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Injuries to the head, including scalp, skull and brain
Types of Head Injury
Skin Trauma: Cut, scrape, bruise or scalp hematoma (goose egg)
Skull Trauma: Fracture.
Brain Trauma: Concussion and other brain injuries can be recognized by the presence of loss of consciousness, amnesia, or other Acute Neurological Symptoms.
Acute Neurologic Symptoms and Calling 911 - You should call 911 for any of the following acute neurologic symptoms occurring after a head injury:
Difficult to awaken OR
Confused or slow thinking and talking OR
Slurred speech OR
Weakness of arms or legs OR
What is a Concussion?
Definition: Confusion or alteration in mental status that follow a head injury. Loss of consciousness is not required.
Symptoms: Headache, nausea, and feeling irritable and sleepy are common, especially during the first couple days after a concussion. Other symptoms of a concussion include amnesia (can't remember what happened), dizziness, difficulty concentrating or 'foggy' feeling, poor memory, feeling tired, feeling dazed or not your normal self, and decreased coordination.
Diagnosis: The diagnosis is made by a doctor based upon the clinical examination of the injured person. A CT scan of a patient with a concussion (and no other brain injuries) is normal. A head CT scan is not need in every case.
Classification: See American Academy of Neurology (AAN) classification below.
Return to Sports: See the AAN recommendations below.
Prognosis: Most people who sustain a concussion recover completely and there are no signs of permanent damage. Sometimes a person can have concussion symptoms that last for weeks or months afterwards.
AAN Concussion Classification (American Academy of Neurology, 1997)
Grade 1: Transient confusion; no loss of consciousness; concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes.
Grade 2: Transient confusion; no loss of consciousness; concussion symptoms or mental status abnormalities on examination last more than 15 minutes.
Grade 3: Any LOC, either brief (seconds) or prolonged (minutes).
Note: All individuals with concussions need a neurological examination by a health care provider.
AAN When to Return to Sports Guidelines
Grade 1: After normal neurologically for over 15 minutes
Grade 2: After normal neurologically for 1 week
Grade 3: After normal neurologically for 4 weeks
Note: Multiple concussions require longer periods of recovery before returning to sports. The reason we sideline athletes who have a concussion is to prevent the "second impact injury". This is a second concussion that occurs within 1 or 2 weeks after the first one. The outcome can be catastrophic or even death.
Caution - Neck Injury
The possibility of a neck injury should also be considered in all individuals with an injury to the head.
Symptoms to be taken seriously include neck pain and arm or leg numbness or weakness.
FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.
FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).
FIRST AID Advice for Shock: Lie down with feet elevated.
FIRST AID Advice for Suspected Spinal Cord Injury: Do not move until a spine board is applied.
FIRST AID Advice for Bruise: Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.
Persisting NEUROLOGIC SYMPTOM, any of the following:
Difficult to awaken
Confused or slow thinking and talking
Weakness of arms or legs
Seizure (convulsion) occurred
Unconscious for more than 1 minute
Neck pain occurring after head injury
Penetrating head injury (e.g., knife, gun shot wound, metal object)
Major bleeding (actively bleeding or spurting) that can't be stopped
Note: For bleeding, see First Aid
You feel weak or very sick
Had a NEUROLOGIC SYMPTOM that is now gone; any of the following:
Numbness or weakness of arms or legs
Knocked out (unconscious) for less than 1 minute
Blurred vision persists longer than 5 minutes
Can't remember what happened (amnesia)
Watery fluid dripping from the nose or ear
Bleeding that won't stop after 10 minutes of direct pressure
Skin is split open or gaping and may need stitches
Large dent in scalp
Dangerous injury (e.g., MVA, diving, trampoline, contact sports, fall more than 10 feet) or severe blow from hard object (e.g., golf club or baseball bat)
You are taking the blood thinner coumadin or have a history of a bleeding disorder
You think you need to be seen
Headache persists longer than 3 days
You have other questions or concerns
Minor head injury and you don't think you need to be seen
Treatment of Minor Cuts, Scratches and Scrapes (abrasions):
Apply 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.
Apply an antibiotic ointment daily.
Treatment of Bruise or Hematoma ("goose egg"):
Apply an ice bag or massage the area with ice for 20 minutes each hour for 4 consecutive hours (20 minutes of ice bag massage followed by 40 minutes of rest for 4 hours in a row).
48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
Observation: The head-injured person should be observed closely during the first 2 hours following the injury. The head-injured person should be awakened every 4 hours for the first 24 hours; check for the ability to walk and talk. Mild headache, mild dizziness and nausea are common.
Diet: Clear fluids to drink at first, in case of vomiting. May resume a regular diet after 2 hours.
For pain relief, take acetaminophen, ibuprofen, or naproxen.
Acetaminophen (e.g., Tylenol):
Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
The most you should take each day is 3,000 mg.
Ibuprofen (e.g., Motrin, Advil):
Take 400 mg by mouth every 6 hours.
Another choice is to take 600 mg by mouth every 8 hours.
Use the lowest amount that makes your pain feel better.
Naproxen (e.g., Aleve):
Take 250-500 mg by mouth every 12 hours.
Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.
Caution: Do not take acetaminophen if you have liver disease.
Caution: Do not take ibuprofen or naproxen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of medicine. Do not take ibuprofen or naproxen for more than 7 days without consulting your doctor.
Before taking any medicine, read all the instructions on the package
Expected Course: Most head trauma only causes an injury to the scalp. Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 1-2 weeks to completely resolve.
Call Your Doctor If:
Pain becomes severe
Neurological Symptoms (see above) occur during the next 3 days
You become worse
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