'.T$m+u' para'$%$%
par%$a' %eper!$ &e"$'an)an %en%r$ %en!u"an, n5er$, 4an %u"u.
Le%$ TC T12Le%$ pa4a !$n)&a! TC men)"$'an)&an %emua re?'e&% a4men.Dar$ !$n)&a! TC
&e +awa", %e)men(%e)men $n4$9$4ua' +er?un)%$, 4an pa4a !$n)&a! 12,
%emua re?'e&% a+4m$na' a4a. A4a para'$%$% %pa%!$& pa4a !u+u" +a)$an
+awa". Pa%$en 4en)an 'e%$ pa4a !$n)&a! !ra&a' "aru% +e?un)%$ %eara
man4$r$.
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Ba!a% a!a% &e"$'an)an %en%r$ pa4a 'e%$ !"ra&a' a4a'a":
•
T2 : Se'uru" !u+u" %ampa$ %$%$ 4a'am 4ar$ 'en)an a!a%.• T3 : A&%$''a.
• T : Pu!!$n) %u%u.
• TC : Pr%e%u% =$?$4.
• T<, T0 : Mar)$n &%!a' +awa".
• T1 : Um+$'$&u%.
• T12 : L$pa! pa"a
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3. -e4era Lum+a'
• Le%$ L1
Semua area e&%!r$m$!a% +awa", men5e+ar &e '$pa! pa"aJ +a)$an +e'a&an)
4ar$ +&n).
• Le%$ L2
E&%!r$m$!a% +a)$an +awa" &eua'$ %eper!$)a a!a% a%pe& an!er$r pa"a
• Le%$ L3
E&%!r$m$!a% +a)$an +awa" 4an 4aera" %a4e'.• Le%$ L
Sama 4en)an L3, &eua'$ a%pe& an!er$r pa"a.
• Le%$ L
A%pe& 'uar &a&$ 4an per)e'an)an &a&$ %er!a e&%!r$m$!a% +awa".
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. -e4era Sa&ra'
Pa4a 'e%$ 5an) men)ena$ S1(S, mun)&$n !er4apa! +e+erapa peru+a"an
p%$%$ 4ar$ !e'apa& &a&$. Dar$ S3(S, !$4a& !er4apa! para'$%$%4ar$ !! &a&$.
Ke"$'an)an %en%a%$ me'$pu!$ area %a4e', %&r!um, 4an )'an% pen$%,
per$neum, area ana', 4an %eper!$)a a%pe& p%!er$r pa"a.
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K'a%$?$&a%$ +er4a%ar&an &epara"an:
K'a%$?$&a%$ ASIA 6Amer$an Sp$na' In*ur5 A%%$a!$n7• Gra4e A : m!r$% 6(7, %en%r$% 6(7 !erma%u& pa4a %e)men
%ara'
• Gra4e B : "an5a %en%r$% 67
• Gra4e - : m!r$% 67 4en)an &e&ua!an !! 3
• Gra4e D : M!r$% 67 4en)an &e&ua!an !! 3
• Gra4e E : m!r$% 4an %en%r$% nrma'
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Temuan ?$%$& pa4a %p$na' r4 $n*ur5 %an)a! +er)an!un) pa4a '&a%$ 5an)!er&ena:
*$&a e4era men)ena$ -(1 %ampa$ -(3 pa%$en a&an men)a'am$ !e!rap'e)$a4en)an &e"$'an)an ?un)%$ pernapa%an a!au %$%!em mu%&u'ar !!a'
*$&a e4era men)ena$ %ara? -( 4an -( a&an !er*a4$ !e!rap'e)$a 4en)an&eru%a&an, menurunn5a &apa%$!a% paru, &e!er)an!un)an !!a' !er"a4apa&!$9$!a% %e"ar$("ar$
*$&a !er*a4$ e4era pa4a -(C 4an -(< pa%$en a&an men)a'am$ !e!rap'e)$a4en)an +e+erapa )era&an 'en)an a!au !an)an 5an) memun)&$n&an un!u&me'a&u&an %e+a)$an a&!$9$!a% %e"ar$("ar$
*$&a !er*a4$ &eru%a&an pa4a %p$na' -(< %ampa$ T(1 %e%eran) a&anmen)a'am$ !e!rap'e)$a 4en)an &e!er+a!a%an men))una&an *ar$ !an)an,men$n)&a! &eman4$r$ann5a
pa4a T(2 %ampa$ L(1 a&an !er*a4$ parap'e)$a 4en)an ?un)%$ !an)an 4an +er+a)a$ ?un)%$ 4ar$ !! $n!er&%!a' 4an a+4men ma%$" +a$&
*$&a !er*a4$ e4era pa4a L(1 4an L(2 a!au 4$+awa"n5a, ma&a ran) !er%e+u!a&an &e"$'an)an ?un)%$ m!r$& 4an %en%r$&, &e"$'an)an ?un)%$ 4e?e&a%$4an +er&em$".
