Kamis, 09 September 2010

Penatalaksanaan Kejang


Tujuan pengelolaan kejang :
1.    Menjamin oksigenasi jaringan otak, serta fungsi jantung dan paru.
2.    Mengatasi kejang secepat mungkin dan mencegah berulangnya kejang.
3.    Memperbaiki gangguan metabolisme dan keseimbangan air dan elektrolit.
4.    Mencegah komplikasi sistemik.
5.    Mengenal dan mengobati penyebab naiknya suhu.

Untuk mencapai tujuan tersebut di atas maka langkah pertolongan yang dilakukan adalah :
1.    Mengatasi dan mencegah berulangnya kejang. Semua anak yang dalam keadaan kejang pada saat pemeriksaan, apapun penyebabnya, obat pilihan adalah diazepam, baik secara perenteral ataupun perrektal.
2.    Perawatan umum
Sementara mengatasi kejang, diberi pertolongan untuk memperbaiki dan menjamin oksigenasi otak dengan jalan:
a.    Memberikan oksigen
b.    Melonggarkan pakaian ketat
c.    Membersihkan jalan nafas, menghisap cairan dari rongga mulut dan saluran pernafasan
d.    Anak diletakkan dalam posisi semi trendelenberg
e.    Untuk mencegah aspirasi sebaiknya posisi kepala anak dimiringkan
f.     Menurunkan suhu bila panas dengan cara :
-  Meniupkan udara dingin
-  Mendinginkan udara sekitarnya
-  Kompres dengan es atau alkohol
-  Antipiretik : parasetamol 30–50 mg/kgBB/hari dibagi dalam 3 dosis atau Asetosal 60 mg/tahun umur/kali, 3 kali perhari



3.    Bila kejang lebih dari 30 menit, maka untuk mengatasi edema otak yang dapat terjadi diberikan kortikosteroid: Deksametason 0,2-0,3 mg/kgBB/kali, 3 kali sehari, lama pemberian 4–5 hari. Bila ada tanda herniasi: pernafasan tidak teratur, bradipnoe, kesadaran makin menurun, diberikan manitol 20% dengan dosis 0,25–1 gram/kgBB/kali intravena. Diberikan dalam waktu ½ jam dapat diulang tiap 8 jam. Berikan cairan dengan kadar natrium yang rendah yaitu cairan 2 : 1 dan jumlah cairan pada hari pertama 70% dari kebutuhan maintenance. Kalau tidak tersedia manitol dapat juga diberikan gliserol 10% dengan dosis 0,5–1 gram/kgBB/hari peroral diberikan 4 dosis.
4.    Mencari dan mengobati penyebab panas.


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