鈍的頭部外傷、頭部鈍的外傷

関: closed head injury、closed head trauma

WordNet

to go or travel towards; "where is she heading"; "We were headed for the mountains"
the length or height based on the size of a human or animal head; "he is two heads taller than his little sister"; "his horse won by a head"
the pressure exerted by a fluid; "a head of steam"
the tip of an abscess (where the pus accumulates)
(nautical) a toilet on board a boat or ship
(usually plural) the obverse side of a coin that usually bears the representation of a persons head; "call heads or tails!"
a projection out from one end; "the head of the nail", "a pinhead is the head of a pin"
a single domestic animal; "200 head of cattle"
the striking part of a tool; "the head of the hammer"
the upper part of the human body or the front part of the body in animals; contains the face and brains; "he stuck his head out the window" (同)caput
a person who is in charge; "the head of the whole operation" (同)chief, top_dog
(grammar) the word in a grammatical constituent that plays the same grammatical role as the whole constituent (同)head word
a rounded compact mass; "the head of a comet"
a user of (usually soft) drugs; "the office was full of secret heads"
an individual person; "tickets are $5 per head"
that part of a skeletal muscle that is away from the bone that it moves
the foam or froth that accumulates at the top when you pour an effervescent liquid into a container; "the beer had a large head of foam"
the front of a military formation or procession; "the head of the column advanced boldly"; "they were at the head of the attack"
the rounded end of a bone that fits into a rounded cavity in another bone to form a joint; "the head of the humerus"
the top of something; "the head of the stairs"; "the head of the page"; "the head of the list"
be the first or leading member of (a group) and excel; "This student heads the class" (同)head up
be in charge of; "Who is heading this project?" (同)lead
be in the front of or on top of; "The list was headed by the name of the president"
form a head or come or grow to a head; "The wheat headed early this year"
remove the head of; "head the fish"
take its rise; "These rivers head from a mountain range in the Himalayas"
make less intense; "blunted emotions"
make less sharp; "blunt the knives"
used of a knife or other blade; not sharp; "a blunt instrument"
characterized by directness in manner or speech; without subtlety or evasion; "blunt talking and straight shooting"; "a blunt New England farmer"; "I gave them my candid opinion"; "forthright criticism"; "a forthright approach to the problem"; "tell me what you think--and you may just as well be frank"; "it is possible to be outspoken without being rude"; "plainspoken and to the point"; "a point-blank accusation" (同)candid, forthright, frank, free-spoken, outspoken, plainspoken, point-blank, straight-from-the-shoulder
devoid of any qualifications or disguise or adornment; "the blunt truth"; "the crude facts"; "facing the stark reality of the deadline" (同)crude, stark
having a broad or rounded end; "thick marks made by a blunt pencil"
any physical damage to the body caused by violence or accident or fracture etc. (同)hurt, harm, trauma
an act that causes someone or something to receive physical damage
wrongdoing that violates anothers rights and is unjustly inflicted
an accident that results in physical damage or hurt (同)accidental injury
of leafy vegetables; having formed into a head; "headed cabbages"
having a head of a specified kind or anything that serves as a head; often used in combination; "headed bolts"; "three-headed Cerberus"; "a cool-headed fighter pilot"
having a heading or caption; "a headed column"; "headed notepaper"
having a heading or course in a certain direction; "westward headed wagons"
the 5th letter of the Hebrew alphabet

