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Head injury - first aid

A head injury is any trauma that injures the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury. Head injury can be either closed or open (penetrating). A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull. An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head. Head injuries include: Concussion, the most common type of traumatic brain injury, in which the brain is shaken Scalp wounds Skull fractures Head injuries may cause bleeding: In the brain tissue In the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, extradural hematoma)

Causes
Common causes of head injury include: Accidents at home, work, outdoors, or while playing sports Falls Physical assault Traffic accidents Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

Symptoms
Symptoms of a head injury can occur right away. Or symptoms develop slowly over several hours or days. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull. In any serious head trauma, the spinal cord is also likely to be injured. Some head injuries cause changes in brain function. This is called a traumatic brain injury. Concussion is a mild traumatic brain injury. Symptoms of a concussion can range from mild to severe.

First Aid
Learning to recognize a serious head injury and give basic first aid can save someone's life. Get medical help right away if the person: Becomes very sleepy Behaves abnormally Develops a severe headache or stiff neck Has pupils (the dark central part of the eye) of unequal sizes Is unable to move an arm or leg Loses consciousness, even briefly Vomits more than once For a moderate to severe head injury, take the following steps: 1. Call 911 right away. 2. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR. 3. If the person's breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head. Keep the head in line with the spine and prevent movement. Wait for medical help. 4. Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one. 5. 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. 6. If the person is vomiting, to prevent choking, roll the person's head, neck, and body as one unit onto his or her side. This still protects the spine, which you must always assume is injured in the case of a head injury. Children often vomit once after a head injury. This may not be a problem, but call a doctor for further guidance. 7. Apply ice packs to swollen areas. A more serious head injury that involves bleeding or brain damage must be treated in a hospital. For a mild head injury, no treatment may be needed. Be aware though, symptoms of a head injury can show up later. Follow the instructions below under Home Care.

DO NOT
Do NOT wash a head wound that is deep or bleeding a lot. Do NOT remove any object sticking out of a wound. Do NOT move the person unless absolutely necessary. Do NOT shake the person if he or she seems dazed.

Do NOT remove a helmet if you suspect a serious head injury. Do NOT pick up a fallen child with any sign of head injury. Do NOT drink alcohol within 48 hours of a serious head injury.

When to Contact a Medical Professional


Call 911 right away if: There is severe head or face bleeding The person is confused, tired, or unconscious The person stops breathing You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury

Home Care
Friends or family may need to keep an eye on adults who have been injured after they are released from the emergency room or office. If the person is an athlete, follow the health care provider's instructions about when the person can return to sports. Parents or caregivers of children will need to learn how to keep an eye on the child after a head injury. Follow the health care provider's instructions on when the child can go back to being active and playing sports. After even a mild concussion do not do activities that can cause further head injury. Avoid tasks that require concentration or complicated thinking. These include reading, homework, preparing reports, and other kinds of brain stimulation. Also avoid bright lights and loud sounds. These can overstimulate the brain. Your health care provider can tell you more.

Follow-Up
Keep all follow-up appointments with your health care provider. These help make sure you or your child is recovering well.

Prevention
Not all head injuries can be prevented. But the following simple steps can help keep you and your child safe: Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats. Learn and follow bicycle safety recommendations. Do not drink and drive, and do not allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is impaired in another way.

Alternative Names
Brain injury; Head trauma

References

Biros MH, Heegaard WG. Head injury. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 38. Landry GL. Head and neck injuries. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 680.

Update Date: 1/1/2013


Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
Head injuries can be serious and require urgent medical attention. A hard blow to the head from a fall, knock or assault can injure the brain, even when there are no visible signs of trauma to the scalp or face. Symptoms of serious head injury include wounds, altered consciousness, clear fluid leaking from the eyes or nose, black eyes or bruises behind the ears, vision changes, nausea and vomiting.

The brain is a soft and delicate organ. A hard blow to the head can injure the brain or spinal cord even when there are no visible signs of trauma to the scalp or face. Thats why all head injuries are considered serious and should be assessed by your doctor or the nearest hospital emergency department. Always call triple zero (000) for an ambulance in an emergency. This article offers first aid suggestions, but is not a substitute for professional medical care.

Two types of head injury


Head injuries can be classified as:

Open with bleeding wounds to the face or head Closed no visible signs of injury to the face or head.
Closed head injuries The soft, jelly-like brain is protected by the skull. The brain doesnt fill the skull entirely it floats in a clear, nourishing liquid called cerebrospinal fluid. This fluid acts as a shock absorber, but its protective value is limited. The kinetic energy of a small knock to the head or face can be absorbed by the cerebrospinal fluid, but a hard impact can smash the brain against the inside of the skull. This can bruise the brain or tear blood vessels. If blood and blood serum start to escape, the swelling is contained within the skull. Intracranial pressure (pressure inside the skull) can cause permanent damage by literally crushing the brain.

