Hematoma Epidural

Hematoma Epidural

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Definisi

Hematoma epidural merupakan perdarahan yang terjadi di dalam kepala, yang terletak di antara tulang tengkorak dan lapisan luar otak (dura). Hematoma epidural terjadi pada 2% seluruh kasus cedera kepala dan hingga 15% dari seluruh cedera kepala fatal. Setiap tahunnya, terdapat sekitar 40.000 kasus hematoma epidural. Hematoma epidural dapat pula terjadi pada tulang belakang, namun hal ini sangat jarang terjadi, sekitar 1 kejadian per 1.000.000 penduduk.

Penyebab

Penyebab hematoma epidural biasanya adalah cedera pada kepala. Sebagian besar cedera tersebut disebabkan oleh kecelakaan lalu lintas, kekerasan fisik, dan jatuh. Selain akibat cedera kepala, hematoma epidural dapat terjadi akibat infeksi pada otak dan jaringan di sekitarnya, gangguan pembekuan darah, perdarahan tumor, serta kelainan bentuk pembuluh darah.

Pada anak-anak, hematoma epidural sering terjadi akibat patah tulang. Lapisan luar otak saat itu belum terlalu menempel dengan tulang kepala, sehingga perdarahan lebih mudah terjadi. Kelainan pembuluh darah dapat menyebabkan pembuluh darah tersebut mudah pecah dan darah memenuhi ruang antara tulang dan lapisan luar otak.  

Faktor Risiko

Laki-laki berisiko lebih tinggi untuk mengalami hematoma epidural daripada perempuan. Hal ini mungkin disebabkan oleh pekerjaan laki-laki yang lebih banyak melibatkan pergerakan dan kendaraan bermotor. Angka kejadian hematoma epidural tertinggi pada usia remaja dan dewasa muda dengan rata-rata usia 20-30 tahun. Seiring usia, lapisan dura akan lebih menempel kepada tulang kepala, sehingga risiko perdarahan di tempat itu semakin menurun.

Gejala

Gejala hematoma epidural yang khas adalah pingsan tepat setelah terjadinya cedera, kemudian bangun kembali, namun dalam beberapa jam, penurunan kesadaran terjadi kembali. Periode bangun di antar kedua penurunan kesadaran disebut sebagai lucid interval. Namun, kejadian ini tidak selalu terjadi pada setiap kasus hematoma epidural.

Selain gejala tersebut, gejala lainnya yang dapat menandai hematoma epidural adalah :

  • Bingung
  • Pusing atau nyeri kepala hebat
  • Rasa mengantuk atau penurunan kesadaran
  • Pupil (lubang hitam di tengah mata) yang besarnya tidak sama pada kedua mata
  • Mual dan muntah
  • Kelemahan anggota tubuh yang seringkali terjadi pada sisi yang berlawanan
  • Kejang tepat setelah cedera terjadi

Pada umumnya, gejala ini muncul dalam beberapa menit hingga jam setelah cedera kepala terjadi.

Diagnosis

Beberapa tanda fisik yang dapat mengarahkan diagnosis ke arah hematoma epidural adalah adanya penurunan denyut nadi dan tekanan darah, patah tulang tengkorak serta adanya luka pada kulit kepala, kebocoran cairan di luar otak yang dapat ditandai dengan keluar cairan bening pada hidung atau telinga setelah cedera kepala, penurunan kesadaran, besar pupil yang tidak simetris, kelemahan satu sisi tubuh setelah cedera, serta gangguan saraf lainnya seperti gangguan berbicara, penyempitan lapang pandang, baal, dan kesulitan mengontrol gerakan. Dokter dapat pula melakukan pemeriksaan saraf secara menyeluruh untuk mencari adanya gangguan pada fungsi saraf tubuh.

Pencitraan dengan CT scan dilakukan jika hematoma epidural dicurigai. CT scan terpilih sebagai pemeriksaan awal karena cepat dan menyediakan banyak informasi. Pada hematoma epidural, hasil CT scan dapat menunjukkan adanya bentuk mirip lensa cembung yang menekan otak.

Pemeriksaan laboratorium dapat dilakukan pada hematoma epidural. Pemeriksaan darah lengkap dapat dilakukan untuk memeriksa kadar darah dan trombosit untuk mengetahui risiko perdarahan lanjut. Pemeriksaan golongan darah diperlukan karena transfusi darah mungkin diperlukan. Pemeriksaan pembekuan darah dapat memberikan petunjuk terhadap risiko perdarahan lanjut. Pemeriksaan kimia darah dapat pula dilakukan untuk mengetahui faktor yang dapat mempersulit terapi. Pemeriksaan toksikologi zat terlarang dan kadar alkohol dapat dilakukan untuk mencari kemungkinan penyebab cedera kepala.

Tata Laksana

Tata laksana hematoma epidural bertujuan untuk menurunkan risiko kematian akibat penekanan pada otak. Saat datang, dokter dapat melakukan pemeriksaan jalan napas (airway), pernapasan (breathing), dan peredaran darah (circulation) untuk mengamankan ketiga hal ini. Dokter dapat memasukkan selang ke dalam tenggorokan untuk memastikan agar tetap ada pertukaran udara pada paru.

Setelah penderita stabil, dokter dapat merujuk pasien untuk dioperasi. Pembedahan terutama direkomendasikan jika hematoma epidural terjadi secara akut, volume darah pada kepala lebih dari 30 mL, dan tingkat kesadaran yang menurun disertai dengan besar pupil yang tidak simetris. Pembedahan ini disebut sebagai kraniotomi, dan bertujuan untuk menurunkan tekanan pada kepala. Pada pembedahan ini, perdarahan akan dikeluarkan sehingga otak dapat kembali pada bentuk asalnya.