PrepTutorEJDIC

(顔を含めた)『頭』,頭部,首;(髪の生えている部分の)頭 / 『頭脳』,頭の働き,知力,才能;理性 / 『長』,指導者,支配者 / (ある物の)頭,上部,先端,先頭 / (川・泉の)源,水源 / (人・動物の)頭数,一人,1頭 / 『首席』,首位 / 《複数形で》(頭像のある)貨幣の表 / 項目,表題(新聞の)見出し / 《米俗》マリファナ常用者 / 長の,指導者の / …‘の'先頭に立つ,‘を'率いる;…‘の'長である / (…の方へ)…‘を'向ける《+『名』+『for』(『toward』)+『名』》 / (サッカーで)〈ボール〉‘を'頭で受ける,ヘディングする / (…に向かって)進む《+for(toward)+名》・「give a head」で「オーラルセックスをする・相手の性器をなめる」
『切っ先の鈍い』,なまくらの / 『ぶっきらぼうな』,無愛想な / …'を'鈍くする,鈍らせる / なまくらになる,鈍る
『負傷』,『損害』,損傷 / (名誉などを)傷つけること,侮辱《+『to』+『名』》
頭[部]のある,見出しのある / (キャベツなどが)結球した / 《複合語を作って》「…の頭を持つ」「頭が…の」の意を表す
彼は,彼が / 《指す人の性別が分からないか,または分かる必要のない場合に》その人,あの人,自分 / 《he who(that)の形で》《文》…するものはだれでも / (動物の)おす(雄)
鬼ごっこ(tag,tick,tig)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/26 10:59:45」(JST)

wiki en

[Wiki en表示]

Closed Head are a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people.^[1]^[2] Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 17 million brain injuries that occur annually in the United States.^[3] Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.^[4]

1 Causes
2 Symptoms
- 2.1 Common symptoms
- 2.2 Severe injury symptoms
- 2.3 Secondary symptoms
3 Classification
- 3.1 Glasgow Coma Scale
- 3.2 ASCOT
- 3.3 Mechanism based
4 Treatments
- 4.1 Pharmacotherapy
- 4.2 Patient education
- 4.3 Cognitive rehabilitation
- 4.4 Other
5 Prevention
6 See also
7 References

Causes

Closed-head injuries are caused primarily by vehicular accidents, falls, acts of violence, and sports injuries.^[4] Falls account for 35.2% of brain injuries in the United States, with rates highest for children ages 0–4 years and adults ages 75 years and older.^[3] Head injuries are more common in men than women across every age group.^[3] Boys aged 0–4 years have the highest rates of brain injury related hospital visits, hospitalizations, and deaths combined.^[3] Multiple mild traumatic brain injuries sustained over a short period of time (hours to weeks), often seen with sports-related injuries, can result in major neurological or cognitive deficits or fatality.^[5]

Blast-related traumatic brain injuries are often closed-head injuries and result from rapid changes in atmospheric pressure, objects dislodged by the blast hitting people, or people being thrown into motion by the blast ^[6] Blast-related injuries have shown a recent increase in occurrence with the return of veterans from Iraq such that traumatic brain injury has been coined the "signature injury" of Operation Iraqi Freedom ^[7]

Closed-head injuries can range from mild injuries to debilitating traumatic brain injuries and can lead to severe brain damage or death. Common closed-head injuries include:^[8]

concussion – a head injury resulting in temporary dysfunction of normal brain function. Almost half of the total concussions reported each year are sports-related ^[8]
intracranial hematoma – a condition in which a blood vessel ruptures causing a pool of blood to form around the brain (subdural hematoma) or between the brain and the skull (epidural hematoma). Intracranial hematoma causes an increase in pressure on the brain and requires immediate medical attention.^[8]
cerebral contusion – a bruise to the brain tissue as a result of trauma. Contusions are local in nature, separating them from concussions.^[8]
diffuse axonal injury – an injury to the axon of the neuron. These injuries are frequently seen in car accidents and cause permanent damage to the brain. Severe diffuse axonal injuries often lead to comas or vegetative states.^[8]

Symptoms

If symptoms of a head injury are seen after an accident, medical care is necessary to diagnose and treat the injury. Without medical attention, injuries can progress and cause further brain damage, disability, or death.^[8]

