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Head Trauma, First Aid
Injuries to the head can involve any or all parts of the head: the scalp, skull, brain, spinal fluid, and blood vessels. Head trauma can be internal or external, or both. External injuries can cause a fractured skull. An internal injury, such as the brain hitting the inside of the skull, can cause bleeding within the skull.
A blow severe enough to affect the head is also likely to affect the neck. When dealing with head trauma, it is of utmost importance to take care for potential neck/spinal injury.
First Aid Guide
If you suspect either a serious head injury or a neck injury, contact emergency medical services. In the case of a potential neck injury, it is very important to not move the person unless it is absolutely necessary. The following first aid steps should be taken while awaiting emergency medical care:
- Check the person’s airway, breathing, and circulation.
- Encourage the person to lie still if he/she is conscious; if the person is unconscious, stabilize his/her head and neck by holding your hands on either side of the head and preventing any movement.
- If there is any bleeding, attempt to stop it.
- For any superficial trauma to the scalp, use a clean bandage and apply direct pressure.
- For a suspected fractured skull, cover the wound with a clean bandage without applying pressure. Note: Do not attempt to remove any foreign object that may be in the wound.
- If the person vomits, as is common after head trauma, attempt to protect his/her airway so he/she does not choke or inhale it.
- If the person is conscious and neck injury is not suspected, lean him/her forward and place support on the person’s forehead.
- If the person is conscious and neck injury is suspected, support his/her neck and head, and roll the person to the side.
- If the person is unconscious, assume the person has a neck injury, and support his/her neck and head, and roll the person to the side.
- If there are signs of swelling on the head, apply ice.
In the case of a suspected minor head injury, such as a bump on the head in the case of a child, apply ice to the area of swelling, and observe the person for at least 24 hours. Symptoms may be delayed in some cases of serious head trauma. The following should be followed during observation:
- Ask the person what their symptoms are, if possible.
- If the person wants to sleep, allow him/her to do so, but wake the person every 2–3 hours and check for alertness by asking questions such as what their address or phone number is.
- Have the person eat easy-to-digest foods and avoid nonprescription medications.
- Continue to observe the person for signs of more serious injury (ie, vomiting more than once, confusion, severe headache, stiff neck, excessive drowsiness, or otherwise behaving abnormally).
Note: Do not allow the person to drink alcohol within 48 hours of the head trauma.
Who's At Risk?
Anyone can be at risk for head trauma. Those who play sports and young children, particularly those learning to walk, are especially prone to head injuries.
Signs & Symptoms
Head trauma can present in many different ways depending on the severity and the type of injury. Many symptoms of head trauma are as follows:
- Bleeding, denting, and other obvious signs of trauma, including bleeding from ears, nose, or mouth. (Note: the amount of blood from the injury is not necessarily indicative of the severity of the injury.)
- Severe headache
- Persistent vomiting
- Decreased alertness of the individual, including lapses in consciousness, drowsiness, or slurred speech
- Stiff neck
- Unequal pupil size
- Unusual eye movements
- Weakness or inability to use an arm or leg
- Slow breathing
In infants, look for swelling of the head, particularly in the soft spot in the skull (the fontanel) at the top of the head. Children are prone to head injuries but are particularly resilient against them. If a child gets a bump on the head and then shows any of the above symptoms or is acting less energetic in the next 24 hours, it may be a sign of a more serious injury.
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Treatment for head trauma varies widely depending on the severity and location of the injury.
For minor head trauma, the physician will likely numb and clean any cuts and search for any foreign objects in the affected area. If necessary, any cuts will be closed with stitches, staples, or a special kind of glue. The patient will likely be given a pain reliever, such as acetaminophen (Tylenol®), and prescribed bed rest, ice for any swelling, and fluids.
Severe head trauma will require observation and tests. Internal injury can cause pressure in the skull, which can be very dangerous and even cause death. The physician will probe to check for such pressure. Surgery may be needed in such a case.
Seizures may result and will be treated accordingly.
The physician may give a tetanus shot if there is a wound that is dirty or deep, if the previous shot was more than 5 years ago. If infection occurs at the wound site, antibiotics will be given.
If head trauma is severe and/or a neck injury is suspected, seek emergency medical care.
If the head trauma does not appear to be severe and no neck injury is suspected, observe the person as specified in the above self-care measures. If severe symptoms develop over the next 24 hours (or more), seek medical help immediately.
While children are particularly resilient to minor head trauma, it is important to watch their behavior carefully following an injury to the head since they often can’t express their symptoms in words. A good rule of thumb is that if the child is not acting like his or herself shortly after the injury or any time within the 24 hours following the injury, seek medical attention.