The brain is a soft and delicate organ. A hard blow to the head can injure the brain or spinal cord even when there are no visible signs of trauma to the scalp or face. That’s why all head injuries are considered serious and you should consult with your doctor or nearest hospital emergency department.
Always call triple zero (000) for an ambulance in an emergency. This article offers first aid suggestions, but is not a substitute for professional medical care.
Two types of head injury
Head injuries are classified as:
* Open – with bleeding wounds to the face or head
* Closed – no visible signs of injury to the face or head.
Closed head injuries explained
The soft, jelly-like brain is protected by the skull. The brain doesn’t fill the skull entirely – it floats in a clear, nourishing liquid called cerebrospinal fluid. This fluid acts as a shock absorber, but its protective value is limited. For example, the kinetic energy of a small knock to the head or face can be absorbed by the cerebrospinal fluid, but a hard impact can smash the brain against the inside of the skull. This can bruise the brain or tear blood vessels. If blood and blood serum start to escape, the swelling is contained within the skull. Intracranial pressure (pressure inside the skull) can cause permanent damage by literally crushing the brain.
Symptoms of serious head injury
Remember that blood is not a reliable indicator of the seriousness of the head injury. Apart from wounds, other symptoms of serious head injury can include:
* Altered consciousness – for example, the person may lose consciousness or may be conscious but confused or drowsy.
* Skull deformities – compressions or deformities are signs of fractures.
* Clear fluid from the ears or nose – a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.
* Black eyes and bruised skin behind the ears – this indicates that the force of the blow was sufficient to rupture blood vessels around the eyes and ears.
* Vision changes – the pupils of the eyes may be dilated to different sizes in a person with a serious head injury. The person may complain of double or blurred vision.
* Nausea and vomiting – these are common side effects of serious head injury.
First aid for serious head injury
In cases where there is a serious head injury, always call an ambulance.
If the injured person is conscious, encourage them to minimise any movement of their head or neck. Control any significant blood loss from any head wounds. Reassure the person and try to keep them calm.
If unconscious, the person should not be moved unless they are in immediate danger. Any unnecessary movement may cause greater complications to the head injury itself, the spine or other associated injuries. Your role is to protect the injured person from any potential dangers at the scene. You should also monitor their airway and breathing until the arrival of an ambulance.
If the person’s breathing becomes impaired due to a problem with their airway, you may need to very carefully tilt their head back (and support it) until normal breathing returns.
If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be required. See the Better Health Channel fact sheet Cardiopulmonary resuscitation (CPR) for guidelines.
First aid for concussion
Concussion is a brief period of unconsciousness (less than five minutes) after sustaining a blow to the head. First aid suggestions include:
* Lie the person down, with their shoulders and head slightly raised.
* Control any bleeding.
* Check for signs of serious head injury.
* If the injury occurred during sport, don’t allow the person to ‘play on’ under any circumstances, even if they insist they feel fine.
* Always seek medical attention following concussion, even if the person only lost consciousness for a few seconds.
* Be alert for any danger signs over the next one or two days – for example, persistent vomiting, loss of coordination or bad headaches. Seek medical attention immediately.
Spinal injuries – symptoms
A person who has sustained a head injury may have also injured their spine. In elderly people, the force required to cause neck injuries is much less than in younger people.
It is important to keep the person’s head in line with their neck. Avoid twisting their head or allowing their head to roll to the side. If you can, roll a t-shirt, towel or similar soft item and place it around their neck to keep their head straight. Don’t try to move them unless there is dire need.
Signs and symptoms of spinal injuries could include:
* Their body is lying in an awkward, unnatural position.
* Their skin is clammy and cool.
* If conscious, they may report unusual tingling sensations in their limbs or an absence of any sensation including pain.
* They can’t move their limbs.
Toddlers and head injuries
Toddlers fall over all the time. Suggestions for parents include:
* A fall from the child’s own height usually isn’t enough to cause a serious head injury.
* The size of a bump on the head has no connection with the severity of injury.
* Minor head injuries, like a bump on the head, can be treated with cuddles and an age-appropriate dose of children’s pain-killing syrup.
* Seek medical attention immediately if the child shows any signs of serious head injury, particularly if they are unusually drowsy or vomiting, if you think the fall was heavy enough to have caused harm or if the child appeared to be unconscious – did not immediately cry after the fall. Examples of a heavy fall would be falling down some stairs or rolling from a normal height change table to a hard floor. If in doubt, see your doctor anyway.
Where to get help
* In an emergency, always call triple zero (000) for an ambulance
* Your doctor
* The emergency department of your nearest hospital
* Maternal and Child Health Line, Victoria (24 hours) Tel. 132 229
For training in first aid and CPR, contact:
* Metropolitan Ambulance Service Tel. 1800 248 859
* St John Ambulance Australia Victoria Tel. (03) 9696 0000
* Australian Red Cross Tel. 1300 367 428
Things to remember
* Always call triple zero (000) for an ambulance in an emergency.
* The presence or absence of blood isn’t a reliable indicator of the seriousness of the head injury.
* Symptoms of serious head injury can include leaking clear fluid from the nose or ears, altered consciousness or a period of unconsciousness, skull deformities, vision changes, bruised eyes and ears, nausea and vomiting.
* A person who has sustained a head injury may also have injured their spine.