Common symptoms

Because the brain swelling that produces these symptoms is often a slow process, these symptoms may not surface for days to weeks after the injury.^[8] Common symptoms of a closed-head injury include:

headache
dizziness
nausea
slurred speech
vomiting

Severe injury symptoms

Severe head injuries can lead to permanent vegetative states or death, therefore being able to recognize symptoms and get medical attention is very important. Symptoms of a severe closed-head injury include:

coma
seizures
loss of consciousness

Secondary symptoms

Secondary symptoms are symptoms that surface during rehabilitation from the injury including social competence issues, depression, personality changes, cognitive disabilities, anxiety, and changes in sensory perception. More than 50% of patients who suffer from a traumatic brain injury will develop psychiatric disturbances.^[9] Although precise rates of anxiety after brain injury are unknown, a 30-year follow-up study of 60 patients found 8.3% of patients developed a panic disorder, 1.7% developed an anxiety disorder, and 8.3% developed a specific phobia.^[10] Patients recovering from a closed-head or traumatic brain injury often suffer from decreased self-esteem and depression. This effect is often attributed to difficulties re-entering society and frustration with the rehabilitation process. Patients who have suffered head injuries also show higher levels of unemployment, which can lead to the development of secondary symptoms.^[11]

Classification

Glasgow Coma Scale

The Glasgow Coma Scale is commonly used to assess the severity of traumatic brain injuries, including closed-head injuries. The scale tests a patient’s eye, verbal, and motor responses. The scale goes up to fifteen points; with fifteen being the most mild injury, less than eight being a severe brain injury, and three being a vegetative state.^[12]

ASCOT

The ASCOT probability of survival encapsulates several of the variables measured in the Glasgow Coma Scale but also includes systolic blood pressure, respiration rates upon admission, and anatomic injuries. The ASCOT was found to be the most sensitive tool for determining severity of head injuries in children and is effective in predicting the outcome of injury.^[1]^[13]

Mechanism based

A mechanism-based TBI classification system divides traumatic brain injuries (TBI) into closed and penetrating head trauma; based on the way in which the person was injured.^[14]

Treatments

There are several different types of treatment available to those who have suffered a closed-head injury. The treatment type chosen can depend on several factors including the type and severity of injury as well as the effects that injury has on the patient.^[15] The course of treatment differs for each patient and can include several types of treatment, depending on the patient’s specific needs. Early treatment is vital to recovering lost motor function after an injury, but cognitive abilities can be recovered regardless of time past since injury.^[16]

Pharmacotherapy

Pharmacotherapy is the utilization of drugs to treat an illness. There are several different drugs that have been used to alleviate symptoms experienced after a head injury including anti-depressants such as amitriptyline and sertraline. Use of these drugs has been associated with a decrease in depression and increased functioning in social and work environments.^[15] An antidiuretic called Desmopressin Acetate (DDAVP) has also been shown to improve memory performance in patients^[15] Recent studies have examined the preventative effects of progesterone on brain injuries. Phase III trials are currently being conducted at 17 medical centers across the United States. Preliminary results have shown a 50% reduction in mortality in those treated with progesterone and showed an improved functional outcome.^[17] Overall, the efficacy of pharmacotherapuetic treatments is dependent on the treatment being used and the symptoms being targeted by the treatment.

Patient education

Patient education has been shown to be one of the most effective ways to decrease secondary symptoms seen with closed-head injuries. Patient education often includes working with a therapist to review symptom management and learn about returning to regular activities.^[15] Educational initiatives have also been shown to decrease the occurrence of PTSD in head-injury survivors.^[15]

Cognitive rehabilitation

Many patients with severe injuries need therapy to regain basic motor and cognitive skills. Cognitive rehabilitation aims to improve attention, memory function, and cognitive-processing speed. The type of rehabilitation used is tailored to the patient’s clinical needs depending on the severity and type of injury sustained.^[15]

Other

Other types of rehabilitation focus on raising patient’s self-esteem by giving him tasks that can be successfully completed despite any cognitive changes as a result of the brain injury. This process can help decrease secondary symptoms such as feelings of worthlessness, depression, and social anxiety.^[18] Some rehabilitation programs use team-building exercises and problem-solving activities to help the patients learn to work with their disabilities.^[15]

Prevention

Many closed-head injuries can be prevented by proper use of safety equipment during dangerous activities. Common safety features that can reduce the likelihood of experiencing a brain injury include helmets, hard hats, car seats, and safety belts. Another safety precaution that can decrease a person's risk for brain injury is not to drink and drive or allow oneself to be driven by a person who has been drinking or who is otherwise impaired.^[19]

Helmets can be used to decrease closed-head injuries acquired during athletic activities, and are considered necessary for sports such as American "tackle" football, where frequent head impacts are a normal part of the game. However, recent studies have questioned the effectiveness of even American football helmets, where the assumed protection of helmets promotes far more head impacts, a behavior known as risk compensation. The net result seems to have been an increase, not decrease, in TBI.^[20] The similar sports of Australian-rules football and rugby are always played helmetless, and see far fewer traumatic brain injuries. (See Australian rules football injuries.)