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Kmp'$&a%$
• Kema!$an &arena )an))uan r)an 9$!a'
• Pneumn$a "$p%!a!$&
• In?e&%$ %a'uran &em$"
• De&u+$!u%
• Ka&u %en4$
•
Spa%me 4an a!r?$ !!• Kea!a!an permanen 5an) men5e+a+&an &e!er)an!un)an pa4a &e'uar)a 4an
ma%5ara&a!
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Pemer$&a%aan Penun*an)
• S$nar %p$na'
Menen!u&an '&a%$ 4an *en$% e4era !u'an) 6?ra&!ur, 4$%'&a%$7, unu!& &e%e*a*aran,re4u&%$ %e!e'a" 4$'a&u&an !ra&%$ a!au pera%$
• -T(San
Menen!u&an !empa! 'u&a ; *e*a%, men)e9a'ua%$ )an))aun %!ru&!ura'
• MRI
Men)$4en!$?$&a%$ a4an5a &eru%a&an %ara? %p$na', e4ema 4an &mpre%$• M$e')ra?$
Un!u& memper'$"a!&an &'umna %p$na'$% 6&ana' 9er!e+ra'7 *$&a ?a&!r pu!')$%n5a
!$4a& *e'a% a!au 4$ur$)a$ a4ann5a 4$'u%$ pa4a ruan) %u+ ana&"n$4 me4u''a %p$na'$%
6+$a%an5a !$4a& a&an 4$'a&u&an %e!e'a" men)a'am$ 'u&a pene!ra%$7.
• 8! rn!)en !ra&
Memper'$"a!&an &ea4an paru 6n!" : peru+a"an pa4a 4$a?ra)ma, a!e'e&!a%$%7
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Pena!a'a&%anaan
• Penan)anan pra ruma" %a&$!
pr$n%$p awa' penan)anan awa' 4$ ruma" %a&$! 5a$!u pr$n%$p A49aneTrauma L$?e Suppr! 5an) men)u!ama&an %ur9e$ pr$mer AB-D 6A$rwa5,
Brea!"$n), -$ru'a!$n, 4an D$%a+$'$!57 un!u& mere%!ra%$ !an4a(!an4a 9$!a'
4an %ur9e$ %e&un4er.
Sur9e$ %e&un4er pa4a ?a%e $n$ umumn5a "an5a ?&u% !er"a4ap )e*a'a 4an
!an4a &'$n$% -MS 6n5er$ 4$ 'e"er a!au pun))un), n5er$ !e&an pa4a !u'an) +e'a&an), parap'e)$a;!e!rap'e)$a, parae%!"e%$a, $n&n!$nen%$a, pr$ap$%m,
pen$n)&a!an !empera!ur 4ar$ &u'$! a!au er$!ema7.
