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First Aid: Head injuries

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First Aid: Head injuries

Treat any suspected head injury with the utmost caution, as they have the potential to be very serious. Head injuries often lead to unconsciousness and all the attendant problems. Also, head injuries can cause permanent damage to the brain. The three main areas of concern with head injuries are concussion, compression and a fractured skull

Head injuries may also be associated with neck and spinal injuries, so they must be treated with the utmost caution


Concussion occurs when the brain is violently shaken. Our brains are cushioned within our skulls by ‘cerebral-spinal fluid’ (CSF), so any blow to the head can cause the brain to bang against the skull which disrupts its usual functions. A casualty may pass out briefly (no more than 2-3 minutes), and when they come round their level of response should return to normal. Concussion casualties should return to normal if no complications arise. However, a concussed casualty should not be left on their own and should ideally be monitored for 24 hours. No sporting activity should be undertaken for at least three weeks after a concussion.

  • Casualty is unconscious for short period, after which response levels are back to normal, recovery is usually quick
  • Short term memory loss, groggy, confused irritable.
  • Mild headache
  • Pale, clammy to the touch.
  • Shallow to normal breathing
  • Rapid, weak pulse.
  • Pupils are normal and react to light
  • Nausea and vomiting can occur on recovery.


Compression injuries are very serious, as the brain is under extreme pressure which is caused by bleeding or swelling in the cranial cavity. Compression can arise from a skull fracture or head injury, but can also be brought on by illness (type of stroke, brain tumor, meningitis, etc.).

  • Possible history of recent head trauma with recovery, followed by deterioration
  • Response level deteriorates as the condition develops.
  • Severe headache.
  • Flushed, dry skin.
  • Deep, slow and noisy breathing (due to pressure on brain).
  • Slow, strong pulse caused by raised blood pressure.
  • One or both pupils may dilate as pressure on the brain increases
  • As condition worsens, fitsmay occur, with no recovery.

Fractured skull

Fractures to the skull are very serious as the broken bone of the skull can cause direct damage to the brain which can cause bleeding and therefore compression. Treat any casualty who has had a head injury, and whose response level is low, as having a fractured skull.

  • Casualty may suffer from concussion or compression also, so symptoms of these may be present.
  • Bleeding, swelling or bruising of the head.
  • Soft, egg shell feeling of the scalp.
  • Bruising apparent around the eyes. ‘Panda eyes’.
  • Bruising or swelling behind one or both ears
  • Blood or fluid coming from an ear or the nose.
  • Deformity or lack of symmetry of the head.
  • Blood visible in the white of the eye.

Treatment of head injuries

Keep in mind that a casualty with any head injury may well be suffering from neck and spine injuries also. Treat the casualty with the utmost care, and call for an ambulance immediately.

· If the casualty is or has been unconscious, you suspect a fractured skull, or their responses deteriorate CALL AN AMBULANCE IMMEDIATELY.

· Keep their airway clear and monitor their breathing.

· If the casualty is unconscious, and you don’t wish to move them as you suspect a neck injury, you can use the jaw thrust method of keeping the airway clear

· If you are unable to use the jaw thrust method, and you cannot keep the airway clear, put the casualty in the recovery position but make sure the head, neck and body are in line as you turn them to avoid any further damage to a neck or spinal injury.


· If the casualty is conscious, you can help them lie down, making sure to keep the head and neck in line with the body. You can help stop any movement of their head by placing your hands on either side of the head and keeping it still.

· If there is bleeding, help to control it by applying pressure directly to or around the wound. However, if there is blood or fluid coming from an ear, do not try to stop the flow, as the fluid must be allowed to drain.

· If there are any other injuries on the casualty, attempt to treat these. Some tips for treating head injuries:

· Monitor the casualty’s breathing, pulse and response levels. If the casualty appears to recover, monitor them closely as they may well deteriorate and their response levels drop.

· If a casualty has been concussed, try to make sure they are not left alone for the next 24 hours. Advise them to seek medical help as soon as possible.

· If a casualty suffers any of the following in the few days after concussion, they should go to A&E immediately: worsening headache, nausea or vomiting, drowsiness, weakness in a limb, problems speaking, dizzy spells, blood or fluid from an ear or the nose, problems seeing, seizures or confusion.

· If the concussion is received playing sports, do not allow the concussed player to continue until they have seen a doctor. Usually, concussed players are not allowed to participate for up to three weeks after being concussed.

Scalp injuries

Wounds of the scalp even if small tend to profusely bleed. Deep scalp wounds may be complicated by fragment from skull fractures or they may contain hair, glass or other foreign material.

First aid measures

• Do not try to clean scalp wounds.

• Control bleeding by raising the victim’s head and shoulder; do not bend the neck (fracture may be present).

• Place a sterile dressing on the wound.

• Apply a bandage to hold the dressing in place and to provide pressure.

Brain injury

May occur not only from wounds of the scalp and open or closed fracture of the skull, but also in the case of an illness such as a stroke or tumor.

Signs and symptoms

Clear or blood tinged cerebrospinal fluid draining from the nose or ears following skull fracture.

• Temporary loss of consciousness.

• Other manifestations of brain injury includes: Partial or complete paralysis of muscle of extremities of the opposite side and facial paralysis on the same side of brain injury; Disturbance of speech; Local or generalized convulsions.

Bleeding from the nose, ear canal or mouth which is indicative of skull fracture.

• Pale or flushed face.

• Fast and weak pulse.

• Headache and dizziness.

• Vomiting.

• Unequal size of pupils.

• Loss of bowel and bladder control.

First aid for suspected brain injury

• Call for ambulance, and obtain medical assistance as quickly as possible.

• Keep the victim lying down and treat for shock.

• Give particular attention to insuring an open air way.

• Control hemorrhage.

• Do not give fluid by mouth to the victim (keep NPO).

• Apply dressing and bandage over the skull if wound is present.

• Record the level of consciousness.

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