Head injuryDefinition 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:
Symptoms 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:
First Aid Get medical help immediately if the person:
For a moderate to severe head injury, take the following steps:
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
Call immediately for emergency medical assistance if Call 911 if:
Prevention
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. Illustrations
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