Head Injuries 3: SKULL FRACTURE

If the mode of injury is a heavy blow to the head suspect a skull fracture. A skull fracture is a very serious injury due to the possibility of underlying damage to the brain. It is good practice to suspect a skull fracture for any casualty that has an obvious head wound or impaired consciousness - treat for the worst, hopefully it won't be that bad. Always suspect that a casualty with a severe head injury has a spinal injury too - maintain a neutral alignment of the casualty's neck and back.

Recognition:

• Wound or bruise to the head.
• Soft area or depression of the scalp.
• Bruising or swelling behind one ear.
• Bruising around one or both eyes.
• Loss of a clear, watery fluid (cerebrospinal fluid) from the ear (a very obvious tell tale sign).
• Blood shot eyes.
• Distortion or loss of symmetry about the head or face.
• Deteriorating responsiveness. Casualty may become unconscious.

Aims:

• To get urgent medical help.
• To maintain the casualty's airway and breathing.
  

Treatment:

• If the casualty is conscious help them to lie down. Support the casualty's head. Do not allow the head to rock or turn.
• Control any bleeding from the head by direct pressure.
• Send for urgent help. If you are by yourself go and summon help and return to the casualty quickly.
• If there is a discharge from the ear, lightly cover it with a sterile dressing or pad. Do not plug the ear.
• Monitor the casualty's responsiveness, airway, breathing and pulse. If the casualty stops breathing be prepared to perform resuscitation.

REMEMBER: Get help urgently and suspect a spinal injury.

Head Injuries 2: COMPRESSION

Cerebral compression is a build up
of pressure on the brain.

Cerebral compression is the condition when there is a build up of pressure pushing on the brain. This can be caused by bleeding in the skull or swelling of the brain tissue after a head injury. It can also occur as the result of an infection (eg. meningitis), stroke or brain tumour. Cerebral compression is a very serious condition and you must get help quickly.

Recognition:

• Probably (but not always) a history of head injury.
• Deteriorating level of response - casualty may become unconscious.
  

Possibly:

• Intense headache.
• Noisy breathing, becoming slow.
• Slow, yet full and strong pulse.
• Unequal pupil size.
• Weakness or paralysis down one side of the face or body.
• High temperature and flushed appearance.
• Drowsiness.
• Change of personality such as irritability or confusion.
  

Aim:

• Get urgent medical attention for the casualty

Treatment:

• Dial for an ambulance immediately.
• Monitor the casualty's level of responsiveness, breathing and pulse.
  
• Open and maintain the casualty's airway if necessary.
• Be prepared to give resuscitation if the casualty stops breathing.

DO NOT allow the casualty to eat, drink or smoke.

COMPRESSION NEEDS URGENT MEDICAL ATTENTION - SUMMON HELP IMMEDIATELY.

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Head Injuries 1: CONCUSSION

The brain is naturally cushioned in the skull by a surrounding fluid. If the head is suddenly or violently moved the brain if free to shake a little bit - this is concussion. Concussion is a common occurence on the sports field, traffic accidents, after falls or after being hit on the head.

This shaking produces a temporary disturbance to the normal brain activity. It doesn't normally result in long term damage, if recognised and treated correctly. Concussion may result in impaired consciousness, but this usually subsides quickly. Concussion can be confidently diagnosed when the casualty is seen to recover. A casualty who is concussed should be monitored and medical attention sought if they begin to vomit, develop a headache or blurred vision. A sports player who has suffered concussion should NEVER be encouraged to play on.

Recognition:

• Impaired consciousness following a blow to the head. The casualty will appear to recover shortly afterwards.
• There might also be dizziness, blurred vision, headache or a loss of memory.

Aims:

• To observe the casualty.
• Ensure a responsible person remains with the casualty until they recover.
• To obtain medical aid if there is any deterioration in the casualty's condition (see above).

Treatment:

• Monitor and record vital signs - level of response, pulse, and breathing. Even if the casualty appears to recover fully, watch them for subsequent deterioration in his level of response.
• When the casualty has recovered, place him in the care of a responsible person.
• Advise the casualty to go to hospital if, following a blow to the head, they later develop:
• headache,
• nausea,
• vomiting, or
• excessive sleepiness

If the casualty does not fully recover OR there is a deteriorating level of response after the initial recovery, call for an ambulance.