Head Injury

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DEFINITION

• Injuries to the head, including scalp, skull and brain.

Types of Head Injuries

• Scalp: cut, scrape, bruise or scalp hematoma (goose egg)
• Skull Bone: bruises, fracture
• Concussion: A concussion is a minor injury to the brain. Symptoms include a brief period of confusion, amnesia (loss of memory), or confusion following head injury. Some individuals with concussion may have loss of consciousness at the time of the head injury. All adults with a possible concussion should have a neurological examination performed by a physician.
• Serious Brain Injury: Is recognized by the presence of persisting neurologic symptoms. If one of these NEUROLOGIC SYMPTOMS persists after a head injury, an ambulance should be called:
  • Difficult to awaken
  • Confused or slow thinking and talking
  • Slurred speech
  • Numbness or weakness of arms or legs
  • Unsteady walking.

Caution - Neck Injury

• The possibility of a neck injury should also be considered in all individuals with an injury to the head.
• Symptoms to be taken seriously include neck pain and arm or leg numbness or weakness.

FIRST AID Advice

FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for Suspected Spinal Cord Injury: Do not move until a spine board is applied.

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Persisting NEUROLOGIC SYMPTOM, any of the following: 
  • Difficult to awaken
  • Confused or slow thinking and talking
  • Slurred speech
  • Numbness or weakness of arms or legs
  • Unsteady walking
• Seizure (convulsion) occurred
• Unconscious for more than 1 minute
• Neck pain occurring after head injury
• Penetrating head injury (e.g. knife, gun shot wound, metal object)
• Major bleeding (actively bleeding or spurting) that can't be stopped
• NOTE: For bleeding, see First Aid

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Had a NEUROLOGIC SYMPTOM that is now gone; any of the following: 
  • Difficult to awaken
  • Confused or slow thinking and talking
  • Slurred speech
  • Numbness or weakness of arms or legs
  • Unsteady walking 
• Knocked unconscious for less than 1 minute
• Blurred vision persists longer than 5 minutes
• Severe headache
• Can't remember what happened (amnesia)
• Vomiting
• Watery fluid dripping from the nose or ear  
• Bleeding that won't stop after 10 minutes of direct pressure
• Skin is split open or gaping and may need stitches
• Large swelling
• Large dent in scalp
• Severe force or speed involved (e.g. auto accident, fall from great height, blows from hard ball or club)
• You are taking the blood thinner coumadin or have a history of a bleeding disorder

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Headache persists longer than 3 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Minor head injury and you don't think you need to be seen

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HOME CARE ADVICE FOR MINOR HEAD INJURY

1. Treatment of Minor Cuts, Scratches and Scrapes (abrasions):
   • Apply direct pressure for 10 minutes to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes.
   • Gently scrub out any dirt with a washcloth.
   • Apply an antibiotic ointment daily.
2. Treatment of Bruise or Hematoma ("goose egg"):
   • Apply an ice bag or massage the area with ice for 20 minutes each hour for 4 consecutive hours.  (20 minutes of ice bag massage followed by 40 minutes of rest for 4 hours in a row).
   • 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
3. Observation: The head-injured person should be observed closely during the first 2 hours following the injury. The head-injured person should be awakened every 4 hours for the first 24 hours; check for the ability to walk and talk. Some mild headache, mild dizziness and nausea are common.
4. Diet: Clear fluids to drink at first, in case of vomiting.  May resume a regular diet after 2 hours.
5. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
6. Expected Course: Most head trauma only causes an injury to the scalp. Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 1-2 weeks to completely resolve.
7. Call Your Doctor If:
   • Pain becomes severe
   • Neurological Symptoms (see above) occur during the next 3 days
   • You become worse

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

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