Injuries to the head are so common that almost everyone in their lifetime will sustain some form of trauma to the head. Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone’s life. Medical advances in detecting and treating these injuries, have improved the outlook for many of these patients.

Every year, millions of people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection.

Head injuries can range from relatively minor damage to the scalp and face such as lacerations, abrasions and bruising to more serious consequences involving damage to the brain. Head injury can be classified as either closed or penetrating. In closed head injury, the head sustains a blunt force by striking against an object. In penetrating head injuries, a high velocity object breaks through the skull and enters the brain.

Accidents are the leading cause of death or disability in men under age 35y. Over 70% of accidents are associated with head injuries and/or spinal cord injuries. Common causes of head injury include traffic accidents, industrial or occupational accidents, recreational accidents, falls, physical assault, and accidents in the home.
Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain or high shearing forces that damage the nerve cells of the brain. These more serious head injuries cause various changes that vary with the degree of trauma. These may include:

• Personality changes
  
• Emotional disturbances
  
• Speech and language deficits
  
• Cognitive deficits
  
• Loss of sensation, hearing, vision, taste or smell
  
• Seizures
  
• Paralysis
  
• Coma

The signs and symptoms of a head injury may occur immediately or develop slowly over several hours. If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, the child should still be closely watched for 24 hours, since the symptoms of a head injury may be delayed. It is always important to try to find out how the injury occurred.
Loss of consciousness, even for a very brief period, is one of the clearest indications that the brain may have been affected by a blow to the head. A state involving uncertainty about time, date, and location and/or a period of memory loss for the events surrounding the head injury are also indicators of trauma to the brain. Any of these symptoms following a blow to the head should be taken seriously.
The following symptoms suggest a more serious head injury that requires emergency medical treatment:

• Altered level of consciousness
  
• Bleeding or fluid drainage from nose, mouth, or ears
  
• Decreased rate of breathing
  
• Confusion
  
• Convulsions
  
• Fracture
  
• Headache
  
• Irritability
  
• Personality changes
  
• Slurred speech
  
• Stiff neck
  
• Blurring
  
• Scalp wound

A doctor’s help needed when:

• there is severe head or facial bleeding
  
• there is a change in the level of consciousness
  
• you suspect a serious head or neck injury

Treatment varies according to the severity, type and location of the injury, and development of complications. For mild head injuries, no specific treatment may be needed other than observation for complications. For moderate to severe head injuries, urgent treatment is required. The following first aid treatment is indicated if the victim is comatose or symptoms are severe.

1. Check his airway, breathing, and circulation. If necessary, begin rescue breathing and CPR (CPR is an emergency lifesaving procedure. It is performed when the breathing or the heartbeat has stopped).
2. If the breathing and heart rate are satisfactory but the patient is unconscious, treat him as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of his head, keeping the head in line with the spine and preventing movement. And wait for medical help.
3. Unless there has been a skull fracture, attempt to stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move his head. If blood soaks through the cloth, do not remove it; just place another cloth over the first one.
4. 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 and get medical help immediately.
   
5. If the head wound is superficial, wash it with soap and warm water and pat dry.
6. If the patient is vomiting and you do not suspect a spinal injury, turn his head to the side to prevent choking. If you do suspect a spinal injury, roll the head, neck and body as one unit. Children often vomit once after a head injury. But even if the child does not vomit again and is not behaving differently, contact a doctor.
7. Apply ice packs to swollen areas.
8. Over-the-counter pain medicine usually helps reduce headache.
9. Over the next 24 hours, observe the patient for any signs of a serious head injury. During the night, awaken him every 2 to 3 hours and check for alertness. Ask him specific questions, such as an address. If he becomes unusually drowsy develops a severe headache or stiff neck, vomits more than once, or behaves abnormally, get medical help immediately.
10. Refrain from vigorous activity for 24 hours after a serious head injury.

Do not

• Do not remove his helmet if you suspect a serious head injury.
  
• Do not wash a head wound profusely.
  
• Do not remove any object sticking out of a wound.
  
• Do not move him unless absolutely necessary.
  
• Do not shake him if he seems dazed.
  
• Do not let other, more obvious, injuries distract you from the head injury.
  
• Do not allow him to consume alcohol within 48 hours of a serious head injury.

Even if the skull is not fractured, the brain can bang against the inside of the skull and be damaged. If there is bleeding inside the skull, complications may follow.