Understanding Head Injuries

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With winter ski season now in full swing, and spring bike riding right around the corner, the Wilton Volunteer Ambulance Corps (WVAC) would like to remind the community about head injuries and the importance of wearing helmets. A head injury is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or can be a serious brain injury.

On our various EMS calls, we see many patients with concern for head injuries. We gather information on what may have caused the head injury, what is the age of the victim, what physical condition we find the patient (are they bleeding? are they alert and conscious or disoriented?), the timing of the incident, medications that the patient takes, as well as some additional factors. The gathered information helps us to provide the necessary care for the patient as we head to the hospital. It also helps to determine an appropriate course of action when the patient is transferred to the care of the hospital emergency department.

Head injuries are serious, and can be either “closed” or “open”. An example of a closed head injury is one where the head receives a hard blow from striking an object, but the object does not break the skull. An example of an open head injury occurs when the head is hit with an object that breaks the skull and the object enters the brain. Bleeding usually occurs.

A concussion, which is also serious, occurs when the brain is shaken inside the head. Concussion is the most common type of traumatic brain injury. A concussion is defined by a constellation of symptoms: headache, dizziness, nausea, difficulty focusing, light sensitivity, and problems with balance and coordination. Symptoms usually last a few days, but some can last for several weeks or months.

Head injuries may cause bleeding, either in the brain tissue itself or in the layers that surround the brain. A subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain. This is generally a low-pressure bleed from a vein. An epidural hematoma is bleeding between the inside of the skull and the dura. These usually occur from high-pressure bleeding from an artery and can rapidly expand, putting pressure on the brain tissue and can lead to death within hours. Minor cuts on the surface of the scalp often bleed heavily due to many blood vessels located close to the surface of the skin. Although the amount of bleeding on the surface of the scalp may be alarming, often the injury may not be severe. Patients who take blood thinners, such as Coumadin, are at a higher risk for dangerous bleeding after an injury.

Additional indications of serious head injuries also include Battle Signs, named after Dr. William Battle and cerebral spinal fluid (CSF) leak. Battle Signs are indicated by bruising behind the ears and often associated with raccoon eyes (bruising around the eyes). Both are signs that indicate a possible base or skull fracture and potential brain injury. CSF leaks occur when the fluid around the brain leaks through a hole through the skull bone. This fluid, typically a clear, watery liquid, can either drain from the ear or the nose, depending on where the skull bone is damaged.

For any head injury, and especially for a patient who takes blood thinners, exhibits Battle Signs, or visible CSF leakage: call 9-1-1 immediately!

Please, always wear a helmet when you’re out on the ski slopes or out riding your bike (adults & children) and stay safe!

The Wilton Volunteer Ambulance Corps is a nonprofit 501(c)3 corporation.

Contributor: Brian McDermott