HEAD INJURIES

HEAD INJURIES

Introduction

All head injuries are potentially serious and require proper assessment because they can result in impaired consciousness. Injuries may be associated with damage to the brain tissue or to blood vessels inside the skull, or with a skull fracture.

A head injury may produce concussion, which is a brief period of unconsciousness followed by complete recovery. Some head injuries may produce compression of the brain (cerebral compression), which is life-threatening. It is therefore important to be able to recognise possible signs of cerebral compression - in particular, a deteriorating level of response.

A head wound should alert you to the risk of deeper, underlying damage, such as a skull fracture, which may be serious. Bleeding inside the skull may also occur and lead to compression. Clear fluid or watery blood leaking from the ear or nose are signs of serious injury.

Any casualty with an injury to the head should be assumed to have a neck (spinal) injury as well and be treated accordingly.

1. Concussion

Introduction

The brain is free to move a little within the skull, and can thus be 'shaken' by a blow to the head. This shaking is called concussion.

Among the common causes of concussion are traffic incidents, sports injuries, falls, and blows received in fights.

Concussion produces widespread but temporary disturbance of normal brain activity. However, it is not usually associated with any lasting damage to the brain. The casualty will suffer impaired consciousness, but this only lasts for a short time (usually only a few minutes) and is followed by a full recovery. By definition, concussion can only be confidently diagnosed once the casualty has completely recovered.

A casualty who has been concussed should be monitored and advised to obtain medical aid if symptoms such as headache or blurred vision develop later.

Recognition

• Brief period of impaired consciousness following a blow to the head.

There may also be :

• Dizziness or nausea on recovery.
• Loss of memory of events at the time of, or immediately preceding, the injury.
• Mild, generalised headache.

Your aims

• To ensure the casualty recovers fully and safely.
• To place the casualty in the care of a responsible person.
• To obtain medical aid if necessary.

Treatment

• Check the casualties level of response using the AVPU code:
• A - Is the casualty alert, eyes open and responding to questions?
• V - Does the casualty respond to voice, obey simple commands?
• P - Does the casualty respond to pain (e.g. eyes open or movement in response to being pinched)?
• U - Is the casualty unresponsive?
• Regularly monitor and record vital signs - level of response, breathing and pulse. Even if the casualty appears to recover fully, watch them for any deterioration in their level of response.
• When the casualty has recovered, place them in the care of a responsible person. If a casualty has been injured on the sports field, never allow them to 'play on' without first obtaining medical advice
• Advise the casualty to go to hospital, if following a blow to the head they develop symptoms such as headache, vomiting, confusion, drowsiness or double vision.

Warning: if the casualty does not recover fully, or if there is a deteriorating level of response after an initial recovery dial 999 for an ambulance.

2. Cerebral compression

Introduction

Compression of the brain - a condition called cerebral compression - is very serious and almost invariably requires surgery. Cerebral compression occurs when there is a build-up of pressure on the brain. This pressure may be due to one of several different causes, such as an accumulation of blood within the skull or swelling of injured brain tissues.

Cerebral compression is usually caused by a head injury. However, it can also be due to other causes, such as stroke, infection, or a brain tumour.

The condition may develop immediately after a head injury, or it may appear a few hours or even days later. for this reason, you should always try to find out whether the casualty has a recent history of a head injury.

Recognition

• Deteriorating level of response - casualty may become unconscious.

There may also be :

• History of a recent head injury.
• Intense headace.
• Noisy breathing, becoming slow.
• Slow, yet full and strong pulse.
• Unequal pupil size.
• Weakness and/or paralysis down one side of the face of body.
• High temperature; flushed face.
• Drowsiness.
• Noticeable change in personality or behaviour, such as irritability or disorientation.

Your aim

• To arrange urgent removal of the casualty to hospital.

Treatment

• Dial 999 for an ambulance.

If the casualty is conscious:

• Keep them supported in a comfortable resting position and reassure them.
• Regularly monitor and record vital signs - level of response, pulse, and breathing - until medical help arrives.

If the casualty is unconscious:

• Open the airway using the jaw thrust method and check breathing (primary survey).
• Be prepared to give chest compressions and rescue breaths if necessary.
• If the casualty is breathing, try to maintain the airway in the position the casualty was found.

3. Skull fracture

Introduction

If a casualty has a head wound, be alert for a possible skull fracture. An affected casualty may have impaired consciousness.

A skull fracture is serious because there is a risk that the brain may be damaged either directly by fractured bone from the skull or by bleeding inside the skull. Clear fluid (cerebrospinal fluid) or watery blood leaking from the ear or nose are signs of serious injury.

Suspect a skull fracture in any casualty who has received a head injury resulting in impaired consciousness. Bear in mind that a casualty with a possible skull fracture may also have a neck (spinal) injury and should be treated accordingly.

Recognition

• Wound or bruise on the head.
• Soft area or depression on the scalp.
• Bruising or swelling behind one ear.
• Bruising around one or both eyes.
• Clear fluid or watery blood coming from the nose or an ear.
• Blood in the white of the eye.
• Distortion or lack of symmetry of the head or face.
• Progressive deterioration in the level of response.

Your aims

• To maintain an open airway.
• To arrange urgent removal of the casualty to hospital.

Treatment

If the casualty is conscious:

• Help them to lie down.
• Do not turn the head in case there is a neck injury.
• Control any bleeding from the scalp by applying pressure around the wound.
• Look for and treat any other injuries.
• Dial 999 for an ambulance.
• If there is discharge from an ear, cover the ear with a sterile dressing or clean pad, lightly secured with a bandage. Do not plug the ear.
• Monitor and record vital signs - level of response, pulse, and breathing - until medical help arrives.

If the casualty is unconscious:

• Open the airway using the jaw thrust method and check for breathing (primary survey).
• Be prepared to give chest compressions and rescue breaths if needed.
• Dial 999 for an ambulance.
• If the position in which the casualty was found prevents maintenance of an open airway or you fail to open it using the jaw thrust, place her in the recovery position. If you have helpers, use the "log-roll" technique.