Head Injuries

Alternative Names

Brain injury; Head trauma; Contusion

Definition

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

Head injury is classified as either closed or open (penetrating).

A closed head injury means you received a hard blow to the head from
striking an object, but the object did not break the skull.
An open, or penetrating, head injury means you were hit with an object that
broke the skull and entered the brain. This usually happens when you move at
high speed, such as going through the windshield during a car accident. It can
also happen from a gunshot to the head.

There are several types of brain injuries, including:

Concussion, the most common type of traumatic brain
injury, in which the brain is shaken
Contusion, which is a bruise on the brain

See also:

Considerations

Every year, millions of people have 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 are often other
organ systems injured. For example, a head injury is sometimes accompanied by a
spinal injury.

Causes

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:

Coma
Chronic headaches
Loss of or change in sensation, hearing, vision, taste, or smell
Paralysis
Seizures
Speech and language problems

Symptoms

The symptoms of a head injury can occur immediately or develop slowly over
several hours or days. Even if the skull is not fractured, the brain can bang
against the inside of the skull and be bruised. The head may look fine, but
complications could result from bleeding or swelling 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 -- other than a
concussion or contusion -- and require emergency medical treatment:

Changes in, or unequal size of pupils
Convulsions
Distorted features of the face
Fluid draining from nose, mouth, or ears (may be clear or bloody)
Fracture in the skull or face, bruising of the
face, swelling at the site of the injury, or scalp wound
Impaired hearing, smell, taste, or vision
Inability to move one or more limbs
Irritability (especially in children), personality changes, or unusual
behavior
Loss of consciousness, confusion, or drowsiness
Low breathing rate or drop in blood pressure
Restlessness, clumsiness, or lack of coordination
Severe headache
Slurred speech or blurred vision
Stiff neck or vomiting
Symptoms improve, and then suddenly get worse (change in consciousness)

First Aid

Get medical help immediately if the person:

Becomes unusually drowsy
Behaves abnormally
Develops a severe headache or stiff neck
Loses consciousness, even briefly
Vomits more than once

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

Call 123.
Check the person's airway, breathing, and circulation. If necessary, begin
rescue breathing and CPR.
If the person's breathing and heart rate are normal
but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your
hands on both sides of the person's head, keeping the head in line with the
spine and preventing movement. Wait for medical help.
Stop any bleeding by firmly pressing a clean cloth on the wound. If the
injury is serious, be careful not to move the person's head. If blood soaks
through the cloth, DO NOT remove it. Place another cloth over the first one.
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.
If the person is vomiting, roll the head, neck, and body as one unit to
prevent choking. This still protects the spine, which you must always assume is
injured in the case of a head injury. (Children often vomit ONCE after a head
injury. This may not be a problem, but call a doctor for further guidance.)
Apply ice packs to swollen areas.

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, such as acetaminophen, may be used for a mild
headache. DO NOT take aspirin, ibuprofen, or other anti-inflammatory medications
because they can increase the risk of bleeding.

DO NOT

DO NOT wash a head wound that is deep or bleeding a lot.
DO NOT remove any object sticking out of a wound.
DO NOT move the person unless absolutely necessary.
DO NOT shake the person if he or she seems dazed.
DO NOT remove a helmet if you suspect a serious head injury.
DO NOT pick up a fallen child with any sign of head injury.
DO NOT drink alcohol within 48 hours of a serious head injury.

When to Contact a Medical
Professional

Call 123if:

There is severe head or facial bleeding
The person is confused, drowsy, lethargic, or unconscious
The person stops breathing
You suspect a serious head or neck injury or the
person develops any signs or symptoms of a serious head injury

Prevention

Always use safety equipment during activities that
could result in head injury. These include seat belts, bicycle or motorcycle
helmets, and hard hats.
Obey traffic signals when riding a bicycle. Be predictable so that other
drivers will be able to determine your course.
Be visible. DO NOT ride a bicycle at night unless you wear bright,
reflective clothing and have proper headlamps and flashers.
Use age-appropriate car seats or boosters for babies and young children.
Make sure that children have a safe area in which to play.
Supervise children of any age.
DO NOT drink and drive, and DO NOT allow yourself to be driven by someone
who you know or suspect has been drinking alcohol or is otherwise impaired

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