The single most useful indicator of a head injury is that the casualty suffers an altered state of consciousness. Head injury is a fairly broad term that covers any injury to the head and may involve impairment to the casualty’s level of consciousness.
All casualties suffering a head injury need to be seen by a doctor and often if a period of unconsciousness has occurred, the casualty may be detained in hospital for observation.
Scalp wounds, if present, will bleed profusely, and indicate the possibility of underlying damage.
Altered state of consciousness
There are four levels of consciousness usefully defined for the first aider, the most obvious being unconsciousness. A useful guide to determine a casualty’s level of consciousness is to use ’AVPU’.
A --------------Alert -Normal level of consciousness
V --------------responds to Voice -Dazed/semi conscious.
P --------------responds to Pain
U --------------Unresponsive -unconscious
All conscious casualties must be given an ABC of Resuscitation .
This occurs when pressure is exerted upon the brain. Because the brain is contained within the skull, any bleeding or swelling will cause a pressure build-up around the brain.
This is potentially a very serious condition that can become apparent immediately following a head injury or may be delayed for quite some time. As for other forms of head injury, medical attention is essential.
You will notice
A deterioration in the casualty’s level of consciousness.
A history of a recent head injury. It is possible that initially the casualty may have made an apparent full recovery.
Unequal eye pupils.
Breathing becomes slow and possibly noisy.
Pulse becomes slow, but is strong and full.
Hot flushed face.
Weakness on one side of the face or body.
If the casualty is unconscious, check the ABC of Resuscitation
If the casualty is fully or semi-conscious, provide support in a semi-sitting position.
Call for an ambulance.
The presence of a fracture of the skull is always indicative of a head injury. The bones of the skull surround the brain, providing protection. A skull fracture may be caused by direct force such as a blow to the head or by indirect force such as someone jumping down and landing heavily on the feet.
You may notice
’Boggy’ area/depression on the head.
Change in the shape of the head.
·A wound to the scalp
Blood in the white of the eye.
Straw-coloured or bloodstained fluid from the nose or ear.
If the casualty is unconscious, check the ABC of Resuscitation and act appropriately.
If the casualty is conscious, make him/her comfortable in a semi-sitting position.
If there is a discharge from the ear, apply a light pad and position the casualty so that the ear is able to drain .
Call for an ambulance.
Possible spinal injury
If you suspect a spinal injury, treat the casualty .
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