Group - 3CHAIRMAN: RABEL RELIANTA ZAGOTOSECRETARY: EKAL SURANTA

MEMBERS:ALVI SHIFAMARIANI NAPITUPULUAMELISA LATERSIA P.RONA PUSPITA SARIARIJAL AZMI VIDYA RACHMATULLAHCHRISTIAN FRANATA P.VELLY ADHITADIANA AGUSTINA R.WILLIAM HALIMEKA WATI SITUMEANGWINITA JOSIKAHASAN CHAMRANDOSEN TUTORIAL: Dr. MAYA SARI

Scenario A boy, Roni 17 years riding a motorcycle crashed due to inconsiderate. Roni not use the helmet. After the accident roni unconscious for 30 minutes and bleeding from the nose and ears. Roni be helped by local people to take him to the nearest hospital. In the RS, Johnson had regained consciousness, but he could only groan in pain, eye opening if ordered alone, and avoid painful stimuli, Roni also projectile vomiting 3 times while in the ER. Presens Status: sens: Somnolence, BP: 130/80 mmHg, HR: 100 times / min, RR: 24 x / minute. On examination found Raccoon Eyes and Battle bilateral positive sign.

What happened to Roni?

Etiology head injuryAccording to Aaron Cholik Rosjidi and Saiful Nurhidayat etiology of head injury are:a. Traffic accidentsb. Fallc. Punch / violenced. Falling objectse. Occupational accident or industrialf. Birth injuryg. Gunshot wounds

Classification of head injury Head injuries can be classified in various aspects. Practically known 3 classification descriptions are based on:The mechanism of injuryWeighing injuryMorphologyDiffuse brain injuryEpidural HemorrhageSubdural hemorrhageContusions and intracerebral hemorrhage

CLINICAL SYMPTOMS head injuryBattle sign (blue or ekhimosis behind the ear over the mastoid os)

Hemotipanum (bleeding in the area of the tympanic membrane of the ear)Raccon Eye / Periorbital ecchymosis (black color eye without direct trauma)

Rhinorrhoe (serobrospinal fluid out of the nose)Otorrhoe (serobrospinal fluid out of the ear)

ANAMNESI SYMPTOMS head injury S More detailed history about:a. The nature of the accidentb. When it happened, a few hours / days before being taken to the hospitalc. Whether there is a clash of heads straightd. State of the patient during the accident and the change of consciousness until examined.

Examination head injuryExamination of head trauma by Greaves and Johnson, among others:Status of vital functionsExamination of consciousnessPupil ExaminationNeurological ExaminationExamination of the scalp and skull

Investigations head injury1. CT ScanUsed to detect fractures of the base of the skull or skull cavity2. X - ray skullX - ray skull can be used for blunt head injury and sharp3. Magnetic Resonance Imaging (MRI)MRI is able to show lesions in the substantia alba and brain stem are often missed on CT - Scan.Cerebral Angiography Ct (CT - A)This examination may indicate the presence of vascular injury at the base of the skull which causes patients at risk of stroke.

MANAGEMENT head injuryEarly treatment head injury1. PRIMARY SURVEYAirway BreathingCirculation2. Hyperventilation3. Intravenous Fluids

HOW TO REFER PATIENTS head injury1. The referring physician2. Information for the person who will accompany3. Documentation4. Treatment before referring5. Management during transport6. Transfer data

COMPLICATIONS OF HEAD INJURYComplications are common and dangerous in head injury, namely:1. Fracture of skull2. Bleeding intrakarnial3. Convulsions4. Infection5. Alzheimer's disease and Parkinson's6. Coma

PROGNOSIS HEAD INJURY

Prognosis is related to the degree of consciousness on arrival at hospital

GCS Now ArrivingMortality158 12< 81 %5%40%

conclusionRoni 17 years falls due to riding a motorcycle, after the accident roni experiencing rhinorrhoe and otorrhoe and vomiting proyekti 3 times while in the ER. On examination found positive Raccon bilateral eyes, the battle to sign and value of GCS = 9 (medium). Roni experienced a head injury. Actions taken are the primary measures of survey then refer or consult a surgeon.

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