Head Injuries in Adults
Head injuries can vary from minor bumps and cuts on the scalp to fractured skulls and brain trauma. Fortunately, most head injuries are minor, but any blow to the head is cause for concern.
If you have any question about the severity of a person's head injury, the person should be seen by a health care provider or taken to the hospital.
A blow to the head caused by a fall or traffic accident can injure brain tissue, rupture blood vessels and break the bones of the skull. Damage to blood vessels may cause them to leak blood, increasing pressure inside the head. The damaged brain tissue swells, which further increases pressure.
Brain cells and nerves can also be damaged in a blow to the head. This damage can interfere with the brain's normal functioning and may cause temporary or permanent brain damage, coma or death.
These are some types of head injuries in adults:
Concussion. This is the most common type of head injury. In a concussion, the brain shifts, hitting the side of the skull. The harder the brain hits the skull, the more serious the concussion.
Contusion. This is a severe bruising or bleeding in one part of the brain.
Coup-contrecoup. This injury refers to bruising on both sides of the brain. It happens when the brain hits one side of the skull and then rebounds forcefully against the other side.
Fracture. Like a fracture elsewhere in the body, this is a cracked or broken bone. In this case, the bone is the skull.
Hematoma. This is a blood clot in the brain. Most bleeding in the brain causes almost immediate symptoms, but a slow leak of blood (called a subdural hemorrhage) may not cause any symptoms for days or weeks.
Symptoms
These symptoms, which can appear with seconds or minutes of a head injury, require immediate medical attention:
Loss of consciousness, even for a few seconds
Confusion, problems in concentrating or thinking
Vomiting
Depressed area on the head
Two black eyes
Blood coming from the ear
Double vision or disturbed vision
Poor coordination
Slurred speech
In addition to the symptoms listed above, there are symptoms that can occur hours or days after injury:
Headache that persists
Dizziness
Memory problems
Unable to tolerate loud noises or bright lights
Irritability or mood swings or depression and anxiety
Problems with balance
Ringing in the ears (Tinnitus)
Seizures
When to Call the Doctor
You should see your health care provider for any significant head injury, or if there is any question about the severity of the injury. The doctor will order an image of the brain by a CT or MRI scan. These scans greatly help in evaluating and treating head injuries. In addition, the doctor will order a thorough neurological exam and evaluation. These procedures will determine whether you are admitted to the hospital or sent home to be watched closely. If you are allowed to return home, someone will need to watch you for at least 24 hours, and a follow-up visit may be scheduled. Be alert for any of these signs: headache, extreme drowsiness, difficulty walking or talking, neck pain, vomiting, a fever of greater than 101 F, blurred vision or seizures.
First Aid
For obviously mild head injuries:
Use an ice bag to ease the swelling of a bump.
Don't take any medicine before you talk with your doctor.
Limit activity for 24 hours.
Wake a child every hour or two to make sure that he or she is responsive.
Wake an adult every few hours to check breathing and responsiveness. Ask for the person's name, age, and address to make sure he or she is not confused.
Clean and bandage the wound.
For significant or obviously severe head injuries:
Immediately take the person to the nearest emergency room, or call 911.
Don't try to move the person if you suspect an injury to the neck or spine.
If the person is conscious, keep the person calm and still until medical help arrives.
If the person is bleeding, apply a dressing with gentle pressure. DO NOT apply pressure if the skull appears fractured or indented. You can cover the area with a clean cloth or dressing.
DO NOT attempt to remove an object that has penetrated the skull.
If the person is not breathing or has no pulse, begin CPR until medical help arrives.
First Aid for Neck or Back Injury
Back and neck injuries often occur at the same time as a head injury. Call 911 right away, then stay with the person. Don't move anyone with a head, neck, or spine injury, unless you think he or she is in danger. If you can, wait for professional help. If you must move the person to keep him or her safe, use these steps:
Be careful not to allow the head, neck, or back to move.
Use a heavy towel or scarf to make a collar around the neck.
Slide a wide and rigid board under or behind the person. A table leaf or a door will do. * Whatever you use should give solid support from the head to the buttocks. If you can, have several people work as a team. They should support the head and neck and keep both head and neck level with the back.
Use broad straps to secure the person to the board. Wide belts or ties will work.
Treat for shock.
Decision guide for Head InjuriesSymptoms/Signs | Action |
|---|
A slight bump or knot that causes minor discomfort | Use self-care |
Bleeding from the scalp that lasts more than 10 minutes, even when pressure is applied | See provider |
Bad headache or neck pain | Seek help now |
Headaches that get worse or vomiting | Seek help now |
Bloody or clear liquid draining from the nose or ears | Seek help now |
Fever rising to about 101F | Call 911 |
Neck or back injury | Call 911 |
Seizures | Call 911 |
Confusion, dazed look, or difficulty waking | Call 911 |
Difficulty walking or talking | Call 911 |
Blurred vision or pupils that are not the same size | Call 911 |
Difficulty breathing | Call 911 |
Loss of consciousness | Call 911 |
