Head Injury

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Head Injury

Problem

Is this your symptom?

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

If NOT, try one of these:

What to Do

Select the First Symptom that Applies

Call 911 Now

  • Lasting NEUROLOGIC SYMPTOM, such as:

    • Trouble waking up

    • Confused or slow thinking and talking

    • Slurred speech

    • Weakness of arms or legs

    • Shaky walking

  • Seizure occurred

  • Knocked out (unconscious) for more than one minute

  • Neck pain after head injury

  • Penetrating head injury (such as from a knife, gunshot wound, or metal object)

  • Major bleeding (nonstop bleeding or spurting)

  • You think you have a life-threatening emergency

Go to ER Now

  • Severe headache

  • Had a NEUROLOGIC SYMPTOM that is now gone; any of the following:

    • Trouble waking up

    • Confused or slow thinking and talking

    • Slurred speech

    • Numbness or weakness of arms or legs

    • Unsteady walking

  • Knocked out (unconscious) for less than one minute

  • Blurry eyesight lasts more than 5 minutes

  • Can't remember what happened (amnesia)

  • Vomiting

  • Watery fluid dripping from the nose or ear

Call Doctor Now or Go to ER

  • Bleeding that won't stop after 10 minutes of direct pressure

  • Skin is split open or gaping and may need stitches

  • Dangerous injury (such as from a car crash, high fall, diving, or on a trampoline)

  • Taking a blood thinner like Coumadin or have a bleeding disorder

  • Large swelling

  • You feel weak or very sick

  • You think you need to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Headache lasts more than 3 days

  • You think you need to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Last tetanus shot was over 10 years ago, for CLEAN cut or scrape

  • Last tetanus shot was over 5 years ago, for DIRTY cut or scrape

  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Care Advice for Minor Head Injury

  1. What You Should Know:

    • There are many types of head injuries. There is skin (scalp) and bone (skull) on the head. There is also tissue (brain) in the head. These can all be injured.

    • You can treat minor cuts, scratches, and bruises at home.

    • Here is some care advice that should help.

  2. Treatment of Minor Cuts, Scratches, and Scrapes:

    • Use 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.

    • Put an antibiotic ointment on the wound daily.

  3. Treatment of Bruise or Hematoma ("goose egg"):

    • Cold Pack: For pain or swelling, use a cold pack or ice wrapped in a wet cloth. Put it on the sore area for 20 minutes. Repeat 4 times on the first day, then as needed.

    • Heat Pack:

      • If pain lasts over 2 days, apply heat to the sore area. Use a heat pack, heating pad, or warm wet washcloth. Do this for 10 minutes, then as needed.

      • For widespread stiffness, take a hot bath or hot shower instead. Move the sore area under the warm water.

  4. Observation: The person should be watched closely during the first 2 hours after the injury. You should wake him or her up 1 time every 4 hours for the first 24 hours. Check that he or she can walk and talk. It is normal for him or her to have a headache, upset stomach, or feel dizzy.

  5. Diet: Drink clear fluids at first in case you vomit. After 2 hours, you can go back to your normal diet.

  6. Pain Medicine:

    • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).

    • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.

    • Use the lowest amount of a drug that makes your pain feel better.

    • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.

    • Read the instructions and warnings on the package insert for all medicines you take.

  7. What to Expect: Most head trauma only causes an injury to the scalp. Pain and swelling most often get better 2 to 3 days after an injury. Swelling is most often gone in 7 days. Pain may take 1 to 2 weeks to go away.

  8. Call Your Doctor If:

    • Pain becomes severe

    • Neurological Symptoms (see above) occur during the next 3 days

    • You think you need to be seen

    • You get worse

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

Causes and Background Information

Some Basics...

  • There are many types of head injuries.

  • Serious head injuries cause a person to lose consciousness or have other neurologic problems. People with serious head injuries should be seen in an emergency department. 

  • There is always a chance that a person with a head injury also has a neck injury.

  • Treatment depends on the type of injury.

Types of Head Injury

  • Skin: Cut, scrape, bruise, or scalp hematoma ("goose egg").

  • Skull: Fracture.

  • Brain: Concussion and other injuries. Signs of these are loss of consciousness, amnesia, or other Acute Neurological Symptoms.

Acute Neurologic Symptoms: Call 911 if you have any of these after a head injury:

  • Trouble waking up

  • Confused or slow thinking and talking

  • Slurred speech

  • Weakness of arms or legs

  • Shaky walking

Pain Scale

  • None: No pain. Pain score is 0 on a scale of 0 to 10.

  • Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.

  • Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.

  • Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

What is a Concussion?

A concussion is confusion or change in mental state after a head injury. People do not always lose consciousness.

  • Symptoms: These may include headaches, an upset stomach, or feeling irritable and sleepy. Most often, these are felt during the first couple days after a concussion. Other symptoms include amnesia, poor memory, trouble staying focused, and decreased coordination. People may not feel like their normal selves. They may feel dizzy, tired, or dazed.

  • Diagnosis: This is done by a doctor. A CT scan may be needed. This is normal.

  • Classification: See American Academy of Neurology (AAN) grading scale below.

  • Return to Sports: See the AAN guidelines below.

  • What to Expect: Most people who get a concussion fully recover. They will have no lasting problems. A person may have symptoms that last for weeks or months.

AAN Concussion Classification

  • Grade 1: Brief confusion. No loss of consciousness (LOC). Concussion symptoms or abnormal mental state on examination go away in less than 15 minutes.

  • Grade 2: Brief confusion. No LOC. Concussion symptoms or abnormal mental state on examination last more than 15 minutes.

  • Grade 3: Any LOC that lasts for either seconds or minutes.

  • Note: All people with concussions need to be seen by a doctor.

AAN When to Return to Sports Guidelines

  • Grade 1: After mental state is normal for over 15 minutes

  • Grade 2: After mental state is normal for 1 week

  • Grade 3: After mental state is normal for 4 weeks

  • Note: Multiple concussions will need more time to recover. Athletes with concussions are sidelined to stop them from getting a "second impact injury." This is a second concussion that happens within 1-2 weeks after the first one. The result can be deadly.

Warning!

  • Always consider the chance of a neck injury in people with head injuries.

  • Watch for neck pain and arm or leg numbness or weakness. These may be signs of a neck injury.

Images

  • Thumbnail of First Aid - Bleeding Head

  • Thumbnail of First Aid - Neck Injury

  • Thumbnail of First Aid - Neck Injury (Modified HAINES)

  • Thumbnail of Laceration - Scalp

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.