| Subject | Contents |
| Definition | 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. Head injury can be classified as either closed or penetrating. In a closed head injury, the head sustains a blunt force by striking against an object. A concussion is a type of closed head injury that involves the brain. In a penetrating head injury, an object breaks through the skull and enters the brain. (This object is usually moving at a high speed.) |
| Alternative Names | Concussion - first aid; Brain injury; Head trauma |
| Considerations | Injuries to the head are so common that almost everyone will sustain some form of trauma to the head at some point during their lifetime. Learning to recognize serious head injury, and implementing basic first aid, can make the difference in saving someone's life. Medical advances in detecting and treating these injuries, however, have improved the outlook for many of these injuries. Every year, approximately two million people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection -- thus symptoms of minor head injuries usually resolve with time. However, more than half a million head injuries a year are severe enough to require hospitalization. In patients who have suffered a severe head injury, there is also often one or more other organ systems injured. An important consideration in early management of these cases is that there is approximately a 5% incidence of associated spine fractures with significant head injury. |
| Causes | Accidents are the leading cause of death or disability in men under age 35, and over 70% of accidents involves head injuries and/or spinal cord injuries. Common causes of head injury include traffic accidents, industrial/occupational accidents, recreational accidents, falls, physical assault, and accidents in the home. Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain (intracranial hematoma), or high shearing forces that damage the nerve cells of the brain (diffuse axonal injury). These more serious head injuries cause deficits that vary with the degree of brain injury. These deficits may include: Personality changes Emotional disturbances Speech and language deficits Cognitive deficits Loss of sensation, hearing, vision, taste, or smell Seizures Paralysis Coma |
| Symptoms | The signs and symptoms of a head injury may occur immediately or develop slowly over several hours. If a child begins to play or run immediately after getting a bump on the head, for example, serious injury is unlikely. However, the child should still be closely watched for the 24 hours, since symptoms of a head injury can be 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. In any head trauma victim that appears to have any serious injury, always assume that there is also injury to spinal cord. The following symptoms suggest a more serious head injury that requires emergency medical treatment:Altered level of consciousnessBleeding Decreased rate of breathing ConfusionConvulsionsFracture in the skull Facial bruising and fractures Fluid drainage from nose, mouth, or ears (may be clear or bloody) Headache (may be severe) Hypotension Increased drowsiness Initial improvement followed by worsening symptoms Irritability Loss of consciousness Personality changes RestlessnessSlurred speechStiff neckSwelling at the site of the injury Blurry vision Scalp wound 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, although an initial medical evaluation should still be done. 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, where the victim is comatose or if symptoms are severe, urgent treatment is required. Take the following first aid treatment steps:
1. Call the local emergency number (such as 911) before you begin treating someone with a severe head injury. 2. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR .
3. 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.
4. 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.
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 and get medical help immediately.
6. If a victim is vomiting , remember you must always suspect a spinal injury and roll the head, neck, and body as one unit 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.
For patients with mild or moderate head injury and no loss of consciousness, a full medical evaluation should still be sought. If the patient is not hospitalized, you will receive instructions to observe the victim for any signs of a serious head injury over the next 24 hours. These instructions may include waking the patient every 2 to 3 hours during the night to check for alertness; you may be told to ask the victim specific questions, such as "What is your address?" If the patient becomes unusually drowsy , develops a severe headache or stiff neck , vomits more than once, or behaves abnormally, get medical help immediately. |
| 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 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. Obey traffic signals when riding a bike. Be predictable so that other drivers will be better able to determine your course. Be visible. Do not ride a bike at night. 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. Don't drink and drive, and don't allow yourself to be driven by someone who you suspect is drunk. Wear seat belts at all times. Use age-appropriate car seats or boosters for babies and young children. Frequently Asked Questions: Q: Can there be brain injury if there is no physical evidence of trauma to the head? A: Yes. 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. |
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