Head Injury

Is this your symptom?

  • Injuries to the head, scalp, skull, and brain

Some Basics...

  • There are many types of head injuries.
  • Serious head injuries cause a person to lose consciousness or have other neurologic problems. People with serious head injuries should be seen in an emergency department.
  • There is always a chance that a person with a head injury also has a neck injury.
  • Treatment depends on the type of injury.

Types of Head Injury

  • Skin: Cut, scrape, bruise, or scalp hematoma ("goose egg").
  • Skull: Fracture.
  • Brain: Concussion and other injuries. Signs of these are loss of consciousness, amnesia, or other Acute Neurological Symptoms.

Acute Neurologic Symptoms: Call 911 if you have any of these after a head injury:

  • Trouble waking up
  • Confused or slow thinking and talking
  • Slurred speech
  • Weakness of arms or legs
  • Shaky walking

Pain Scale

  • None: No pain. Pain score is 0 on a scale of 0 to 10.
  • Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
  • Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
  • Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

What is a Concussion?

A concussion is confusion or change in mental state after a head injury. People do not always lose consciousness.

  • Symptoms: These may include headaches, an upset stomach, or feeling irritable and sleepy. Most often, these are felt during the first couple days after a concussion. Other symptoms include amnesia, poor memory, trouble staying focused, and decreased coordination. People may not feel like their normal selves. They may feel dizzy, tired, or dazed.
  • Diagnosis: This is done by a doctor. A CT scan may be needed. This is normal.
  • Return to Sports: See the guidelines below.
  • What to Expect: Most people who get a concussion fully recover. They will have no lasting problems. A person may have symptoms that last for weeks or months.

Sports-related Concussion and When to Return to Play

When it is safe to return to play (RTP) depends on the person. The athlete should be free of concussion symptoms at rest and during exertion before returning to full participation. RTP should follow a stepwise process as outlined in the Stages below.

The stepwise process through these stages may take days to weeks. Typically, each step should take 24 hours; a patient-athlete would typically take one week to proceed through the six stages assuming that he/she has no post-concussion symptoms. If concussion symptoms recur at any stage, then the patient should drop back to the previous level for another 24 hours.

  • Stage 1: No activity
  • Stage 2: Light aerobic activity (walking, swimming, stationary cycling)
  • Stage 3: Sports-specific exercise
  • Stage 4: Non-contact training drills
  • Stage 5: Full contact practice
  • Stage 6: Return to play

Multiple concussions will need more time to recover. Athletes with concussions are sidelined to stop them from getting a "second impact injury." This is a second concussion that happens within 1-2 weeks after the first one. The result can be deadly.

Warning!

  • Always consider the chance of a neck injury in people with head injuries.
  • Watch for neck pain and arm or leg numbness or weakness. These may be signs of a neck injury.

When to Call for Head Injury

Call 911 Now

  • Lasting NEUROLOGIC SYMPTOM, such as:
    • Trouble waking up
    • Confused or slow thinking and talking
    • Slurred speech
    • Weakness of arms or legs
    • Shaky walking
  • Seizure occurred
  • Knocked out (unconscious) for more than one minute
  • Neck pain after head injury
  • Deep penetrating wound (such as from a knife, gunshot wound, or sharp object)
  • Major bleeding (nonstop bleeding or spurting)
  • You think you have a life-threatening emergency

Call Doctor Now or Go to ER

  • Bleeding that won't stop after 10 minutes of direct pressure
  • Skin is split open or gaping and may need stitches
  • Dangerous injury (such as from a car crash, high fall, diving, or on a trampoline)
  • One or two "black eyes" (bruising, purple color of eyelids)
  • Large swelling
  • Taking a blood thinner like Coumadin (warfarin) or have a bleeding disorder
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Headache lasts more than 3 days
  • You think you need to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Last tetanus shot was over 10 years ago, for CLEAN cut or scrape
  • Last tetanus shot was over 5 years ago, for DIRTY cut or scrape
  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Care Advice for Minor Head Injury

  1. What You Should Know:
    • There are many types of head injuries. There is skin (scalp) and bone (skull) on the head. There is also tissue (brain) in the head. These can all be injured.
    • You can treat minor cuts, scratches, and bruises at home.
    • Here is some care advice that should help.
  2. Treatment of Minor Cuts, Scratches, and Scrapes:
    • Use direct pressure for 10 minutes to stop any bleeding.
    • Wash the wound with soap and water for 5 minutes.
    • Gently scrub out any dirt with a washcloth.
    • Put an antibiotic ointment on the wound daily.
  3. Treatment of Bruise or Hematoma ("goose egg"):
    • Cold Pack: For pain or swelling, use a cold pack or ice wrapped in a wet cloth. Put it on the sore area for 20 minutes. Repeat 4 times on the first day, then as needed.
    • Heat Pack:
      • If pain lasts over 2 days, apply heat to the sore area. Use a heat pack, heating pad, or warm wet washcloth. Do this for 10 minutes, then as needed.
      • For widespread stiffness, take a hot bath or hot shower instead. Move the sore area under the warm water.
  4. Observation: The person should be watched closely during the first 2 hours after the injury. You should wake him or her up 1 time every 4 hours for the first 24 hours. Check that he or she can walk and talk. It is normal for him or her to have a headache, upset stomach, or feel dizzy.
  5. Diet: Drink clear fluids at first in case you vomit. After 2 hours, you can go back to your normal diet.
  6. Pain Medicine:
    • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
    • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
    • Use the lowest amount of a drug that makes your pain feel better.
    • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
    • Read the instructions and warnings on the package insert for all medicines you take.
  7. What to Expect: Most head trauma only causes an injury to the scalp. Pain and swelling most often get better 2 to 3 days after an injury. Swelling is most often gone in 7 days. Pain may take 1 to 2 weeks to go away.
  8. Call Your Doctor If:
    • Pain becomes severe
    • Neurological Symptoms (see above) occur during the next 3 days
    • You think you need to be seen
    • You get worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Last Reviewed: 8/20/2017 1:16:09 AM
Last Updated: 5/17/2017 5:42:34 PM

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Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
First Aid - Bleeding Head
  • Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth.
First Aid - Neck Injury
  • Protect the neck from movement. Roll up towels (or blanket or clothing) and place them on either side of the head to keep the head from moving.
  • Don't move victim until a neck brace is applied.

Notes:

  • The Modified HAINES Position is preferable if the victim is vomiting or having trouble breathing. See: First Aid - Neck Injury (Modified HAINES)
First Aid - Neck Injury (Modified HAINES)

This position is termed the High Arm IN Endangered Spine or HAINES position.

Note that the this position has two significant differences when compared with the standard lateral recovery position:

  • The arm closest to the ground is fully outstretched and lies under the head
  • Both legs are flexed at the hip and the knee resulting in one lying on top of the other.

The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients in whom cervical spine injury may have occurred.

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