!$!$& u!ama 5an) mem+e4a&an penan)anan pra(rua) a&$! 4en)an 4$ ruma"
%a&$! a4a'a" !$n4a&an $m+$'$%a%$ 4ar$ !u'an) +e'a&an) %er!a mem$n4a"&an
pa%$en &e un$! )awa! 4arura! 6UGD7 ruma" %a&$!.
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• Penan)anan 4$ ruma" %a&$!
penan)anan 4$ RS mena&up %e'uru" %$%!em 5an) mun)&$n men)a'am$
&mp'$&a%$ 4ar$ -MS, 5a$!u mu'a$ 4ar$ %$%!em re%p$ra!r$&, &ar4$9a%&u'ar,
ur')$, )a%!r$n!e%!$na', &u'$!, %ampa$ !$n4a&an re4u&%$ nn(pera!$?
maupun pera!$?.
1. Penan)anan awa'
Penan)anan awa' %aa! mener$ma pa%$en 4$ IGD RS umumn5a %ama, 5a$!u
4$!$n4a&'an*u!$ %eua$ penan)anan !rauma 6ATLS7 5a$!u %ur9e$ pr$mer 4an%e&un4er. Apa+$'a pa4a %aaa! 4$!er$ma 4$ RS +e'um 4$'a&u&an !$n4a&an
$m+$'$%a%$ !u'an) +e'a&an), ma&a !$n4a&an awa' 5n) "aru% 4$'a&u&an
a4a'a" !$n4a&an $m+$'$%a%$.
Pemer$&%aan neur')$% 'en)&ap 4$'a&u&an %e%ua$ In!erna!$na' S!an4ar4%
?r Neur')$a' -'a%%$?$a!$ ? Sp$na' -r4 In*ur5 re9$%$ 211 5an)4$pu+'$&a%$&an 'e" ASIA. Pa4a %aa! pemer$&%aan neur')$% awa' 4apa!
4$!en!u&an 'e9e' &e!$n))$an 'e%$, 'e%$ &mp'$! a!au $n&mp'$!, 4an a4a
!$4a&n5a ?a%e %5& %p$na'. Pemer$&%aan ra4$')$ &emu4$an 4$'a&u&an
un!u& me'$"a! a!au men5$n)&$r&an &emun)&$nan !er*a4$n5a -MS.
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2. Penan)anan %pe%$?$& un!u& &mp'$&a%$ -MS
a. S$%!em re%p$ra!r$&
&mp'$&a%$ pa4a !ra&!u% re%p$ra%$ merupa&an pen5e+a+ mr+$4$!a%
4an mr!a'$!a% u!ama pa4a pa%$en -MS. Le%$ 5an) +er&a$!an 'an)%un)4en)an ?un)%$ pernapa%an a4a'a" 'e%$ %e!$n)&a! - &e a!a%, %e4an)&an
'e%$ pa4a !$n)&a! !ra&a' "an5a men))an))u ?un)%$ +a!u& 4an 'e%$
4$'um+a' !$4a& mempen)aru"$ %ama %e&a'$. Pa%$en 4en)an 'e%$ 4$a!a%
- %e+a$&n5a 4$$n!u+a%$ 4an men))una&an 9en!$'a%$ me&an$& &arena
penurunan ?un)%$ re%p$ra%$ %eara )ra4ua' 4apa! !er*a4$. 8un)%$ re%p$ra%$"aru% 4$ mn$!r %eara &e!a! 4en)an memer$&%a %a!ura%$ &%$)en,
&apa%$!a% 9$!a' 69$!a' apa$!5;-7 paru, 4an ana'$%a )a% 4ara" +er&a'a.