Bicycle helmets are perhaps the most promoted variety of helmet, based on the assumption that cycling without a helmet is a dangerous activity, with a large risk of serious brain injury. However, available data clearly shows that to be false. Cycling (with approximately 700 American fatalities per year from all medical causes) is a very minor source of fatal traumatic brain injury, whose American total is approximately 52,000 per year.^[21] Similarly, bicycling causes only 3% of America's non-fatal TBI.

Still, bicycle-helmet promotion campaigns are common, and many U.S jurisdictions have enacted mandatory bicycle-helmet laws for children. A few such jurisdictions, a few Canadian provinces, plus Australia and New Zealand mandate bicycle helmets even for adults. A bicycle-helmet educational campaign directed toward children claimed an increase in helmet use from 5.5% to 40.2% leading to a claimed decrease in bicycle-related head injuries by nearly 67%.^[22] However, other sources have shown that bicycle-helmet promotion reduces cycling, often with no per-cyclist reduction in TBI.^[23]^[24]

Estimates of bicycle-helmet use by American adults vary. One study found that only 25-30% of American adults wear helmets while riding bicycles,^[25] despite decades of promotion and despite sport cyclists' adoption of helmets as part of their uniform. It would appear that the typical American adult correctly recognizes ordinary cycling as a very minor risk.

Following the commercial (as opposed to public-health) success of bicycle helmets, there have been successful attempts to promote the sale of ski helmets. Again, results have been less than impressive, with great increases in helmet use yielding no reduction in fatalities, and with most injury reduction confined to lacerations, contusions, and minor concussions, as opposed to more serious head injuries.^[26]

There have been rare campaigns for motoring helmets.^[27] Unfortunately, just as people greatly overestimate the TBI danger of bicycling, they greatly underestimate the risk of motoring, which remains the largest source of TBI in the developed world, despite the protective effects of seatbelts and airbags.