Jika keadaan pasien tidak memerlukan operasi, penggunaan obat-obatan dapat dilakukan. Selain itu, kepala diposisikan terangkat sekitar 30 derajat. Jika pasien sudah dimasukkan selang ke dalam tenggorokan (intubasi), pemberian bantuan napas secara dalam dan cepat dapat dilakukan untuk menurunkan tekanan pada otak. Jika pasien mengalami gangguan pembekuan darah, obat seperti vitamin K serta transfusi fresh frozen plasma (FFP) atau trombosit dapat dilakukan untuk membantu menghentikan perdarahan.

Hal lain yang perlu diperhatikan adalah diet dan aktivitas. Pada hematoma epidural, dokter dapat memilih untuk memberikan makan lewat infus, namun pemberian makan lewat selang hidung juga dapat menjadi pilihan jika pasien terintubasi. Selama perawatan, aktivitas yang berlebih sebaiknya dihindari. Pada beberapa hari pertama, sangat disarankan bagi penderita untuk tirah baring, sehingga biasanya penderita akan dirawat inap. Selama dirawat inap, dokter akan memantau kondisi pasien serta memberikan obat-obatan untuk mencegah terjadinya tukak lambung dan pembentukan gumpalan darah pada pembuluh darah balik akibat kurangnya gerak.

Dalam jangka panjang, jika kerusakan otak cukup fatal, penderita dapat menjalani terapi fisik. Terapi ini bertujuan untuk mengembalikan fungsi anggota gerak tubuh. Selain itu, terapi wicara juga dapat dilakukan apabila penderita mengalami kesulitan berbicara.

Komplikasi

Komplikasi hematoma epidural bervariasi menurut keparahannya. Kejang dapat terjadi mulai sesaat setelah cedera terjadi hingga 3 bulan setelahnya. Selain itu, kelumpuhan atau penurunan sensasi pada beberapa anggota tubuh dapat terjadi. Pada kasus yang parah, penekanan otak oleh perdarahan dapat menyebabkan penekanan batang otak sehingga menyebabkan kematian.

Pencegahan

Pencegahan hematoma epidural dapat dilakukan dengan menggunakan pelindung kepala saat berkendara dengan sepeda atau sepeda motor, saat melakukan aktivitas fisik yang dapat berakibat jatuh atau terbentur. Selain itu, ikutilah aturan keselamatan saat melakukan rekreasi atau berolahraga. Minum alkohol atau menggunakan zat terlarang sebelum menyetir sebaiknya tidak dilakukan untuk mencegah terjadinya kecelakaan lalu lintas.

Kapan harus ke dokter?

Segeralah ke dokter apabila Anda atau keluarga Anda baru saja mengalami cedera kepala diikuti pingsan, namun bangun kembali. Periode bangun ini dapat merupakan lucid interval, yang khas pada hematoma epidural. Segeralah ke dokter agar perdarahan dapat segera dihentikan dan tekanan di dalam kepala tidak meningkat hingga menekan otak.

Setelah hematoma epidural ditangani, Anda harus ke dokter apabila terjadi gejala seperti penurunan memori, pusing, sakit kepala, cemas, gangguan berbicara, serta kelumpuhan pada anggota tubuh. Selain itu, segeralah ke IGD terdekat apabila Anda atau orang di sekitar Anda mengalami gejala seperti kesulitan bernapas, kejang, besar pupil mata tidak simetris, tidak merespon terhadap panggilan atau sentuhan, serta penurunan kesadaran.

 

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Writer : dr Teresia Putri
Editor :
  • dr Nadia Opmalina
Last Updated : Rabu, 7 Agustus 2024 | 04:14

Khairat, A., & Waseem, M. (2021). Epidural Hematoma. Retrieved 6 December 2021, from https://www.ncbi.nlm.nih.gov/books/NBK518982/

Liebeskind, D. (2018). Epidural Hematoma: Background, Pathophysiology, Epidemiology. Retrieved 6 December 2021, from https://emedicine.medscape.com/article/1137065-overview

Shelat, A. (2020). Epidural hematoma: MedlinePlus Medical Encyclopedia. Retrieved 6 December 2021, from https://medlineplus.gov/ency/article/001412.htm

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      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#779aicare_prod_new8.49msupdate `posts` set `views_count` = 714 where `id` = 1944
      Bindings
      • 0: 714
      • 1: 1944
      Backtrace
      • app/Http/Controllers/WebController.php:779
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new4.48msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 1944, 'App\\Models\\Admin\\Post', 'updated', '2025-01-12 18:45:19', '2025-01-12 18:45:19')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 1944
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-01-12 18:45:19
      • 8: 2025-01-12 18:45:19
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:779
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new1.16msselect * from `users` where `users`.`id` = 25 limit 1
      Bindings
      • 0: 25
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.61msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4155 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4155
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new4.94msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 1200 and `categories`.`deleted_at` is null
      Bindings
      • 0: 1200
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new940μsselect * from `categories` where `categories`.`id` = 6 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 6
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.78msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6673 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6673
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.75msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9686 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9686
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.08msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3570 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3570
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new11.02msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8576 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8576
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.38msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9947 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9947
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.33msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 1822 and `categories`.`deleted_at` is null
      Bindings
      • 0: 1822
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.39msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 1942 and `categories`.`deleted_at` is null
      Bindings
      • 0: 1942
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.62msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5053 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5053
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.14msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2000 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2000
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new1.47msselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new960μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new1.24msselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
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    App\Models\Admin\Category
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    App\User
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    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
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    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
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