Penurunan Kesadaran

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DEFINISI PENURUNAN KESADARAN

Kesadaran adalah tanggap atau jaga akan diri dan lingkungan secara spontan.
Penurunan kesadaran adalah keadaan dimanapenderita tidak sadar dalam arti tidak
terjaga / tidak terbangun secara utuh sehingga tidak mampu memberikan respons
yang normal terhadap stimulus.
Kesadaran terdiri dari 2 aspek, yaitu :
1) Aspek bangun (wakefullness) ; diatur oleh fungsi otonom vegetatif otak yang
bekerja akibat adanya stimulus ascenden dari tegmentum pontin,
hipothalamus posterior dan thalamus (ascending reticular activating system,
ARAS).
2) Aspek tanggap (awareness) diatur oleh neuron kortikal dan proyeksi timbal
baliknya dengan inti-inti subkortikal.
Tanggap membutuhkan bangun, tetapi bangun dapat terjadi tanpa
harus tanggap.
-Consciousness is the state of awareness of self and the environment
i. Normal consciousness dependent upon:
1. Intact cerebral hemispheres for cognition (kesadaran)
2. Reticular formation for alertness (ketanggapan)
-Altered mental status results from an impairment of arousal or cognition
-Disorders of consciousness can see acute confusional states or delirium
-Disorders of cognition lead to impairment of memory or other cognitive function
(i.e. judgment or abstract thinking)
i. Dementia affects cognition without affecting consciousness
ii.
Focal neurologic disease can affect cognition if critical cortical areas of cognition a
re involved.
-Coma due to dysfunction of both cerebral hemispheres and/or the upper brainstem

Bila terjadi penurunan kesadaran menjadi pertanda disregulasi dan disfungsi otak
dengan kecenderungan kegagalan seluruh fungsi tubuh. Dalam hal menilai penurunan
kesadaran, dikenal beberapa istilah yang digunakan di klinik yaitu kompos mentis,

somnolen, stupor atau sopor, soporokoma dan koma. Terminologi tersebut bersifat
kualitatif.
Levels of consciousness
Normal state of consciousness consists of either the state of attentiveness in which
most people function while not asleep, or one of the recognised stages of normal sleep
from which the person can be easily aroused. Abnormal state of consciousness is more
difficult to categorise, and many terms are used.
Some of the more common terms include:

Hyper-alert : heightened arousal with increased sensitivity to immediate


surroundings. Hyper-alert patients can be verbally and physically threatening,
restless, and/or aggressive.

Confused: disorientated: bewildered, and having difficulty following commands.

Delirious

Somnolent : sleepy, responding to stimuli only with incoherent mumbles or


disorganised movements

Lethargic: reduced level of alertness with decreased interest in the surrounding


environment.

Obtunded: similar to lethargy; the patient has a lessened interest in the


environmen t, has slowed responses to stimulation,and tends to sleep more than
normal, with drowsiness in between sleep states.

Stuporous: profoundly reduced alertness and requiring continuous noxious


stimuli for arousal.

Comatose: state of deep, unarousable, sustained unconsciousness.

: disorientated; restless, hallucinating, sometimes delusional.

Sementara itu, penurunan kesadaran dapat pula dinilai secara kuantitatif, dengan
menggunakan skala koma Glasgow.
Metoda lain adalah menggunakan sistem AVPU, dimana pasien diperiksa apakah sadar
baik (alert), berespon dengan kata-kata (verbal), hanya berespon jika dirangsang nyeri
(pain), atau pasien tidak sadar sehingga tidak berespon baik verbal maupun diberi
rangsang nyeri (unresponsive).

Ada metoda lain yang lebih sederhana dan lebih mudah dari GCS dengan hasil yang
kurang lebih sama akuratnya, yaitu skala ACDU, pasien diperiksa kesadarannya
apakah baik (alertness), bingung / kacau (confusion), mudah tertidur (drowsiness),dan
tidak ada respon (unresponsiveness).

Sedangkan selain itu ada skala baru yaitu FOUR (Full Outline of UnResponsiveness)
score. Skala ini terdiri dari four components (eye, motor, brainstem, and respiration),
and each component has a maximal score of 4. The FOUR score detects a locked-in
syndrome, as well as the presence of a vegetative state where the eyes can
spontaneously open but do not track the examiners finger. The motor response is
obtained preferably at the upper extremities.

ETIOLOGI
a. Metabolic causes
Hypoxia
Electrolyte and/or glucose disturbances
Nutrisi - defisiensi tiamin, defisiensi piridoksin, asam folat
Uremia
Hepatic failure
Drugs sedatives, opiates, antidepressants, anticonvulsants
Toxins alcohol, carbon monoxide, heavy metals
Psychiatric disorders
sarkoidosis, hipoglikemia

b. Intracranial/structural causes
Trauma diffuse axonal injury, epidural or subdural hematoma, perdarahan
intrakranial, contusio
Vascular ischemic stroke with mass effect, brainstem stroke, hemorrhagic strok
e, infark otak,perdarahan, malformasi arteriovenous, trombosis arterial atau venous
Infection meningitis, encephalitis, abscess , serebritis

Other epilepsy(kejang), hydrocephalus


Neoplasma

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