Head Injury

A head injury is any trauma that leads to injury of the scalp, skull, or brain. These injuries can range from a minor bump on the skull to a devastating brain injury.

Concussion - first aid; Brain injury; Head trauma

Every year, millions of people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection. The symptoms of minor head injuries usually go away on their own. More than half a million head injuries a year, however, are severe enough to require hospitalization. Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone's life.

In patients who have suffered a severe head injury, there is often one or more other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury.

Accidents are the leading cause of death or disability in 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, falls, physical assault, and accidents at home, work, outdoors, or while playing sports. Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. These more serious head injuries may cause:

• Changes in personality, emotions, or mental abilities
• Speech and language problems
• Loss of sensation, hearing, vision, taste, or smell
• Seizures
• Paralysis
• Coma

The signs of a head injury can occur immediately or develop slowly over several hours. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. (This is called a concussion.) The head may look fine, but complications could result from bleeding inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume the spinal cord is also injured.

The following symptoms suggest a more serious head injury that requires emergency medical treatment:

Get medical help immediately if the person:

• Becomes unusually drowsy
• Develops a severe headache or stiff neck
• Vomits more than once
• Loses consciousness (even if brief)
• Behaves abnormally

For a moderate to severe head injury, take the following steps:

For a mild head injury, no specific treatment may be needed. However, closely watch the person for any concerning symptoms over the next 24 hours. The symptoms of a serious head injury can be delayed. While the person is sleeping, wake him or her every 2 to 3 hours and ask simple questions to check alertness, such as "What is your name?"

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, as with anyone with a head injury, closely watch the child for 24 hours after the incident. Over-the-counter pain medicine (like acetaminophen or ibuprofen) may be used for a mild headache. DO NOT take aspirin, because it can increase the risk of bleeding.

Call 911 if:

Definition

Your spinal cord contains the nerves that carry messages between your brain and body. The cord passes through your neck and back. A spinal cord injury is very serious because it can cause paralysis below the site of the injury.

Alternative Names

Considerations

Causes

• Bullet or stab wound
• Direct trauma to the face, neck, head, or back (e.g., car accidents)
• Diving accident
• Electric shock
• Extreme twisting of the trunk
• Sports injury (landing on head)
• Major blow to the head or chest, car accident, fall from a great height

Symptoms

• Head held in unusual position
• Numbness or tingling that radiates down an arm or leg
• Weakness
• Difficulty walking
• Paralysis of arms or legs
• No bladder or bowel control
• Shock (pale, clammy skin; bluish lips and fingernails; acting dazed or semi-conscious)
• Unconscious
• Stiff neck, headache, or neck pain

First Aid

1. Check the person's breathing and circulation. If necessary, begin rescue breathing and CPR.
2. DO NOT tilt the head back when attempting to open the airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward.

DO NOT

• DO NOT bend, twist, or lift the person's head or body.
• DO NOT attempt to move the person before medical help arrives unless it is absolutely necessary.
• DO NOT remove a helmet if a spinal injury is suspected.

When to Contact a Medical Professional

Prevention

• Wear seat belts.
• Avoid drinking alcohol and driving.
• Avoid diving into pools, lakes, rivers and surf, particularly if you cannot determine the depth of the water, or if the water is not clear.
• Avoid motorcycles and all-terrain vehicles.
• Avoid "spearing" (tackling or diving into a person with your head).

Definition

This condition involves losing blood. This can occur internally (when blood leaks from blood vessels inside the body), externally through a natural opening (such as the vagina, mouth, or rectum), or externally through a break in the skin.

Alternative Names

Considerations

Blood loss can cause bruises, which usually result from a blow or a fall. They are dark, discolored areas on the skin. Apply a cool compress to the area as soon as possible to reduce swelling. Wrap the ice in a towel and place the towel over the injury. Do not place ice directly on the skin.

Serious injuries don't always bleed heavily, and some relatively minor injuries (for example, scalp wounds) can bleed profusely. People who take blood-thinning medication or who have a bleeding disorder, such as hemophilia, may bleed excessively and quickly because their blood cannot clot properly. Bleeding in such people requires immediate medical attention.