References

^ ^a ^b Ibrahim, N., Ralston, J., Smith, C., & Margulies, S. (2010). Physiological and Pathological Responses to Head Rotations in Toddler Piglets. Journal of Neurotrauma, 1021-1035. doi:10.1089/neu.2009.1212
^ Cossa, F. M., & Fabiani, M. (1999). Attention in closed head injury: a critical review. [Review]. Italian Journal of Neurological Sciences, 20(3), 145-153.
^ ^a ^b ^c ^d Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
^ ^a ^b Ragnarsson, K. T., Moses, L. G., Clarke, W. R., Daling, J. R., Garber, S. L., Gustafson, C. F., . . . Traumat, N. I. H. C. D. P. R. P. (1999). Rehabilitation of persons with traumatic brain injury. [Article]. Jama-Journal of the American Medical Association, 282(10), 974-983.
^ Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States. MMWR 1997;46(10):224–227.
^ Taber, K. H., Warden, D. L., & Hurley, R. A. (2006). Blast-related traumatic brain injury: What is known? [Article]. Journal of Neuropsychiatry and Clinical Neurosciences, 18(2), 141-145.
^ Vasterling, J. J., Verraellie, M., & Sullivan, K. D. (2009). Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. [Review]. Clinical Psychology Review, 29(8), 674-684. doi:10.1016/j.cpr.2009.08.004
^ ^a ^b ^c ^d ^e ^f ^g http://www.allabouttbi.com/symptoms.htm
^ Rao, V., & Lyketsos, C. G. (2003). Psychiatric aspects of traumatic brain injury: new solutions to an old problem. [Editorial Material]. International Review of Psychiatry, 15(4), 299-301. doi:10.1080/09540260310001606674
^ Koponen, S., Taiminen, T., Portin, R., Himanen, L., Isoniemi, H., Heinonen, H., . . . Tenovuo, I. (2002). Axis I and II psychiatric disorders after traumatic brain injury: A 30-year follow-up study. [Article]. American Journal of Psychiatry, 159(8), 1315-1321.
^ Kissinger, D. B. (2008). Traumatic brain injury and employment outcomes: Integration of the working alliance model. [Review]. Work-a Journal of Prevention Assessment & Rehabilitation, 31(3), 309-317.
^ Morrow, S. E., & Pearson, M. (2010). Management Strategies for Severe Closed Head Injuries in Children. [Article]. Seminars in Pediatric Surgery, 19(4), 279-285. doi:10.1053/j.sempedsurg.2010.07.001
^ GOTSCHALL, C., PAPERO, P., SNYDER, H., JOHNSON, D., SACCO, W., & EICHELBERGER, M. (1995). COMPARISON OF 3 MEASURES OF INJURY SEVERITY IN CHILDREN WITH TRAUMATIC BRAIN INJURY. Journal of Neurotrauma, 611-619.
^ Maas AI, Stocchetti N, Bullock R (August 2008). "Moderate and severe traumatic brain injury in adults". Lancet Neurology 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021.
^ ^a ^b ^c ^d ^e ^f ^g Comper, P., Bisschop, S., Carnide, N., & Tricco, A. (2005). A systematic review of treatments for mild traumatic brain injury. Brain Injury, 863-880. doi:10.1080/02699050400025042
^ Interview with Dr. Anthony Stringer, Emory University, Department of Rehabilitation Medicine
^ http://www.sciencedaily.com/releases/2010/02/100219204407.htm
^ http://whqlibdoc.who.int/hq/2004/WHO_DAR_01.9_eng.pdf
^ http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm
^ Albergotti, Reed; Wang, Shirley S. (11 November 2009). "Is It Time to Retire the Football Helmet?". The Wall Street Journal.
^ http://www.cdc.gov/traumaticbraininjury/statistics.html
^ Sandel, M. E., Bell, K. R., & Michaud, L. J. (1998). Brain injury rehabilitation. 1. Traumatic brain injury: Prevention, pathophysiology, and outcome prediction. [Article]. Archives of Physical Medicine and Rehabilitation, 79(3), S3-S9.
^ http://www.cyclehelmets.org/1041.html
^ Robinson, D.L., Head Injuries & Bicycle Helmet Laws, 1996, Accident Analysis Prevention, vol 28, pp. 463 - 475
^ Rosenkranz, K. A., & Sheridan, R. L. (2003). Trauma to adult bicyclists: a growing problem in the urban environment. [Article]. Injury-International Journal of the Care of the Injured, 34(11), 825-829.
^ http://www.nsaa.org/nsaa/press/facts-ski-snbd-safety.asp
^ http://casr.adelaide.edu.au/developments/headband/

UpToDate Contents

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1. 幼児および小児における軽微な頭部外傷：評価 minor head trauma in infants and children evaluation
2. 乳児および小児における軽度頭部外傷：マネージメント minor head trauma in infants and children management
3. 脳振盪および軽度外傷性脳損傷 concussion and mild traumatic brain injury
4. 成人外傷患者における入院マネージメントの概要 overview of inpatient management in the adult trauma patient
5. 小児における重度の外傷性脳損傷に対する初期アプローチ initial approach to severe traumatic brain injury in children

English Journal

Mild Traumatic Brain Injury in Translation.

Levin HS, Robertson CS.Source1 Department of Veterans Affairs, Neurorehabilitation: Neurons to Networks Traumatic Brain Injury Center of Excellence (project #B6812C), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Journal of neurotrauma.J Neurotrauma.2013 Mar 14. [Epub ahead of print]
Abstract This Introduction to a Special Issue on Mild Traumatic Brain Injury (mTBI) highlights the methodological challenges in outcome studies and clinical trials involving patients who sustain mTBI. Recent advances in brain imaging and portable, computerized cognitive tasks have contributed to pro
PMID 23046349

Retrospective analysis of free-fall fractures with regard to height and cause of fall.

