The head injury, it can range from minor to severe requiring a simple bandage or professional medical attention in an emergency room. How do you know when a visit to the ER is the best decision versus on the spot first aid is the call to make? Head injuries can be tricky, so there are signs to check for, look at and watch for to provide proper emergency first aid.
Head Injury – Traumatic Brain Injury – Concussion
When the head is struck against or by an object, a concussion can occur with unconsciousness or bleeding on, or around the brain. A head injury is defined as any trauma to the scalp, skull or the brain. This can be a minor bump on the head or a serious injury to the brain, and can be closed or an open penetration.
Types of Head Injuries
- Scalp Wounds
- Concussions – Traumatic Brain Injuries (TBI)
- Skull Fractures
Bleeding Can Occur
- In Brain Tissue
- In Brain’s Surrounding Layers – meninges three protective layers of tissue surrounding the brain – dura mater, arachnoid mater and pia mater
Subarachnoid Hemorrhage – The bleeding in the space between the brain and thin tissues covering the brain.
Subdural Hematoma – Collection of blood located in the space between the surface of the brain and the brain covering.
Extradural Hematoma (A.K.A. epidural haematoma) – Collection of blood forms between the skull and the dura mater.
Closed Injury – a hard blow to the head was received from a forceful impact with an object, but did not penetrate the skull (break it).
- a bump on the head from falling
- sports activity – head-butt, tackles, hits, etc.
- spinal injury – body “twisted” in an unnatural manner
Open Injury – penetration has occurred – the hard blow by an object to the head was forceful enough to break through the skull and enter into the brain.
- force from an auto accident – severe impact forces the head through the windshield
- gunshot to the head
Head injuries are a leading cause for emergency room visits accounting for more than one in six injuries related hospital admissions each year; children being a large number of victims. If serious head injury is suspected, three important things need to be taken care of right from the start.
- Signs – shock, skull fracture or concussion
- Immobilize – position victim to prevent further brain and spinal cord damage
- Avoid Infection – treat bleeding wounds and scalp cuts
Concussion Types – 3 Levels
Grade One – symptoms last under 15 minutes and remains conscious
Grade Two – symptoms last over 15 minutes and remains conscious
Grade Three – unconsciousness occurs (this can be a few seconds or longer)
When a situation occurs where a person has incurred a severe head injury and they need help, first aid steps should be taken to prevent the risk of further injury.
Head Injury First Aid
- Call 911 for immediate help.
- Check for unconsciousness, noting the length of time if present.
- Check to be sure the person’s airway is not blocked and is breathing. Perform breathing rescue if not breathing.
- Check the victim’s heart rate, perform CPR if not present and needed.
- Check the eyes, nose and ears for any type of bleeding – brownish in color can be a sign of internal hemorrhaging. If this is present, keep the victim face up in a prone position.
- If the victim is unconscious, but breathing treat as a spinal cord injury has occurred. Place both of your hands on either side of the head to stabilize and prevent movement until medical help arrives.
- If the victim is conscious and there is no evident neck injury, if possible place a pillow or some other type of “cushion” under the head and turn their face to the side.
- While waiting for help to arrive, treat any visible scalp wounds. As best as possible, thoroughly clean any cuts, use gauze to cover and apply tape securely without constricting the wounds.
- No skull fracture suspected – Cover with a clean cloth applying direct pressure. If the blood soaks through, place another cloth over it and resume direct pressure. Do not remove the first cloth.
- Skull fracture suspected – DO NOT apply direct pressure. DO NOT remove any intrusive object from the wound; cover with clean gauze or cloth.
- Look for any physical signs of brain injury.
- behaves out of the normal or personality change – dazed or “punch drunk”
- unconsciousness – brief or extended time
- slurred speech
- severe headache
- stiff neck
- dizziness or balance difficulties
- clumsiness or sluggishness
- urge to sleep – becomes very sleepy
- vision issues – double vision or vision loss
- light sensitivity
- unequal pupils
- ringing in the ears
- sound sensitivity
- bruising behind ears or around eyes
- clear (or bloody) liquid draining from nose, ear or mouth
- nausea or vomiting
- weakness in limbs
- paralysis in limbs – unable to move leg(s) or arm(s)
- concentration difficulties
- short-term memory loss
- If any signs are present listed in step-6 and professional medical help has not arrived yet, it is crucial to immobilize the victim to prevent further injury to the brain, spinal cord or the neck.
- Once the victim is released from medical care, watch for any of the symptoms in step-6 for at least 48-hours. If symptoms reoccur, the victim needs to seek emergency medical attention as quickly as possible.
- Wash a deep head wound or if it is bleeding a lot.
- Remove any penetrating object sticking out from the wound.
- Apply direct pressure to a skull fracture.
- Move the victim if not unavoidable.
- Shake the victim if dazed or “punch drunk”.
- Victims should not drink alcohol within 48 hours after the injury.
According to Harvard University, the minutes, to a few days following a concussion injury, there are brain cells not irreversibly destroyed and remain alive; however, they exist in a vulnerable state.
When a person has been unconscious from a head injury they may be very agitated when they wake up; the longer unconscious, the chances for heightened agitation. Once conscious again, it is common for the person to not remember what has happened or recognize family or friends. They may shake their head and kick their feet, but agitation is a good thing; it means there is brain activity and it is functioning. Keep them as calm and still as possible until medical help arrives.
When the victim is at a medical center and consciousness happens, and if they have tubes (IV for example) in their arm(s), they may attempt to pull them out. Again, this is a sign of brain activity and a positive sign.
In both instances above – pre and post professional medical attention – if an unconsciousness victim wakes up and there is no movement, or their eyes seem to stay focused off in the distance, there could be brain damage present.
Knowing what to do in emergencies can be difficult, but following the steps listed above will help if this situation occurs. Immediate action and taking proper steps to provide emergency first aid for head injuries can prevent further injury to a victim. It is always best for any injured victim to see the advice of a medical professional.