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Head injuries are a common problem, and in some cases, they require little treatment but always be aware that problems can be not that easy to find for the first aider. Your brain is a very sensitive organ, and it's surrounded by solid bone, the skull, and it has fluid to protect the brain further. You should always suspect spinal injury with a head injury as you need to assess the way that the injury happened and make your decision if spinal injury could have happened. People can be at different conscious levels when they could be fully alert, dazed, or they could appear unconscious but be able to hear fully, or they could even be unconscious. When dealing with a head injury, you need to find out what level of consciousness the patient has. You can use the AVPU scale to make an assessment. "A" Are they alert? This means, are they alert enough but not necessarily orientated. Are the eyes open, and do they respond to questions? "V" Voice. Do they respond to voice? Can they answer simple questions or commands? The "P" stands for pain. Do they respond to touch or pinching? This could be where you pinch them and their eyes are open. And finally, the "U" stands for unresponsive. This is where the patient does not give any eye or voice or motor responses. You ideally need to record your findings and repeat your assessment so you can report if the condition's improving or deteriorating. If you have any concerns activate emergency services as head injuries can be very serious. On, your head! [vocalization] Are you all right? Yeah, I think so. Just a knock to the head. Are you alright Taylor? No, no. Yeah, I don't feel well. Any other parts of your body hurting? No, it's just... Just my head. Well, I'm just going to look into your ears and nose. I can't see very clearly. Dave, can you go and grab the bag and coat I think we need to elevate his head. I think it’s looking quite serious. Just stay still don't move. Don't move. Can I have the bag as well... Sit him upright... You ready to sit up with us. After three, we'll get you up. Ready, one two three... [vocalization] Is that comfortable? Yeah, that's good. Damien, can you call the emergency services? Yeah. And just tell them what's happened. Okay. All right. What did they say? Well, I've spoken to emergency services, and they're on their way. So that's good news. We just need to comfort you and keep you warm until they arrive. All right. Put my coat over you and hopefully, a nice furry jacket will keep you nice and warm. I don't feel too well, guys. You're doing well. When dealing with a patient take care of them and monitor the patient carefully. Sometimes they can act out of character maybe in an aggressive manner. And there's not always an obvious injury site, as it may be a result of shock through the spine from an impact on their feet and the impact of those feet transmits up through the spine to the base of the skull. There are different types of head injury, and the first one we'll look at is a concussion. The brain can move a little and the shaking of the brain due to a blow to the head can because of concussion. A concussion usually produces a temporary disturbance to the normal brain function. Symptoms of concussion can be from mild to severe, and in some cases, emergency treatment may be needed. The most common symptoms of concussion are: A headache and dizziness; nausea and loss of balance; confusion; difficulties with memory; and finally, feeling dazed or stunned. Cerebral compression is when the pressure on the brain, caused by swelling or bleeding, and this is a serious condition. The swelling can be due to a buildup of blood within the skull or swelling of the injured brain tissues. Cerebral compression is usually caused by head injury, but it can also be caused by a stroke, brain tumour, or infection. Cerebral compression can occur immediately after the head injury or after a few hours. Signs and symptoms include: A change in personality; deteriorating levels of consciousness; noisy breathing which becomes slow; an intense headache; vomiting; drowsiness; the pulse will be slow but strong; unequal pupils; weakness or paralysis down one side of the body; and finally, tiredness and an evidence of injury. Cerebral contusion is where there's bruising on the brain, and this happens in about 20% to 30% of all head injuries. Blood vessels in the brain get damaged and leak causing a pressure build-up. Signs and symptoms would depend on the location of the contusion on the brain, but they'll include: Motor coordination problems, numbness, and memory problems. Skull fractures is where the skull is fractured due to direct or indirect force. There is sometimes blood which is straw coloured or clear fluid coming from the ears or the nose. Blood in the whites of the eyes and evidence of impact or depression or bruise. The treatment for head injuries is basically the same. Be aware that there could be spinal injury. Treat for bleeding, activate the EMS, lie the patient down with their head and shoulders raised, monitor the patient's breathing, and do not give them any food or drink. Finally, it's worth mentioning what to do if the patient is wearing a helmet. A helmet could be a cycle helmet, riding helmet, or full motorcycle helmet. These are very good ways of reducing head injuries and they're best left on, as by removing them you can make things worse or put extra strain on the neck. The reason you would want to remove the helmet is if you cannot maintain an airway or if they're not breathing. If you do need to remove the helmet, you must do this slowly and carefully, ideally with two people. First, make sure you remember to remove the strap and have a good look to see what you're doing. Then one person holds the helmet and the other supports the neck as the helmet is removed. Keep the helmet, as it usually goes to the hospital with the patient, as the marks on the helmet can be an indicator of what's happened.
Head Injuries: First Aid Guide
Introduction
Head injuries are relatively common, and their severity may not always be immediately apparent to a first aider. It's crucial to handle them with caution due to the brain's sensitivity and the potential for spinal injury.
1. Suspecting Spinal Injury
Always consider the possibility of spinal injury when dealing with head injuries. Assess the injury's circumstances carefully.
2. Assessing Consciousness with AVPU
To gauge the patient's level of consciousness, use the AVPU scale:
- A - Alert: Are their eyes open, and do they respond to questions?
- V - Voice: Do they respond to voice or simple commands?
- P - Pain: Do they react to touch or pinching?
- U - Unresponsive: If they don't respond to voice or pain.
Record your findings and reassess to report any changes to their condition.
3. Activating Emergency Services
If you have any concerns or the head injury seems serious, activate the emergency services immediately. Head injuries can be severe.
4. Monitoring a Head Injury
A head injury might not have an obvious site. Monitor the patient carefully as they may act out of character, potentially being aggressive.
5. Recognizing Concussion
Concussion can result from head injuries. Symptoms can range from mild to severe, and emergency treatment may be necessary.
The common symptoms of concussion include:
- Nausea and loss of balance
- Confusion
- Memory difficulties
- Feeling dazed or stunned
6. Identifying Cerebral Compression
Cerebral compression involves pressure on the brain due to swelling or bleeding, and it's a severe condition. It can be caused by head injuries, strokes, brain tumours, or infections.
Signs and symptoms of cerebral compression include:
- Personality changes
- Deteriorating consciousness
- Slow and noisy breathing
- Intense headache
- Vomiting
- Drowsiness
- Unequal pupils
- Weakness or paralysis on one side of the body
7. Understanding Cerebral Contusion
Cerebral contusion involves brain bruising, occurring in 20-30% of serious head injuries. It results from damaged blood vessels and can lead to motor coordination, numbness, and memory problems.
8. Recognizing Skull Fractures
Skull fractures result from direct or indirect force, sometimes causing clear fluid or blood from ears and nose. Seek immediate medical attention in such cases.
9. Basic Treatment for Head Injuries
The general approach for head injuries is consistent:
- Consider potential spinal injury.
- Treat any bleeding.
- Activate emergency services.
- Lie the patient down with head and shoulders raised.
- Monitor breathing.
- Avoid giving food or drink.
10. Dealing with Helmets
If the patient is wearing a helmet (e.g., cycle, riding, or motorcycle helmet), leave it on unless it obstructs the airway or if they aren't breathing.
If helmet removal is necessary, do it slowly and carefully with two people. Note any marks on the helmet as they may provide insight into the injury.