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Medical Information
>> Types of Traffic Accident Injuries >> Head
Injury
Alternative names: Concussion;
Brain injury; Head trauma
Definition: A head injury is any trauma that
leads to injury of the scalp, skull, or brain. These injuries
can range from a minor bump on the skull to a devastating
brain injury.
Head injury can be classified as either closed
or penetrating. In a closed head injury, the head sustains
a blunt force by striking against an object. A concussion
is a type of closed head injury that involves the brain.
In a penetrating head injury, an object breaks
through the skull and enters the brain. (This object is usually
moving at a high speed like a windshield or another part of
a motor vehicle.)
Considerations: Every year,
millions of people sustain 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 is often one or more other organ systems injured.
For example, a head injury is sometimes accompanied by a spinal
injury.
Causes: Accidents are the
leading cause of death or disability in men under age 35,
and over 70% of accidents involve head injuries and/or spinal
cord injuries.
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:
- Changes in personality, emotions, or mental
abilities
- Speech and language problems
- Loss of sensation, hearing, vision, taste,
or smell
- Seizures
- Paralysis
- Coma
- Symptoms Return to top
The signs of a head injury can occur immediately
or develop slowly over several hours. Even if the skull is
not fractured, the brain can bang against the inside of the
skull and be bruised. (This is called a concussion.) The head
may look fine, but complications could result from bleeding
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 that requires emergency medical treatment:
- Loss of consciousness, confusion, or drowsiness
- Low breathing rate or drop in blood pressure
- Convulsions
- Fracture in the skull or face, facial bruising,
swelling at the site of the injury, or scalp wound
- Fluid drainage from nose, mouth, or ears
(may be clear or bloody)
- Severe headache
- Initial improvement followed by worsening
symptoms
- Irritability (especially in children), personality
changes, or unusual behavior
- Restlessness, clumsiness, lack of coordination
- Slurred speech or blurred vision
- Inability to move one or more limbs
- Stiff neck or vomiting
- Pupil changes
- Inability to hear, see, taste, or smell
First Aid: Get medical help
immediately if the person:
- Becomes unusually drowsy
- Develops a severe headache or stiff neck
- Vomits more than once
- Loses consciousness (even if brief)
- Behaves abnormally
For a moderate to severe head injury, take
the following steps:
- Call 911.
- 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 (like acetaminophen
or ibuprofen) may be used for a mild headache. DO NOT take
aspirin, because it 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.
Call 911 if:
- 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 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.
- 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.
References:
- Marx JA, Hockberger RS, Walls RM, eds. Rosen’s
Emergency Medicine: Concepts and Clinical Practice. 5th
Ed. St. Louis, MO: Mosby; 2002.
- DeLee JC, Drez, Jr., D, Miller MD, eds. DeLee
and Drez’s Orthopaedic Sports Medicine. 2nd Ed. Philadelphia,
PA: Saunders; 2003.
- Goetz CG, Pappert EJ. Textbook of Clinical
Neurology. 2nd Ed. Philadelphia, PA: Saunders; 2003:1130-1134.
If believe you have a head injury as a result
of a traffic accident, it is important to visit a qualified
doctor to evaluate your injuries. Trying to "heal yourself"
could cause your body more harm.
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