My elderly mother called me the other day and mentioned that she’d had fallen and hurt her head at a party a few days earlier. Despite her advanced years – she was born in 1929 – she loves red, white or rosé wine with her evening meal and isn’t averse to a gin and tonic as an aperitif. She’d been at a friend’s party on the day in question and as she left after a jolly evening she missed the step down between the house and terrace, and fell. As she’d been half-turning at the time, to say a last cheery goodbye to her friend, she managed to fall backwards and hit her head on the stone terrace.
It’s not the first time she’s fallen in recent years. She had a couple of other falls – one after an equally high-spirited social event and one while carrying shopping in the snow. On both those occasions she hit her head and ended up with two huge panda-style black eyes. The severe bruising cleared amazingly quickly.
This latest accident left her with a bit of a sore head and a black and blue arm as she hit her elbow too.
“Did you go to Accident and Emergency?” I asked. “A&E for that?” she said mockingly. “No-o. I whacked my head a bit but I didn’t pass out. I felt fine after a few minutes.” One of her friends, a retired General Practitioner, had a look at her and decided she was probably OK. By the time she called me she said she was feeling fine and having no symptoms.
She was lucky as it happens. Head injuries can occasionally be devastatingly serious after even quite light traumas. The actress wife of film star Liam Neeson, Natasha Richardson, died in March 2009 shortly after a minor fall on a beginners’ slope at the Mont Tremblant ski resort in Quebec. At the time, Richardson – a fit and active 45 year old – brushed the fall off as nothing to worry about. In fact, she’d sustained a fatal epidural hematoma, causing bleeding inside her skull. Blows to the head which cause bruising, or rupture a blood vessel, can result in swelling and pressure. Without rapid treatment, pressure on the brain stem can disprupt breathing and other essential functions. Natasha Richardson unfortunately felt fine at first, which meant she didn’t seek life-saving treatment immediately. It was only four hours later, after serious symptoms had developed, that she was admitted to hospital. By then it was sadly already too late to save her life.
It can be difficult to assess whether a blow to the head is serious or not but head injury should always be taken seriously and assessed carefully. Here are some essential reference notes on dealing with head injury. It’s worth taking a moment to memorise them because you never know when you may suddenly be confronted by head injury affecting a loved one, an acquaintance or a stranger.
Head injuries may affect the scalp, skull and/or brain. The scalp is vulnerable to cuts, bruises and hematoma. The skull is vulnerable to bruising and fracture. Like the scalp, the brain is vulnerable to minor and major injuries. Concussion is a minor brain injury. Symptoms may include confusion and some loss of memory. Anyone suffering possible concussion should seek a neurological examination. If the sufferer lost consciousness at the time of the injury their condition is potentially more serious than if they remained conscious.
Major brain injuries involve persistent neurological symptoms. If the following symptoms occur after a blow to the head, an ambulance should be called. You need to call 911 if the sufferer has any of these symptoms:
* they lost consciousness for more than a minute during the incident
* they had a seizure (convulsion or fit) during or shortly after the impact
* they have bleeding difficult to stop
* they are hard to wake
* they have amnesia or severe headache
* they are vomiting
* they have slurred speech or blurred vision
* they have severe neck pain
* they have watery fluid leaking from nose or ear
* they are confused and thinking and talking slowly
* they have numbness or weakness in their arms or legs
* they are unsteady on their feet
Always call 911 for any penetrating head injury whether by weapon or simple sharp object.
Minor head injuries can be treated at home – as long as you are sure they are minor. If none of the above symptoms are present you can treat the patient as follows.
For minor cuts, scratches and abrasions you need to:
apply pressure for 10 minutes to staunch bleeding
wash the wound gently with soap and water for 5 minutes to prevent infection
apply an antiseptic ointment each day for five days
To treat bruising:
press an ice bag to the area affected for 20 minutes and then repeat as necessary.
make sure the injured person can be woken and is conscious every 4 hours for the first 24 hours after the injury. Ensure they can talk coherently and walk. If these conditions are met, moderate headache, some dizziness and feeling sick are not emergency symptoms.
give clear fluids to drink during the two hours after injury.
give 650 mg of Tylenol or Ibuprofen, or 400 mg of Advil or Motrin, every 6 hours for 24 hours. (Avoid Ibuprofen for people with sensitive stomachs, kidney disease, and women who are pregnant.)
When dealing with someone who has sustained a head injury consider also the strong possibility that they may have a neck injury as well as their head injury. Symptoms of serious neck injury include neck pain and weakness or numbness in the arms and legs. Call 911 if you observe any of those symptoms.
http://www.muschealth.com/SelfHelp/Adult.aspx?path=adult/HeadorBrainSymptoms/HeadInjury.htm&rtopic=Head or Brain Symptoms