The bones of the skull are designed to withstand some hard knocks. Most of the time, a blow to the head causes nothing more serious than a swollen bump, or "goose egg."
But some injuries to the head can be serious, even life-threatening. The brain is a delicate organ, and head injuries are dangerous when they cause bleeding and/or swelling inside the skull. When someone receives a hard blow to the head, it is very important to carefully monitor him or her for 24 hours, watching out for signs of moderate or severe head injury.
What to do
If you suspect that there may be an injury to the spine, do not move the person unless there is an immediate, life-threatening danger. Call 911. Keep the head and neck stable by placing your hands on both sides of the injured person's head, keeping it in line with the spine and preventing movement. Continue to hold the head still and in alignment until medical help arrives.
If the person is vomiting, roll the head, neck, and body over as one unit (the "log roll") to prevent choking and protect the spine.
If the person is unconscious, check for breathing. If he or she is not breathing, immediately prop open the mouth and begin rescue breathing. Check the pulse. If there is none, begin cardiopulmonary resuscitation (CPR) and call 911.
If there is bleeding, quickly put on gloves and a surgical mask, if you have them. Apply firm pressure directly over the wound with a clean cloth or bandage; if the blood soaks through the cloth, don't remove it. Just place another clean cloth on top of it. Apply pressure for 20 minutes. Note: Even minor cuts to the head may bleed heavily, because blood vessels in the scalp are close to the surface. Heavy bleeding is not necessarily a sign of a severe injury. However, if head or facial bleeding is severe, if you suspect internal bleeding, or if you are unable to stop the bleeding after 20 minutes, call 911.
Caution: If you suspect a skull fracture, or break in the skull, do NOT apply direct pressure to the bleeding site (apply gentle pressure around the edges of the wound). In addition, do NOT remove dirt or debris from the wound. Instead, cover the wound with a sterile gauze dressing. (Trying to clean the wound might cause bacteria to enter, which could cause a brain infection.)
After the bleeding stops, apply ice or a cold pack to reduce swelling.
The National Institutes of Health also issued the following warnings:
Do NOT wash a deep head wound.
Do NOT move someone unless it's absolutely necessary.
Do NOT remove any object sticking out of a wound.
Do NOT shake the injured person if he or she seems dazed.
Do NOT remove a helmet if the head injury seems serious.
Do NOT pick up a fallen child who has any sign of head injury.
Do NOT drink alcohol within 48 hours of a serious head injury.
When to seek emergency medical assistance
For 24 hours after an impact to the head, check the person every few hours and be alert to any of the following signs of severe head injury. Call 911 or go immediately to an emergency room if the person shows any of these symptoms:
- Confusion. If the person seems disoriented or confused, ask his or her name, address, age, telephone number, and so on. If he or she can't answer, seek emergency medical help.
- Problems moving arms or legs. If the person can't move the limbs on one side of the body, or seems to drag one side, get emergency help.
- Dizziness, seizures, convulsions, loss of balance, lethargy, or loss of consciousness
- Headache, nausea, or vomiting
- Vision changes, slurred speech, or difficulty breathing
Because some of these serious symptoms may develop over time, it is very important to keep checking on someone who has received a head injury carefully, over the whole 24-hour period. During the night, wake the person up every few hours to monitor his or her condition. If you cannot wake the person or you note any of the symptoms listed above, call 911 or go to an emergency room immediately.
Different head injuries, different symptoms
Finally, be on the alert for changes in behavior that may develop several days or even weeks or months after a head injury. In the case of concussion, people sometimes temporarily lose their short-term memory -- something called "anterograde amnesia" -- they may repeatedly ask questions about what you just told them for several hours or even a few days.
In the case of a blow to the head that results in a subdural hematoma, or blood collecting on the surface of the brain, often the person seems fine at first, but gets worse over the next few days or weeks, with increasing levels of confusion. (This is usually caused by bleeding in the brain, which in turn causes a buildup of pressure in the skull.)
Symptoms also include personality changes, anxiety, dizziness, vomiting, unexplained headaches, difficulty concentrating, and a sudden weakness in an arm or leg. (In infants, symptoms include head swelling, irritability, a high-pitched cry, seizures, separated wound sutures, and bulging fontanelles (bulges in the soft spots of an infant's head). If you notice such symptoms, seek medical help immediately.
Handbook of First Aid and Emergency Care, American Medical Association, 2000, pp. 194-200
American College of Emergency Physicians, First Aid Manual. DK Publishing. 2010.
Head injury. Medical Encyclopedia of Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm
Subdural hematoma. University of Missouri Health Care. www.muhealth.org
Mayo Clinic. Severe Bleeding: First Aid. January 2008. http://www.mayoclinic.com/health/first-aid-severe-bleeding/FA00038