HEAD INJURY

HEAD INJURY


Victims of head injury can be divided into two groups, according to whether or not they have lost consciousness. Always be aware that the dazed or unconscious victim cannot protect his airway; you must be vigilant in your observation. The most common complication of head injury is obstruction of the airway with the tongue, blood, or vomitus. The most common associated serious injury is a broken neck.



LOSS OF CONSCIOUSNESS


If a person struck in the head has lost consciousness, he has suffered at least a concussion. The definition of a concussion is an immediate and temporary loss of consciousness accompanied by a brief period of amnesia after a blow to the head. The following signs and symptoms are commonly associated with a concussion: unaware of what happened; confusion; loss of memory (not typically including, however, one’s name and address); loss of consciousness; headache or sensation of pressure in the head; dizziness; balance problems; nausea; vomiting; feeling “foggy,” “dazed,” or “stunned;” visual problems (e.g., seeing stars or flashing lights, or seeing double); hearing problems (e.g., ringing in the ears); irritability or emotional changes; slowness or fatigue; inability to follow directions or slow to answer questions; easily distracted or poor concentration; inappropriate emotional behavior; glassy-eyed or vacant staring; slurred speech; seizure. With regard to the latter, a single brief seizure immediately following a concussion is not necessarily an ominous sign. Headache, dizziness, and difficulty concentrating may persist for weeks after a concussion, so the victim should not be in a position, such as lead climber, to put others at risk.




1. Protect the airway (see page 22) and cervical spine (see page 37).


2. If the victim wakes up after no more than a minute or two and quickly regains his normal mental status and physical abilities, he has probably suffered a minor injury—so long as there is no relapse into unconsciousness or persistent lethargy, nausea or vomiting, or severe headache. If the victim is far from help, he should undertake no vigorous activity and be kept under close observation for at least 24 hours. It is commonly taught that after someone has sustained a head injury with loss of consciousness (implying a concussion), he or she should be kept awake. It is also taught that if the victim falls asleep, he should be awakened regularly, presumably to demonstrate that he can be woken up, and has not worsened or lapsed into a coma. However, be aware that sleeping in and of itself has no influence on the progression of the head injury. Furthermore, some persons who have suffered a concussion (or worse) become sleepy. If they fall asleep, they will not worsen because they fall asleep. If they worsen, it is part of the progression of the head injury, not related in any way to sleep. You cannot keep someone awake forever, because they need sleep in order to rest.


So, if you are in a situation where you are assessing someone who has suffered a head injury to determine their neurologic status, you need to set reasonable intervals at which to perform the examinations. There is no magic number, but if you are concerned that someone is worsening, at least once an hour seems reasonable. Signs of worsening following a blow to the head include nausea and vomiting, blurred vision, increasing headache, and any change in mental status (e.g., declining alertness, ability to converse, or ability to follow commands; increasing confusion; or decreasing level of consciousness). If someone seems more sleepy than usual after a head injury, particularly if it is a child, perhaps difficult to assess and compounded with exhaustion, it is better to be safe than sorry. Bring that person to medical attention as soon as possible.

3. Confusion or amnesia for the event that caused the blackout is not uncommon and not necessarily serious, so long as the confusion does not persist for more than 30 to 45 minutes. Because a serious brain injury may not become apparent for hours, the wilderness traveler who has been knocked out should not venture farther from civilization for 24 hours. If headache or nausea persists beyond 2 to 3 hours, the victim should begin to make his way (assisted by rescuers) to medical care.


If the injury is minor and evacuation is not undertaken, advance the victim’s activity as follows: no activity and complete rest until without symptoms; next, light walking without any heavy lifting or resistance activity; next, mild exercise with slight resistance; finally, full activity. Do not progress beyond one “level” each 24-hour period.

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Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on HEAD INJURY

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