Re!en%$ %pu!um umumn5a !er*a4$ 4a'am +e+erapa "ar$ %e!e'a" e4era
4$a&$+a!&an )an))uan pa4a ?un)%$ +a!u& 5an) e?e&!$?, "a' $n$ a&an
men5e+a+&an a!e'e&!a%$% 4an pneumn$a. -"e%! p"5%$!"erap5, a%%$%!e4
u)" 4an 'a!$"an na?a% %eara re)u'er 4apa! mene)a" a!e'e&!a%$% 4an
$n?e&%$ paru.
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+. S$%!em &ar4$9a%&u'er
Kmp'$&a%$ u!ama 5an) &ru%$a' pa4a %$%!em &ar4$9a%&u'er a&$+a! -MS
a4a'a" %5& neur)en$& a&$+a! 4ar$ %5& %p$na'. Pa4a umumn5a %5&
neur)en$& !er*a4$ pa4a 'e%$ 4$a!a% TC a&$+a! "$'an)n5a 4ar$ !nu% %$mpa!$%.H$'an)n5a !nu% !er%e+u! men5e+a+&an 9a%4$'a%$ 4an +ra4$&ar4$a 5an)
men5e+a+&an "$p!en%$ 4an %5&. S5& pa4a -MS "aru% 4$+e4a&an an!ara
"$p9'em$& 4an neur)en$& &arena apa+$'a pa4a %5& neur)en$&
4e+er$&an !er'a'u +an5a& a$ran ma&a a&an !er*a4$ e4ema paru.
Ta!a'a&%ana %5& neur)en$&, an!ara 'a$n pem+er$an a$ran I, 9a%pre%%r4en)an &ara&!er$%!$& a'p"a 4an +e!a a4rener)$& 6%eper!$ nrep$ne?r$n,
ep$ne?r$n, 4an 4pam$ne7, a!rp$ne un!u& men$n)&a!&an na4$, 4an "$n4ar$
"$p!erm$a a&$+a! 9a%4$'a%$.
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. S$%!em ur')$
Se!e'a" !er*a4$n5a -MS +era!, +u'$(+u'$ !$4a& 4apa! men)e'uar&an ur$n
%eara %pn!an, 4an pa%$en 5an) !$4a& 4$!an)an$ 'e+$" 'an*u! a&an
men5e+a+&an re!en%$ ur$n 5an) +er'an*u! pa4a re?'u&% ur$n 4an )a)a')$n*a'. Se)era !$+a 4$ RS "aru% 4$'a&u&an pema%an)an &a!e!er ?'e5. a&!u
pu'$"n5a re?'e&% +er&em$" +er9ar$a%$, umumn5a C(0 m$n))u, !e!eap$ +$%a
%ampa$ 1 !a"un 6a4a '$!era!ur 5an) men)a!a&an +$%a !$4a& &em+a'$7.
Pr)ram &a!e!er$%a%$ $n!erm$!en 4$mu'a$ %aa! ?a%e %u+a&u!, &e$&a $n!a&e 4an
u!pu! a$ran mu'a$ %!a+$'. Ha' $n$ 4$'a&u&an un!u& mene)a" !er*a4$n5a$n?e&% %a'uran &em$". Namun +$'a &a!e!er 8'e5 4$'epa% !er'a'u 4$n$, 4apa!
!er*a4$ &erua&an !! 4e!ru%r 4an re?'u&% &arena !e&anan pen)$%$an +u'$(
+u'$ 5an) !$n))$.
Kmp'$&a$ -MS pa4a %a'uran &em$" a4a'a" !er*a4$n5a $n?e&%$ %a'uran
&em$" 6ISK7. ISK %$mp!ma!$& 5an) 4$%er!a$ 4emam, 'eu&%$!%$%, 4an p5ur$a "aru% 4$era$ 4en)an an!$+$!$& 5an) a4e&ua! %e'ama <(1 "ar$,
%e4an)&an $n?e&%$ a%$m!ma!$& !$4a&per'u 4$!erap$ %eara ru!$n. Penerapan
me!4e %!er$' pen!$n) 4$'a&u&an un!u& pene)a"an ISK.