Petaros A, Slaus M, Coklo M, Sosa I, Cengija M, Bosnar A.SourceDepartment of Forensic Medicine and Criminalistics, Rijeka University School of Medicine, Brace Branchetta 20, 51 000 Rijeka, Croatia. Electronic address: anja.petaros@yahoo.com.
Forensic science international.Forensic Sci Int.2013 Mar 10;226(1-3):290-5. doi: 10.1016/j.forsciint.2013.01.044. Epub 2013 Feb 17.
Free-fall fractures represent a specific form of blunt force trauma that can be hard to interpret because of the numerous factors that affect it. The aim of this study is to focus on skeletal injury patterns resulting from free-falls and to analyse the relationship between specific skeletal fracture
PMID 23422164

A bilateral head injury that shows graded brain damage and behavioral deficits in adultmice.

Liu NK, Zhang YP, O'Connor J, Gianaris A, Oakes E, Lu QB, Verhovshek T, Walker CL, Shields CB, Xu XM.SourceSpinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery and Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. Electronic address: nailiu@iupui.edu.
Brain research.Brain Res.2013 Mar 7;1499:121-8. doi: 10.1016/j.brainres.2012.12.031. Epub 2012 Dec 28.
Reliable animal models of traumatic brain injury (TBI) are essential to test novel hypotheses and therapeutic interventions. In this study, based on advantages of both the closed head injury (CHI) and controlled cortical impact (CCI) models, we developed a bilateral head injury model in mice. C57BL/
PMID 23276498

Japanese Journal

頭頸部外傷後の咽頭後間隙血腫により上気道狭窄を来した2例

田中真生,米満尚史,川副友,宮本恭平,木田真紀,岩崎安博,加藤正哉
日本救急医学会雑誌 25(3), 119-124, 2014
外傷性咽頭後間隙血腫によって上気道狭窄を呈した2例を経験した。症例1：55歳の男性。高血圧の既往があった。バイクと軽自動車の接触事故にて当院に救急搬送された。頭頸部打撲と左大腿骨頸部骨折を認めたが，意識や呼吸循環動態は安定していた。受傷2時間後に意識清明な状態で上気道狭窄音が出現したため，気管挿管を実施しようとしたが困難であったため，輪状甲状靭帯切開にて緊急気道確保を行った。頸部CTで咽頭後間隙血 …
NAID 130004542395

頭部打撲に伴う頸部過伸展屈曲により生じた椎骨動脈分枝出血

益田尚典,藤岡政行,渡邊知朗,中川一郎,中瀬裕之,田岡俊昭,奥地一夫
Journal of Japanese Congress on Neurological Emergencies 25(2), 33-36, 2013
はじめに：鈍的頸部外傷による椎骨動脈損傷は稀である．また，その主たる病態は椎骨動脈狭窄・閉塞による椎骨脳底動脈循環不全とされる．今回，我々は，頸部過伸展屈曲外傷後に気道狭窄，呼吸不全で発症した椎骨動脈分枝出血の一例を経験したので報告する．症　例：81 歳，男性．転倒による頭部打撲後の意識障害のため当院救命救急センターに搬送された．来院時，意識レベルはGlasgow Coma Scale：E4V2M …
NAID 130004623128

頭頸部外傷患者における頸椎CT撮影の新たなclinical decision ruleの提案

稲垣剛志,木村昭夫,萩原章嘉,佐々木亮,新保卓郎
日本救急医学会雑誌 24(4), 192-199, 2013
【目的】鈍的頭頸部外傷患者において，頸椎CT撮影の新たなclinical decision rule（CDR）を作成することを目的とした。【方法】Derivation研究の対象は2008年4月1日～2010年8月14日に当院へ救急搬送された頭頸部外傷患者のうち頸椎CTを施行した1,076症例，Validation研究の対象は2010年8月15日～12月31日に当院へ救急搬送された頭頸部外傷患者88 …
NAID 130004542377

Related Pictures

★リンクテーブル★

リンク元	「closed head injury」「closed head trauma」「鈍的頭部外傷」「頭部鈍的外傷」
関連記事	「injury」「heading」「head」「blunting」「blunt」