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Head Injury

Is this your symptom?

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

Types of Head Injuries

  • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. Big lumps and bruises can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.
  • Skull Fracture (serious). Not all people with head injuries will have a skull fracture. Some fractures are more serious than others. Most often, the only symptom is a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily. Other fractures are more severe and involve injury to the brain or the blood vessels on the surface of the brain. Blood clots that form due to brain injury may need surgery to release the pressure they cause. Fractures in the base of the skull can be difficult to spot. Signs of a fractured base of skull include a watery or bloody discharge from the nose or ears, bruising around both eyes and/or bruising behind the ears. If this type of fracture is not found and treated, it can lead to later problems, such as infection, epilepsy and/or brain damage. If a head injury has resulted in a possible fracture, a CT scan is often recommended.
  • Concussion. A concussion is a type of brain injury. It causes a change in how the brain works for a short time. It is usually caused by a sudden blow or jolt to the head. Most people bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache, vomiting, dizziness or acting dazed. A person does not need to be knocked out to have had a concussion. Following a concussion, some people have ongoing symptoms. These can include headaches, dizziness, thinking difficulties or emotional changes. These symptoms can last for several weeks.
  • Brain Injuries (serious) are uncommon. This includes bleeding, bruises or swelling within the brain. They are suspected by the symptoms listed below:
    • Hard to wake up or keep awake or
    • Acts or talks confused or
    • Slurred speech or
    • Weakness of arms or legs or
    • Walking is not steady
    • Increasing headache
    • Persistent vomiting.
  • These symptoms are an emergency. If they happen, call 911.
  • Neck Injury (serious). Any head injury also has the risk of a neck injury. These can range from a mild sprain to a fracture or dislocation of the neck vertebrae. After a head injury, it is very important that the neck is also checked for injury. Especially if the person was knocked out or if there is neck pain. Do not attempt to move the head or neck and encourage the injured person not to move it. If there is any doubt, keep them still until help arrives.

Concussion Treatment

  • Treating a concussion requires both Physical Rest and Brain Rest.
  • Brain Rest means a gradual return to full work and mental activity.
  • Physical Rest means a gradual return to normal activity, work and exercise or sports.
  • If symptoms occur (like a headache), the person needs to return to the previous level of physical and mental activity. In 24 hours, they can try again to take it to the next level.
  • Athletes involved in sports need to have a stepwise plan for "return to play." Progressing through stages should be supervised by a doctor or athletic trainer.

Pain Scale

  • Mild: you feel some pain,but it does not keep you from your normal activities. Work, chores and sleep are not changed.
  • Moderate: the pain keeps you from doing some normal activities. It may wake you up from sleep.
  • Severe: the pain is very bad. It keeps you from doing all normal activities.

When to Call for Head Injury

When to Call for Head Injury

Call 911 Now

  • Seizure occurred
  • Knocked out (unconscious) for more than 1 minute
  • Neck pain after the head injury and not moving the neck normally. Caution: protect the neck from any movement.
  • Large dent in skull
  • You (or patient) have any of these symptoms NOW:
    • Hard to wake up
    • Acts or talks confused
    • Slurred speech
    • Walking not steady
    • Weakness in arms or legs
  • Major bleeding that can't be stopped
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • Age more than 65 years
  • You take blood thinning medicine or have a blood clotting disorder
  • Have been drinking alcohol or using recreational drugs
  • You have wound and have never had any tetanus shots
  • Bruising around both eyes or behind the ear(s)
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Headache lasts more than 24 hours
  • Dirty cut or hard to clean and no tetanus shot for more than 5 years
  • Clean cut and no tetanus shot for more than 10 years
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Call 911 Now

  • Seizure occurred
  • Knocked out (unconscious) for more than 1 minute
  • Neck pain after the head injury and not moving the neck normally. Caution: protect the neck from any movement.
  • Large dent in skull
  • You (or patient) have any of these symptoms NOW:
    • Hard to wake up
    • Acts or talks confused
    • Slurred speech
    • Walking not steady
    • Weakness in arms or legs
  • Major bleeding that can't be stopped
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • Age more than 65 years
  • You take blood thinning medicine or have a blood clotting disorder
  • Have been drinking alcohol or using recreational drugs
  • You have wound and have never had any tetanus shots
  • Bruising around both eyes or behind the ear(s)
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Headache lasts more than 24 hours
  • Dirty cut or hard to clean and no tetanus shot for more than 5 years
  • Clean cut and no tetanus shot for more than 10 years
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Care Advice for Minor Head Injury

  1. What You Should Know About Mild Head Injuries:
    • Most head injuries only cause a swelling or bruise to the scalp.
    • The main symptom is pain.
    • Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.
    • The skull bone protects the brain from getting injured.
    • Big lumps or bruising can occur with minor injuries to the scalp. This is normal. Reason: the scalp has a large blood supply.
    • The mildest brain injury is a concussion. Most of those make a full recovery.
    • Here is some care advice that should help.
  2. Wound Care:
    • If there is a scrape or cut, wash it off with soap and water.
    • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.
  3. Cold Pack for Swelling:
    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.
    • Reason: prevent big lumps ("goose eggs"). Also, helps with the pain.
    • Repeat in 1 hour, then as needed.
  4. Watch for Symptoms:
    • Ask another adult to watch you closely during the first 2 hours after the injury and through the first night, if they will.
    • Lie down and rest until all symptoms have cleared. Note: mild headache, mild dizziness and nausea are common.
    • Sleep if you want to, but have the adult check on you after a couple of hours of sleep, to see that you can be awakened.
    • Avoid taking sleeping pills unless they are recommended by your doctor.
  5. Work, Exercise and Activities:
    • Do not return to work, exercise or activities until you are fully recovered.
    • Ask your doctor’s advice about when you can return to exercise or sports, especially for impact or jarring sports such as football, boxing or horseback riding.
    • Do not drive a car or motorcycle, ride a bike or operate machinery until you are fully recovered.
  6. Diet - Start with Clear Fluids:
    • Drink clear fluids to start with, in case you vomit.
    • You can follow a regular diet after 2 hours, as long as you are not being sick.
    • Avoid alcohol.
  7. Pain Medicine:
    • To help with the pain, take an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain.
    • Use as needed, but do not take more than the maximum recommended dosage as stated on the package.
    • If you are not sure what to take, ask a pharmacist.
  8. Neck Pain:
    • Any head injury could also have a neck injury.
    • A broken neck can result in death right away if the spinal cord is also damaged.
    • If the person was knocked out or had a severe head injury, assume that there could also be a serious neck injury. Be sure to have it checked out.
  9. What to Expect:
    • Most head trauma only causes a scalp injury.
    • The deep headache usually clears in 24 hours.
    • The scalp pain at the site of impact may last 3 days.
    • The swelling may take a week or more to go away.
  10. Call Your Doctor If:
    • Headache becomes severe
    • Vomits 2 or more times
    • You become more drowsy, hard to wake up or confused
    • Walking or talking is not normal
    • Headache lasts more than 24 hours
    • You think you need to be seen
    • Your symptoms get worse

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

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2023 Schmitt Decision Logic LLC.

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