Head injury can be classified as either:
In a closed head injury, the head sustains a blunt force by striking against an object.
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.)
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.
In patients who have suffered a head injury, there is often one or more other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury. Hence learning to recognise when someone has sustained a head injury and implementing treatment quickly can mean the difference between life and death.
Common causes of head injury include, Road traffic accidents, assaults, falls and accidents in the home, school and work environments.
Depending on the seriousness of the head injury people may recover quickly or in a minority of cases people can suffer from conditions that will affect their health and well being for the rest of their life. These can include:
- Speech and communication difficulties
- Loss of senses - Sight, Smell, Taste and Hearing
- Personality changes
- Permanent mental and physical disabilities.
Scalp wounds often appear a lot worse than they actually are due to the amount of blood coming from the injury. The reason for this is that the scalp is rich with blood vessels, so even a minor cut to the scalp can bleed profusely. These types of injury can be seen when attending to someone who has been in a fight or a person who has tripped and banged their head on a table edge.
Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.
Types of Fracture
- A simple fracture is a break in the bone without damage to the skin.
- A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
- A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.
- A compound fracture involves a break in, or loss of skin and splintering of the bone.
Your brain floats within your skull surrounded by cerebrospinal fluid, which cushions it from the light bounces of everyday movement. But the fluid may not be able to absorb the force of a sudden hard blow or a quick stop. A violent jar or shock to your head can cause a concussion. A concussion causes at least a temporary loss in brain function. Although losing consciousness is a common sign of a concussion, it's possible to suffer a concussion without being completely knocked out.
Concussion can be categorised as follows -
- Mild concussion occurs when the person does not lose consciousness (pass out) but may seem dazed.
- Slightly more severe form occurs when the person does not lose consciousness but has a period of confusion and does not recall the event.
- Classic concussion, which is the most severe form, occurs when the person loses consciousness for a brief period of time and has no memory of the event.
Compression happens when pressure inside the skull is abnormally high, which may cause damage to the brain. Compression can cause a decrease in blood flow to the brain. This Increase in pressure can also force the brain downward into the brainstem. This area controls vital functions like breathing, so this is a potentially fatal condition.
Compression may be caused by:
- Bleeding inside the skull
- Cerebral oedema
- Swelling of brain tissue from a contusion
- Vascular haematoma
- Blood Clots
Signs and Symptoms of a head injury
- Bleeding from wound, ears, nose, or around eyes
- Drainage of clear or bloody fluid from ears or nose
- Loss of consciousness
- Restlessness, irritability
- Slurred speech
- Difficulties with balance
- Visual disturbances
- Bruising behind the ears or under the eyes (Consider C spine immobilisation)
- Changes in pupils (sizes unequal, not reactive to light)
- Stiff neck (Consider C spine immobilisation)
Treat and stem the flow of any external haemorrhage, Consider treating patient with cervical collars and a spinal board, Check for neurological deficit i.e. pupil reaction, confusion, pins and needles etc, Observe and document all findings especially breathing, heart rate and blood pressure, Look for battle signs associated with base of skull fracture - blood or fluid from the ears, Treat as a stretcher case and position patient to facilitate postural drainage if necessary.
Transport to Hospital