THE ROLE OF SURGERY IN HEMORRHAGIC STROKE

THE ROLE OF SURGERY IN HEMORRHAGIC STROKE

A. DEFINITION

Definition of stroke according to World Health Organization (WHO) is the clinical signs that developed rapidly due to focal brain dysfunction (or global), with symptoms lasting 24 hours or more, and can cause death.

Stroke is a brain attack caused by blockage or sudden onset of rupture of blood vessels of the brain that causes certain brain cells are deprived of blood, oxygen or nutrients and eventually death can occur in these cells in a very short time (Stroke Foundation of Indonesia, , 2006).

Hemorrhagic stroke is rupture of the walls of blood vessels, causing bleeding in the brain. Generally occurs when patients do activities. Bleeding and impairment of consciousness are real (Stroke Foundation of Indonesia, 2006).

B. EPIDEMIOLOGY

Stroke is a major health problem in modern life today. In Indonesia, an estimated 500,000 residents each year occur suffered a stroke, about 2.5% or 125,000 people died, and the remainder mild or severe disability. Number of patients with stroke tend to increase every year, not just attack the elderly, but also experienced by those who are young and productive. Stroke can strike at any age, but which often occurs at the age of 40 years. The incidence of stroke increases with age, the older someone is, the higher the chances of developing a stroke (Stroke Foundation of Indonesia, 2006).

In Indonesia, there are no data to complete epidemiologic stroke, but the proportion of stroke patients from year to year tend to increase. It is seen from the Household Health survey report MOH in various hospitals in 27 provinces in Indonesia. The survey results showed an increase between 1984 and 1986, from 0.72 per 100 patient pada1984 to 0.89 per 100 patients in 1986. In RSU Banyumas, in 1997 stroke patients hospitalized as many as 255 people, 298 people in 1998 sebnyak, in 1999 as many as 393 people, and in 2000 as many as 459 people (Hariyono, 2006).

Stroke or cerebrovascular accident, is the most frequent cause of invalidity in the age group over 45 years in industrialized countries stroke is the third leading cause of death after heart disease and malignancy (Lumbantombing, 1984).

C. Etiology

Hemorrhagic strokes occur because one of the blood vessels in the brain ruptures or tears objec hemorrhagic stroke patients are generally more severe than non-hemorrhagic stroke. Awareness is generally declining. They are in a state of somnolence, osmnolen, spoor, or commas in the acute phase.

D. CLASSIFICATION

According to the cause can be divided into:

1) intracerebral hemorrhage

Intracerebral hemorrhage was found in 10% of all stroke cases, consisting of 80% in the hemispheres of the brain and the rest in the brainstem and cerebellum.

2) Subarachnoid hemorrhage

Subarachnoid hemorrhage is a condition where there is bleeding in the subarachnoid space which arises in the primary.

E. Pathophysiology

Basic skills of medical personnel: CPR / Cardiopulmonary Resuscitation

CHAPTER I

INTRODUCTION

1.1 Background

Cardiac Pulmonary Resuscitation is very important in the life of the medical world, so that every doctor should be able to perform Cardiac Pulmonary Resuscitation. Well as other paramedics. In fact, any layperson who works in a place where a lot of people (the crowd) or the place where a lot of work to contain the risk of work should be able to be trained in Cardiac Pulmonary Resuscitation is a simple to a more competent medical officer. B-gels or in the Indonesian language known as the Emergency First Aid (PPGD) is the set of the first attempts to do in emergency conditions in order to save patients from death. Abroad, PPGD is actually taught in many ordinary people or ordinary people special, but it seems this is still very little known by the people of Indonesia.

1.2 Key Principles

 PPGD is the main principle of saving the patient from death in emergency conditions. Later in the PPGD philosophy is "Saving Time is Life Saving", in the sense that all actions taken during emergency conditions to be truly effective and efficient, because the patient's condition may have lost their lives in just minutes (stopping breathing for 2 -3 minutes can cause death).

1.3 Basic Steps

The basic steps in PPGD known by the acronym ABCD (Airway - Breathing - Circulation - Disability). These four points are the points that should be kept in the response of patients in emergency conditions.

