|a. General Considerations. The
casualty with a head injury (or suspected head injury) should
be continually monitored for the development of conditions which
may require the performance of the necessary basic lifesaving
measures, therefore be prepared to--
- Clear the airway (and be prepared to perform the basic lifesaving
- Treat as a suspected neck/spinal injury until proven otherwise.
(See Chapter 4 for more information.)
- Place a dressing over the wounded area. DO NOT attempt to
clean the wound.
- Keep the casualty warm.
- DO NOT attempt to remove a protruding object from the head.
- DO NOT give the casualty anything to eat or drink.
|b. Care of the Unconscious Casualty.
If a casualty is unconscious as the result of a head injury, he
is not able to defend himself. He may lose his sensitivity to
pain or ability to cough up blood or mucus that may be plugging
his airway. An unconscious casualty must be evaluated for breathing
difficulties, uncontrollable bleeding, and spinal injury.
(1) Breathing. The brain requires a constant supply of
oxygen. A bluish (or in an individual with dark skin--grayish)
color of skin around the lips and nail beds indicates that the
casualty is not receiving enough air (oxygen). Immediate action
must be taken to clear the airway, to position the casualty on
his side, or to give artificial respiration. Be prepared to give
artificial respiration if breathing should stop.
(2) Bleeding. Bleeding from a head injury usually comes
from blood vessels within the scalp. Bleeding can also develop
inside the skull or within the brain. In most instances bleeding
from the head can be controlled by proper application of the field
first aid dressing.
DO NOT attempt to put unnecessary pressure on the wound or
attempt to push any
brain matter back into the head (skull). DO
NOT apply a pressure dressing.
(3) Spinal injury. A person that has an injury above
the collar bone or a head injury resulting in an unconscious state
should be suspected of having a neck or head injury with spinal
cord damage. Spinal cord injury may be indicated by a lack
of responses to stimuli, stomach distention (enlargement), or
(a) Lack of responses to stimuli. Starting with the feet,
use a sharp pointed object--a sharp stick or something similar,
and prick the casualty lightly while observing his face. If the
casualty blinks or frowns, this indicates that he has feeling
and may not have an injury to the spinal cord. If you observe
no response in the casualty's reflexes after pricking
upwards toward the chest region, you must use extreme caution
and treat the casualty for an injured spinal cord.
(b) Stomach distention (enlargement). Observe the casualty's
chest and stomach. If the stomach is distended (enlarged) when
the casualty takes a breath and the chest moves slightly, the
casualty may have a spinal injury and must be treated accordingly.
(c) Penile erection. A male casualty may have a penile
erection, an indication of a spinal injury.
Remember to suspect any casualty who has a severe head
injury or who is
unconscious as possibly having
a broken neck or a spinal cord injury! It is better to
treat conservatively and assume that the neck/spinal cord is injured
rather than to
chance further injuring the casualty. Consider
this when you position the casualty. See
paragraph 4-9 for treatment procedures of spinal column injuries.
c. Concussion. If an individual receives a heavy blow
to the head or face, he may suffer a brain concussion, which is
an injury to the brain that involves a temporary loss of some
or all of the brain's ability to function. For example, the
casualty may not breathe properly for a short period of time,
or he may become confused and stagger when he attempts to walk.
A concussion may only last for a short period of time. However,if a casualty is suspected of having suffered a concussion, he
must be seen by a physician as soon as conditions permit.
d. Convulsions. Convulsions (seizures/involuntary jerking)
may occur after a mild head injury. When a casualty is convulsing,
protect him from hurting himself. Take the following measures:
(1) Ease him to the ground.
(2) Support his head and neck.
(3) Maintain his airway.
(4) Call for assistance.
(5) Treat the casualty's wounds and evacuate him immediately.
e. Brain Damage. In severe head injuries where
brain tissue is protruding, leave the wound alone; carefully
place a first aid dressing over the tissue. DO NOT remove
or disturb any foreign matter that may be in the wound.
Position the casualty so that his head is higher than his body.
Keep him warm and seek medical aid immediately.
- DO NOT forcefully hold the arms and legs if they are jerking
because this can lead to broken bones.
- DO NOT force anything between the casualty's teeth--especially
if they are tightly clenched because this may obstruct the casualty's
- Maintain the casualty's airway if necessary.