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Head Injuries - GENERAL

Alternative names:
Brain injury; concussion - first aid; injury to the head.

Considerations:
The signs and symptoms of a head injury may occur immediately or develop slowly over several hours.

Most head injuries are minor. The skull provides the brain with considerable protection form injury. Most head injuries are mild, but head injury may be a serious problem when it occurs. Accidents are the leading cause of death or disability of men under age 35, and over 70% of accidents involve head injuries and/or spinal cord injuries. Common causes of head injury include traffic accidents, industrial/occupational accidents, falls, physical assault, and accidents in the home.

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, the child should still be closely watched for the next day, since sometimes symptoms of a head injury are delayed.

When encountering a victim of a head injury, try to find out what happened. If the victim cannot tell you, look for clues and ask witnesses.

Even if the skull is not fractured, the brain can bang against the inside of the skull and be damaged. If there is bleeding inside the skull, complications may follow.

Causes:
Injury or trauma to the head can result in

• concussion--the head sustains a hard blow
• intracranial hematoma--blood vessel ruptures between the skull and the brain (see subdural hematoma)
• skull fracture

Symptoms:

• altered level of consciousness
• bleeding
• breathing slowed
• confusion
• convulsions
• fracture in the skull
• fluid drainage from nose, mouth, or ears (may be clear or bloody)
• headache (may be severe)
• increased drowsiness
• initial improvement followed by worsening symptoms
• irritability
• loss of consciousness
• personality changes
• restlessness
• slurred speech
• stiff neck
• swelling at the site of the injury
• vision difficulties
• vomiting (may be severe and persistent)
• wound in the scalp
• pupil changes

First aid:
Treatment varies according to the severity of the injury, type and location of injury, and development of secondary complications. For mild head injury, no specific treatment may be needed other than observation for complications. Over-the-counter analgesics may be used for headache. Aspirin is usually discouraged because prolonged use increases the risk of bleeding.

For moderate to severe head injury, urgent treatment is required. The following first aid treatment is indicated if the victim is comatose or symptoms are severe.

1. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. If the victim's breathing and heart rate are satisfactory but he or she is unconscious, treat him or her as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the victim's head, keeping the head in line with the spine and preventing movement. Wait for medical help.

3. Unless there has been a skull fracture, attempt to stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the victim's head. If blood soaks through the cloth, don't remove it; just place another cloth over the first one.

4. If you suspect a skull fracture, do not apply direct pressure to the bleeding site and do not remove any debris from the wound. Cover the wound with sterile gauze dressing and get medical help immediately.

5. If the head wound is superficial, wash it with soap and warm water and pat dry.

6. If a victim is vomiting and you don't suspect a spinal injury, turn his or her head to the side to prevent choking. Children often vomit once after a head injury. But even if the child does not vomit again and is not behaving differently, contact a doctor.

7. Apply ice packs to swollen areas.

8. Over-the-counter pain medicine usualy helps reduce headache.

9. Over the next 24 hours, observe the victim for any signs of a serious head injury. During the night, awaken the victim every 2 to 3 hours and check for alertness. Ask the victim specific questions, such as an address. If the victim becomes unusually drowsy, develops a severe headache or stiff neck, vomits more than once, or behaves abnormally, get medical help immediately.

10. Refrain from vigorous activity for 24 hours after a serious head injury.

Do not:

• DO NOT remove the helmet of a victim if you suspect a serious head injury.
• DO NOT wash a head wound that is deep or bleeding profusely.
• DO NOT remove any object sticking out of a wound.
• DO NOT move the victim unless absolutely necessary.
• DO NOT shake the victim if he or she seems dazed.
• DO NOT let other, more obvious, injuries distract you from the head injury.
• DO NOT pick up a fallen child with any sign of head injury.
• DO NOT consume alcohol within 48 hours of a serious head injury.

Call immediately for emergency medical assistance if:

• there is severe head or facial bleeding.
• there is a change in the victim's level of consciousness (such as confusion or lethargy).
• there is any cessation of breathing.
• you suspect a serious head or neck injury.

Prevention:

• Always wear a helmet when biking.
• Make sure that children have a safe area in which to play.
• Provide adequate supervision for children of any age.
• Be visible. Don't ride a bike at night.
• Obey traffic signals when riding a bike. Be predictable so that other drivers will be better able to determine your course.
• Use appropriate safety equipment (such as hard hats, bicycle or motorcycle helmets, and seat belts) when involved in activities that could result in head injury.