1.4 Pulmonary Resuscitation heart

Stop the breath because:

- Airway Obstruction

- Foreign bodies

- Aspiration

- The tongue falls down

- Pipe folded endotracheal

- Blocked tracheal cannula

- Acute Abnormalities of the glottis and surrounding

- Depression of central respiratory

- Drugs

- Intoxication

- High pCO2

- Low pO 2

- After the cardiac arrest

- Brain tumors

- Sunset

Peripheral:

- Drug muscle paralytic

- Myasthenia gravis

- Poliomyelitis

For the Stop Heart

1. Cardiovascular (heart disease siskemik, IMA, pulmonary embolism and conduction system fibrosis)

2. Acute oxygen deficiency (stopping breathing, and obstruction due to foreign body secretions)

3. Overdose of drugs (digitalis and adrenaline)

4. Acid-base disturbances / electrolyte (K increases or decreases, increased Mg, Ca increases, acidosis)

5. Accidents (electric shock, drowning)

6. Vagal reflex

7. Anesthesia and surgery

8. Medical diagnostic and therapeutic measures

9. Shock, cardiac arrest can be accompanied by electrical phenomena.

Adam Stokes syndrome

Condition caused by high degree AV block heart is characterized by episodic bradycardia or asystole that resulted in the attack who are not aware of themselves suddenly with / without a seizure action.

- Artificial Circulation

- External cardiac massage

Indications CPR: Stop or stopping breathing and circulation.

Contraindications: Cardiac arrest, rib fractures, thoracic fractures, cardiac tamponade, pneumothorax, severe emphysema, Cardiac Arrest over 5-6 minutes.

KEMAMPUAN DASAR MEDIS : RESUSITASI JANTUNG PARU / CARDIO PULMONARY RESUSCITATION ( CPR)

BAB I

PENDAHULUAN

1.1 Latar Belakang

Resusitasi Jantung Paru sangat penting dalam kehidupan dunia medis, sehingga setiap dokter harus bisa melakukan Resusitasi Jantung Paru. Juga petugas paramedis lainnya. Malah orang awam pun yang bekerja di tempat tempat yang banyak orang (keramaian) atau tempat tempat pekerjaan yang banyak yang mengandung resiko kerjaan harus bisa untuk dilatih Resusitasi Jantung Paru yang sederhana sampai petugas medis yang lebih berwenang datang. B-GELS atau dalam bahasa Indonesia dikenal dengan Pertolongan Pertama Pada Gawat Darurat (PPGD) adalah serangkaian usaha-usaha pertama yang dapat dilakukan pada kondisi gawat darurat dalam rangka menyelamatkan pasien dari kematian. Di luar negeri, PPGD ini sebenarnya sudah banyak diajarkan pada orang-orang awam atau orang-orang awam khusus, namun sepertinya hal ini masih sangat jarang diketahui oleh masyarakat Indonesia. 

1.2 Prinsip Utama

 Prinsip Utama PPGD adalah menyelamatkan pasien dari kematian pada kondisi gawat darurat. Kemudian filosofi dalam PPGD adalah “Time Saving is Life Saving”, dalam artian bahwa seluruh tindakan yang dilakukan pada saat kondisi gawat darurat haruslah benar-benar efektif dan efisien, karena pada kondisi tersebut pasien dapat kehilangan nyawa dalam hitungan menit saja ( henti nafas selama 2-3 menit dapat mengakibatkan kematian). 

1.3 Langkah-langkah Dasar 

Langkah-langkah dasar dalam PPGD dikenal dengan singkatan A-B-C-D ( Airway - Breathing – Circulation – Disability ). Keempat poin tersebut adalah poin-poin yang harus sangat diperhatikan dalam penanggulangan pasien dalam kondisi gawat darurat.

1.4 Resusitasi jantung Paru

Sebab Henti nafas :

- Sumbatan jalan nafas

- Benda asing

- Aspirasi

- Lidah jatuh kebawah

- Pipa endotrakeal terlipat

- Kanul trakeal tersumbat

- Kelainan akut glottis dan sekitarnya

- Depresi pernafasan sentral

- Obat

- Intoksikasi

- pCO2 tinggi

- pO2 rendah

- Setelah henti jantung

- Tumor otak

- Tenggelam 

Perifer  :

-    Obat pelumpuh otot

- Miastenia gravis

- Poliomielitis