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Head injury

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Brain injury; Head trauma; Contusion

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:

1. Call 911.
2. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR .
3. 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.
4. 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.
5. 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.
6. 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.)
7. 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 immediately for emergency medical assistance if:

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.

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.

• Review Date: 1/8/2007
• Reviewed By: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network.

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