Symptoms of a head injury


Blood is not a reliable indicator of the seriousness of a head injury. Apart from wounds, other symptoms of serious head injury can include:

Altered consciousness for example, the person may lose consciousness for

short or longer periods or may be conscious again, but confused or drowsy. They may even have a brief seizure. They may also change by improving for a while and deteriorating again later.

Skull deformities compressions or deformities are signs of fractures. Clear fluid from the ears or nose a skull fracture, especially a fracture to the
base of the skull, can allow cerebrospinal fluid to leak from the ears or nose. the blow was sufficient to rupture blood vessels around the eyes and ears. different sizes in a person with a serious head injury. The person may complain of double or blurred vision. and should always be considered important if they persist.

Black eyes and bruised skin behind the ears this indicates that the force of Vision changes the pupils of the eyes may be dilated (enlarged) and be Nausea and vomiting these are common side effects of serious head injury

First aid for head injury


In cases where there is a serious head injury, always call an ambulance. First aid when the injured person is conscious Encourage the injured person to minimise any movement of their head or neck. Scalp injuries can bleed profusely, so control any significant blood loss from head wounds with direct pressure and a dressing. While examining the wound, avoid disturbing blood clots forming in the hair. Reassure the person and try to keep them calm. First aid when the injured person is unconscious The person should not be moved unless they are in immediate danger. Any unnecessary movement may cause greater complications to the head injury itself, the spine or other associated injuries. A good rule is that if the head is injured, the neck may be injured too. Your role is to protect the injured person from any potential dangers at the scene. You should also monitor their airway and breathing until the arrival of an ambulance. If the persons breathing becomes impaired due to a problem with their

airway, you may need to very carefully tilt their head back (and support it) until normal breathing returns. If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be required.

Treatment of concussion
Concussion is a mild traumatic brain injury that follows some trauma to the head. It is a diagnosis made by a doctor when it is certain a more serious head injury has not occurred. Symptoms of concussion can persist for up to three weeks after trauma. Your doctor or hospital will provide advice for yourself and your family regarding your ongoing care when being discharged for home. Most importantly, be alert for any danger signs over the next one or two days, such as persistent vomiting, loss of coordination, or bad or worsening headaches despite analgesia (pain-relieving medication). Seek medical attention immediately.

Spinal injuries
A person who has sustained a head injury may have also injured their spine. In elderly people, the force required to cause neck injuries is much less than in younger people. It can even occur from a standing height fall in the elderly. It is important to keep the injured persons head in line with their neck. Avoid twisting their head or allowing their head to roll to the side. If you can, roll a t-shirt, towel or similar soft item and place it around their neck to keep their head straight. Dont try to move them unless there is an urgent need to. Signs and symptoms of spinal injuries may include:

Body lying in an awkward, unnatural position Skin feeling clammy and cool Reporting unusual tingling sensations in the limbs or an absence of any
sensation, including pain

Inability to move limbs.

Toddlers and head injuries


Toddlers fall over all the time. Parents should note that:

A fall from the childs own height usually isnt enough to cause a serious head
injury

The size of a bump on the head has no connection with the severity of injury Minor head injuries, like a bump on the head, can be treated with cuddles and
an age-appropriate dose of childrens pain-relieving syrup. Medical attention should be sought immediately if the child shows any signs of serious head injury, particularly if they are unusually drowsy or vomiting, if you think the fall was heavy enough to have caused harm or if the child appeared to be unconscious or did not immediately cry after the fall. Examples of a heavy fall are falling down some stairs, rolling from a normal height change table to a hard floor, falling from a bed to a hard surface or a head strike on bedside furniture. If in doubt, see your doctor.

Where to get help


In an emergency, always call triple zero (000) Your doctor The emergency department of your nearest hospital Maternal and Child Health Line, Victoria (24 hours) Tel. 13 22 29

Things to remember
Always call triple zero (000) for an ambulance in an emergency. The presence or absence of blood isnt a reliable indicator of the seriousness
of the head injury.

Symptoms of serious head injury can include clear fluid leaking from the nose
or ears, altered consciousness or a period of unconsciousness, skull deformities, vision changes, bruised eyes and ears, nausea and vomiting.

A person who has sustained a head injury may also have injured their spine.