surgical epidural hematom: 6 handling and therapy

Handling of HED depending on various factors. Side effects that may occur in the brain due to the mass by, among others, structural distortion, herniasi that threatens life, and increased pressure intrakranial (Ullman, 2006).

Two options in the handling of patients, namely 1. operative action immediately, and 2. initial observations, a conservative, and strict clinical supervision. HED notes that the speed has to be knowledgeable more quickly disbanding hematoma subdural, and patients have a very strict control, if steps taken conservative will (Ullman, 2006).
Not all cases get HED acute surgical action immediately. If lesi existing small and patients neurologist in good condition, with the supervision of the patient examination neurological the frequent be reasonable. Scanning the development can be done to assess the size of hematoma enlargement in the deorientasi. When it was found that increasing the size very quickly, then further surgical action is indicated (Ullman, 2006).

handling prehospital
According to Price (2006), actions taken prior to reaching the health center immediately control the situation - the situation can quickly threaten the lives and provide therapy suportif early. ABC control is the cornerstone that must be remembered. Then needs to be done vena access, the provision of oxygen, and strict supervision. Kristaloid per the provision of IV fluids to maintain blood pressure remains adequate. In addition, can also be done intubasi and sedative drugs, drugs neuromuskular appropriate resistor protocol.
- Use lidokain 1 mg / kg IV BB premedikasi as to prevent increased pressure intrakranial done intubasi time (Argyle, 1996).
- There are several responses about the increased mortality in patients with head injury Moderate to heavy intubasi done before in the hospital compared with patients in diintubasi Emergency Installation (IGD).
- Heating Ventilation mask the face with a good technique can be more beneficial for the brain injury compared with intubasi pre-hospital

handling in emergency intalasi
According to Price (2006), handling up to when the Installation of Emergency Access vena others, giving oxygen, strict supervision, and the liquid kristaloid important to maintain blood pressure remains adequate. This is the first step in handling the patient until after the health center.
Intubasi using Rapid Sequence Induction (RSI), which generally includes the use of lidokain, brain protective agent sedation (eg, etomidate), and agents neuromuskular resistor as premedikasi. Lidokain have a limited effect on the situation like this, even to this day can be spelled without the risk. Premedikasi using fentanyl may also be able to increase the pressure intrakranial. Intubasi should be done after the examination neurologik basis to facilitate oksigenisasi, to protect the roads of breath, and when necessary can be done hiperventilasi.
30o elevate the head of the bed is put back after, or with the reverse Trendelenburg's position to reduce pressure and increase the flow of intrakranial back vena.
Giving manitol 0.25 - 1 g / kg IV BB after consultation with the surgeon if the nerves of the average arterial pressure - average (MAP) greater than 90 mmHg with a sign - a clinical sign of increased pressure intrakranial ongoing. Manitol can decrease the pressure intrakranial (with a decrease in brain edema in osmotik) and viskositas blood, where it can improve blood flow to the brain circulation and oxygen. Fluid must be replaced and should be avoided hipovolemia (urin monitor output produced, it is better when using a down Catheter).
Hiperventilasi to the partial pressure of CO2 ( PCO2 ) 30 - 35 mmHg can alleviate signs - signs herniasi or increased pressure intrakranial, nevertheless, it is still controversial. A decrease in PCO2 should be - the heart that is not too far ( < 25 mmHg). Hiperventilasi given if it appears a sign - a sign of increasing pressure intrakranial progress and continue on sedation, paralisis, diuresis osmotik, and if possible serebrospinal fluid drainage. How to reduce pressure intrakranial with vasokonstriksi hipokarbi and decrease the risk of hipoperfusi cell death and the injury.
Phenytoin may decrease the incidence of spastic post-trauma, although it does not mean a strain on the go or a persistent disturbance.

medication
Some classes of drugs that can be given as a therapy or to prevent further occurrence of side effects (Price, 2006):

Group Diuretik Osmotik
Manitol (Osmitrol) given to maintain serum osmolalitas < 320 mOsm so that it can prevent the occurrence of kidney failure. Dose in adults is 0.25 to 1 gr / kgBB IV, and the dose for children in accordance with the calculation of body weight on the adult dose. Contraindicate of the drug among other drugs of this history hipersensitif before, anuria, the heavy congestion tuberculosis, dehydration weight, bleeding intrakranial of the active, progressive damage to the kidneys, sistolik blood pressure < 90 mmHg. The drug is given to the safe in pregnant women.

Group Antiepilepsi
Phenytoin (Dilantin) therapy is an option to profilaksi strain. Dose pemberiannya in adults is 17 mg / kgBB IV are mixed in with the NS infus no faster than 50 mg / min, and dose to the child - the child in accordance with the calculation of body weight of adult dose. This class can not be given to patients who have a history hipersensitif before, there is sinoatrial block, sinus bradikardi, AV block 2 and 3 degrees, or in patients with Adam-Stokes syndrome. The drug is not safe when given to women in situations that are pregnant.