Management of Head Injury

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Head injury is including injury of scalp, skull and also the brain. Approximately statistic in Malaysia from year 2009 to 2010 that more than 6,000 people accidental death sustain with a head injury. According to Deputy Minister of transport Malaysia , Datuk Abdul Rahim Bakri said most of the cause of death among the passengers and pillion riders is head injury (56.5%) , brain injury (38.1%), head and brain injury (34%) and head fracture (27.9%) .(nuffnang.blogspot). This scenario should have impact for our public health. Focusing on treatment especially for the suspecting patients who having a severe head injury can prevent a secondary of brain injury. In Malaysia we focused in triage system to classify all the cases starting from pre hospital,emergency department and also discharged from the hospital. DEFINITION

‘Damage to any of the structures of the head as a result of trauma. While the term "head injury” is most often used to refer to an injury to the brain, head injuries may also involve the bones, muscles, blood vessels, skin, and other organs of the face or head (picked from The Free Dictionary by Farlex state head injury means “Injury to the head may damage the scalp, skull or brain. The most important consequence of head trauma is traumatic brain injury. Head injury may occur either as a closed head injury, such as the head hitting a car's windshield, or as a penetrating head injury, as when a bullet pierces the skull. Both may cause damage that ranges from mild to profound. Very severe injury can be fatal because of profound brain damage”. From my understanding head injury was a trauma to the head including all inside anatomy of head including scalp, skull or brain either traumatic or non-traumatic.


Made up with 5 layers of tissue to cover the skull which is skin, connective tissue, aponeurosis, loose areoar tissue and pericranium. Bleeding from a scalp laceration end up can result major blood loss especially for infants and children. It is happen when loose areolar tissue separates the galea from the pericranium because the scap generous blood supply.

The skull is composed of the cranial vault and the base. The calvaria is especially thin in the temporal regions but is cushioned here by the temporalis muscle. The base of the skull is irregular and this may contribute to injury as the brain moves within the skull during acelaration and deceleration. The floor of the cranial cavity divided into 3 distinct region it was anterior,middle and posterior cranial fossa.

Its cover the brain and consist with 3 layers it was dura, arachnoid and pia. Maningeal arteries lie between the dura and the epidural space. Commonly injured meningeal vessel is in the middle meningeal artery, which is located over the temporal fossa. Cerebrospinal fluid circulates in the subarachnoid spaces. Haemorrage in this space frequently caused by brain injury.

Consists of cerebrum, cerebellum and brainstem. Cerebrum composed with right and left hemispheres and separated by the falx cerebri. The left hemisphere contains the language centers in virtually all right handed people. The frontal lobes concerned with emotions, motor function and motor speech areas. The brainstem is composed of the midbrain, pons and medulla oblongata. The midbrain and upper pons contain the reticular activating system and responsible for the state of alertness. The cerebellum responsible for coordination and and balance.

1) Motor Vehicle Crashes
* most common cause of head trauma
* most common cause of subdural hematoma
2) Sports Injuries
3) Falls
4) common in elderly and in presence of alcohol
5) associated with subdural hematomas
6) Penetrating Trauma
7) missiles more common than sharp projectiles

1) Coup injury
* directly posterior to point of impact
* more common when...
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