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4. S$%!em )a%!r$n!e%!$na'
pa%$en 4en)an -MS %e!$4a&n5a "aru% mener$ma a$ran %eara $n!ra9ena
%e'ama 0 *am &arena umumn5a !er*a4$ $'eu% para'$!$& pa4a -MS +era!. Pa4a
&n4$%$ !er%e+u!, na%)a%!r$ !u+e 4$pa%an) 6NGT7 4an n$' per ra' 6NPO74$'a&u&an %ampau +$%$n) u%u% &em+a'$ nrma'. T!a' paren!era' nu!r$!$n
%e+a$&n5a 4$+er$&an. Apa+$'a $'eu% para'$!$& !er*a4$ 'ama, 4$%!en%$ a+4men
!er*a4$ 4an 4apa! men5e+a+&an )an))uan per)era&an 4$a?ra)ma. U'&u%
pep!$&um a&u! 4apa! !er*a4$ 4en)an per4ara"an a!au per?ra%$, wa'aupun
!$4a& umum !er*a4$, namun &mp'$&a%$ $n$ +er+a"a5a. O'e" &arena $!u,
pem+er$an an!a)n$% H2 a!au pr!n pump $n"$+$!r 6PPI7 "aru% 4$mu'a$
%eepa!n5a 4an 4$+er$&an m$n$ma' 3 m$n))u %e!e'a" !rauma.
E9a'ua%$ ?un)%$ 4e?e&a%$ "aru% 4$'a&u&an %e*a& 4$n$ 4an pena!a'a&%anaan
4$mu'a$ %eara a)re%$? %e)era %e!e'a" !$m+u' +$%$n) u%u% 4an m!$'$!a% u%u%
nrma'. Ke!$n))$an 'e%$ menen!u&an ?un)%$ 4e?e&a%$, an!ara 'a$n 'e%$ 4$a!a%
T12 men5e+a+&an "$perre?'e&%$a 4an %pa!$ 4ar$$ %?$n)!er an$, %e4an)&an 'e%$
4$+awa"n5a men5e+a+&an arre?'e&%$a 4an ?'a$4 4ar$ %?$n)!er !er%e+u!.
Me!4e pen)%n)an u%u% 4en)an &m+$na%$ %up%$!r$a 4an %!$mu'a%$
anre&!a', meran)%an) p'a e9a&ua%$ pa4a &'n 4$%!a'.
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e. Ku'$!
u'&u% 4$&u+$!u% a&an %e'a'u men*a4$ &mp'$&a%$ -MS, 'e" &arena $!u
pene)a"an per'u 4$'a&u&an %e*a& 4$n$. Pa4a ?a%e a&u!, pa%$en 4$p%$%$&an
m$r$n) &$r$(m$r$n) &anan %e!$ap 2 *am un!u& mene)a" u'&u%. Pen))unaan
ma!ra% +u%a 4an a$r +$%a mem+an!u men)uran)$ !e&anan pa4a !n*'an
!u'an), namun p%$%$ pa%$en "aru% !e!ap 4$u+a" !$ap 2 *am.
?. Pen))unaan Kr!$&%!er$4
pen))unaan &r!$&%!er$4 6!eru!ama me!$'pre4n$%'n 4%$% !$n))$7%e&aran) $n$ men)a'am$ &n!r9er%$. S!u4$ 5an) 4$'a&%ana&an 'e" NAS-IS
2 6Na!$na' Au!e Sp$na' -r4 In*ur5 S!u457 menun*u&&an pem+er$an
me!$'pre4n$%'n 4%$% !$n))$ 6+'u% 3 m);&)BB 4a'am 1 men$! &emu4$an
4$an*ur&an , m);&)BB 4a'am 23 *am7 5an) 4$mu'a$ 4a'am 0 *am %e!e'a"
-MS !er!u!up men$n)&a!&an pr)n%$% neur')$% pa%$en. S!u4$ NAS-IS 3
&emu4$an menam+a"&an +a"wa !erap$ me!$'pr$4n$%'n 5an) 4$mu'a$ 4a'am
3 *am %e!e'a" !rauma "aru% 4$'an*u!&an %e'ama 2 *am, %e4an)&an 5an)
4$mu'a$ an!ar 3(0 *am pa%a !rauma "aru% 4$'an*u!&an %e'ama 0 *am.