Although puncture wounds usually don't bleed very much, they carry a high risk of infection. Seek medical care to prevent tetanus or other infection. Abdominal wounds can be very serious because of the possibility of severe internal bleeding, which may not be obvious from looking at a person, but which may result in shock.

Seek medical care immediately for any penetrating abdominal wound. If organs are showing through the wound, do not try to push them back into the abdomen unless they slide back in without your assistance. Cover the injury with a moistened cloth or bandage, and do not apply more than very gentle pressure to stop the bleeding. Always seek emergency assistance if internal bleeding is suspected. This can rapidly become life-threatening. Immediate medical intervention may be needed. This can range from medications and intravenous fluids, to use of an internal scope (endoscope), to surgery. Seek emergency assistance for severe bleeding, loss of a body part, or any serious head injury.

Causes

Symptoms

• Blood coming from an open wound
• Bruising
• Shock
• Paleness
• Clammy skin
• Dizziness or light-headedness after an injury
• Rapid pulse, increased heart rate
• Low blood pressure
• Shortness of breath
• Confusion or decreasing alertness
• Weakness

• Abdominal pain
• Swollen abdomen
• Signs of shock (see above)
• External bleeding through a natural opening
• Blood in the stool (appears black, maroon, or bright red)
• Blood in the urine (appears red, pink, or tea-colored)
• Vaginal bleeding (heavier than usual or after menopause)
• Blood in the vomit (looks bright red, or brown like coffee-grounds)

First Aid

1. Calm and reassure the victim. The sight of blood can be very frightening.
2. If the wound is superficial, wash it with soap and warm water and pat dry. Superficial wounds or scrapes are injuries that affect the top layers of skin and bleeding from such wounds is often described as "oozing," because it is slow.
3. Lay the victim down. This will reduce the chances of fainting by increasing the blood flow to the brain. When possible, elevate the bleeding area.
4. Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes embedded in the body, DO NOT remove it. Doing so may cause more damage to the victim and may increase the amount of bleeding. The object also might be embedded in an artery or organ. Place pads and bandages around the object and tape the object in place.
5. Put pressure directly on an external wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand. Direct pressure is best for external bleeding, except for an eye injury.
6. Maintain pressure until the bleeding stops. When it has stopped, bind the wound dressing with adhesive tape or a piece of clean clothing. A cold pack should be applied over the dressing. Do not peek to see if the bleeding has stopped.
7. If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one. Be sure to seek medical attention.
8. If the bleeding is severe, get medical help and take steps to prevent shock. Immobilize the injured body part. Lay the victim flat, raise the feet about 12 inches, and cover the victim with a coat or blanket. However, do not place the victim in this position if there has been a head, neck, back, or leg injury or if the position makes the victim uncomfortable. Get medical help as soon as possible.

DO NOT

• DO NOT apply a tourniquet to control bleeding, except as a last resort. Doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person. A tourniquet can be used if there is torrential bleeding and if continuous pressure isn't stopping the bleeding. A tourniquet should be applied to the limb between the bleeding site and the heart. The tourniquet should be tightened to the point where the bleeding can be controlled by applying direct pressure over the wound. To make a tourniquet, use bandages 2 to 4 inches wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place. Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.
• DO NOT probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm.
• DO NOT try to clean a large wound. This can cause heavier bleeding.
• DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top.
• DO NOT peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you'll be able to control the bleeding.
• DO NOT try to clean a wound after you get the bleeding under control. Get medical help.

When to Contact a Medical Professional

• The bleeding can't be controlled, or is associated with a serious injury.
• The wound might need stitches, or if embedded gravel or dirt cannot be removed easily with gentle cleaning.
• Internal bleeding or shock is suspected.
• Signs of infection develop including increased pain, redness, swelling, discharge, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart. (This is usually treated with topical or oral antibiotics. If untreated, an infection can cause a skin abscess or other complications.)
• If the injury involves an animal or human bite.
• If you are not up-to-date on tetanus immunization (within 5-10 years).

Prevention

• Use good judgment and keep knives and sharp objects away from small children.
• Stay up-to-date on vaccinations. Generally, the tetanus immunization (vaccine) is renewed every 10 years. The victim should get a tetanus shot at 5 years if the person has had two or fewer prior immunizations; the wound is heavily contaminated (foreign material); or there is extensive crush injury or devitalized tissue.