Head injuries - ouch!

What you need to know and what to do about them!

This month’s blog is all about head injuries, how to recognise them and what to do. To help you with this, I have two stories to tell you which cover a lot of the blog content. Both have concussion in them, and one has the addition of cerebral compression and skull fractures.

On the last Thursday of January, I received a WhatsApp message from a dear friend Billy. The photo was horrific showing a lot of blood around his face, black eyes and cuts across his face and skull. Billy was re-felting his shed roof when he slipped off the ladder and crashed to the slabs below from about 8 feet.

He had a full range of head injuries, bleed on the brain, cerebral compression, fractured skull, fractured eye socket, a fractured wrist and a de-gloved and dislocated mid finger. He was unconscious for a short while. Billy was in a state – Silly Billy.

Billy was very lucky, he can’t remember any of this happening, but he did drag himself from the garden to the lounge where he called his wife. Luckily, his wife was only 5 minutes away and called the emergency services as soon as she returned home. Billy is still getting better at home, progress is slow, though.

That story is bad enough, but 5 days later, my brother in law Richard was at work, went up the stairs to his office and a door that’s “always” open was jammed closed. He pulled it, his hand slipped from the door handle, and he fell backwards down a set of stairs. Richard suffered from concussion and was unconscious for a short time. He also damaged his wrist and it will be a while before he can return to work.

Both recent accidents cover everything I want to discuss in this blog. Concussion, Cerebral Compression and skull fractures. Head injuries can be life changing, painful and in some cases, life threatening.

Concussion: We’ve known about concussion for many many years, but a few years ago it was dragged into the forefront of the news by American Footballers. There were several former players trying to sue their clubs because they were “punch drunk” after many head hits resulting in concussion. Boxers famously have long term problems from being hit in the head. Anybody who’s had an accident where their head hits a solid object from either a height or at speed, will suffer from concussion. In the sports arena, concussions are treated with the respect they deserve. Concussion is the rapid movement of the brain inside its protective home – the skull. Both Billy and Richard had concussion, and typically they can’t remember the incident. They were both confused after the incident, with repetitive speach, blurred vision and agitated. Some people with concussion will get aggressive, so look after yourself. As you look at them you will notice un-equal pupil sizes and they will struggle to follow a finger lead. (Making the sign of a cross in front of their eyes – approx. 300-400mm away from their face).

Cerebral Compression: Billy suffered from this as his brain was bleeding, causing a build-up of pressure in the skull. This can also be caused by swelling of the brain and growing tumours in the brain. The pressure builds up because the brain is in its protective case and can’t go anywhere. Like concussion, cerebral compression and skull fractures can have long term consequences. You can recognise cerebral compressions by the casualty complaining of extreme headaches, agitation, drowsiness, un-equal pupil sizes, slow or strong pulse, weakness of paralysis down one side of the body and noisy breathing. I’ve suffered from cerebral compression but at the time, I didn’t know it. (My story is for another blog). Your brain lives in a light pink fluid called cerebral spinal fluid or CSF, if this appears or there is blood coming from eyes, ears nose or mouth – stop it by any method.

Skull Fractures: As important as your skull is, it’s like any other bone in your body and can be broken. Billy had this, in multiple places as well as by the eye. The break can be open or closed caused by a direct or indirect blow to the head. The skull break can cause brain damage if it pushes into the brain. There’s a further problem with open skull fractures as you have a chance of infection. What to look for; associated wound, tenderness and pain from the area, depression or deformity to the skull and bleeding and or CSF coming from the nose, ears or eyes.

In All Cases: Keep calm and treat the casualty with care and respect. Control any bleeding or loss of cerebral spinal fluid. Contact emergency services urgently. Place the casualty in a comfortable position, if you don’t suspect spinal injury as well, on a flat surface with the head and shoulders raised slightly. If you do suspect a spinal injury leave the casualty where you find them and manage any CSF or blood. Monitor the casualty as they will be in shock and be prepared to carry out basic life support (BLS).

Managing head injuries are covered in my courses and is an important skill to recognise, know what is happening and be able to manage the incident. Billy and Richard would appreciate you passing this blog on as would I.

Kim Ronaldson

First aid instructor at first aid development

6th February 2020.

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