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n%r!$um ?r %p$na' r4 me4$$ne !$4a& mere&men4a%$&an pen))unaan
neurpr!e&!an *en$% aapapun 6%!er$4, )an)'$%$4e GM(I, )a5'$4$ne,
!$r$'a@a4 4an na'=ne7 &arena +u&!$ &'$n$% pen$n)&a!an pr)n%$% a&"$r
+e'um 4$4apa!&an %eara 4e?$n$!.
3. Terap$ re4u&%$ nn(pera!$? 4an pera!$?
%e!e'a" parame!er %$%!em$& %u4a" %!a+$', ma&a per"a!$an 4$ara"&an pa4a
%!a+$'$%a%$ 4an a'$)nmen! 4ar$ !u'an) +e'a&a) 4an me4u''a %p$na'$%. Se!$ap
-MS 5an) !$4a& %!a+$' "aru% 4$%!a+$'&an un!u& mene)a" a4an5a
&eru%a&an 'e+$" 'an*u! a&$+a! per)era&an 4an *u)a me'epa%&an &mpre%$
me4u''a %p$na'$%. Pa%$en 4en)an -MS 4aera" %er9$&a' 4apa! 4$!an)an$
4en)an men))una&an %&e'e!a' !ra!$n un!u& mere4u&%$ 4$%'&a%$,
me'epa%&an &mpre%$ pa4a me4u''a %p$na'$% pa4a +ur%! ?ra!ure, 4an %p'$n!
!u'an) +e'a&an).
%&e'e!a' !ra!$n un!u& men)em+a'$&an a!au memper!a"an&an a'$)nmen!
5an) nrma' merupa&an me!4e 5an) epa! 4an e?e&!$?.
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Be+an 5an) 4$)una&an !er)an!un) a4an5a 4$%'&a%$ a!au !$4a&. Pa4a ?ra&!ur
!anpa 4$%'&a%$ a!au !$4a&. Pa4a ?ra&!ur !anpa 4$%'&a%$, +e+an 5an)
4$)una&an umumn5a 3( &), %e4an)&an pa4a 4$%'&a%$ 4$)una&an
pen$n)&a!an +era! &) %e!$ap 3 men$! 6%ampa$ !!a' 2 &)7 4a'am p%$%$'e"er 4a'am &ea4aan ?'e&%$. Pa%$en "aru% 4$per$&%a %!a!u% neur')$%n5a
%e!$ap pen$n)&a!an +e+an, 4an +e+an !ra&%$ "aru% 4$&uran)$ %eepa!n5a +$'a
!er*a4$ per+uru&an %!a!u% neur')$%.
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DA8TAR PUSTAKA
"!!p:;;&$m"ar$%$mn$4a.+')%p!.m;213;<;+a+($$(%p$na'(
r4($n*ur5."!m' "!!p:;;rep%$!r5.u%u.a.$4;+$!%!ream;123C<0/;10<0;1;m&n(
*un2<(26<7.p4?
"!!p:;;%an$ra"man.+')%p!.m;2/;11;pena!a'a&%anaan(
!rauma(%p$na'(4an."!m' "!!p:;;www.?$%$!erap$.we+.$4;212;;%&ema(4erma!m(4an(
%&'er!m."!m'
"!!p:;;4r$an"uan).m;$n?rma%$(&e%e"a!an;!ena)a(
me4$%;%p$na'(r4($n*ur5(%$;
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SEKIAN