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Head injury - first aid

Definition

A head injury is any trauma that injures the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury.

Head injury can be either closed or open (penetrating).

A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

Head injuries include:

Concussion, the most common type of traumatic brain injury, in which the brain is shaken
Scalp wounds
Skull fractures

Head injuries may cause bleeding:

In the brain tissue
In the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, extradural hematoma)

Alternative Names

Brain injury; Head trauma

Causes

Common causes of head injury include:

Accidents at home, work, outdoors, or while playing sports
Falls
Physical assault
Traffic accidents

Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

Symptoms

Symptoms of a head injury can occur right away. Or symptoms develop slowly over several hours or days. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull.

In any serious head trauma, the spinal cord is also likely to be injured.

Some head injuries cause changes in brain function. This is called a traumatic brain injury. Concussion is a mild traumatic brain injury. Symptoms of a concussion can range from mild to severe.

First Aid

Learning to recognize a serious head injury and give basic first aid can save someone's life.

Get medical help right away if the person:

Becomes very sleepy
Behaves abnormally
Develops a severe headache or stiff neck
Has pupils (the dark central part of the eye) of unequal sizes
Is unable to move an arm or leg
Loses consciousness, even briefly
Vomits more than once

For a moderate to severe head injury, take the following steps:

Call 911 right away.
Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
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. Keep the head in line with the spine and prevent movement. Wait for medical help.
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.
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.
If the person is vomiting, to prevent choking, roll the person's head, neck, and body as one unit onto his or her side. 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.
Apply ice packs to swollen areas.

A more serious head injury that involves bleeding or brain damage must be treated in a hospital.

For a mild head injury, no treatment may be needed. Be aware though, symptoms of a head injury can show up later. Follow the instructions below under Home Care.

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 right away if:

There is severe head or face bleeding
The person is confused, tired, or unconscious
The person stops breathing
You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury

Home Care

Friends or family may need to keep an eye on adults who have been injured after they are released from the emergency room or office. If the person is an athlete, follow the health care provider's instructions about when the person can return to sports.

Parents or caregivers of children will need to learn how to keep an eye on the child after a head injury. Follow the health care provider's instructions on when the child can go back to being active and playing sports.

After even a mild concussion do not do activities that can cause further head injury. Avoid tasks that require concentration or complicated thinking. These include reading, homework, preparing reports, and other kinds of brain stimulation. Also avoid bright lights and loud sounds. These can overstimulate the brain. Your health care provider can tell you more.

Follow-Up

Keep all follow-up appointments with your health care provider. These help make sure you or your child is recovering well.

Prevention

Not all head injuries can be prevented. But the following simple steps can help keep you and your child safe:

Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
Learn and follow bicycle safety recommendations.
Do not drink and drive, and do not allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is impaired in another way.

References

Biros MH, Heegaard WG. Head injury. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 38.

Landry GL. Head and neck injuries. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 680.

Review Date: 1/1/2013
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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