How to recognise and manage a suspected head injury.

Head injuries can be potentially life-threatening. Loss of consciousness often follows a head injury, which could compromise the airway.

There are different types of head injury.

Concussion. Where the brain is shaken and hits against the inside of the skull. This can be caused by a fall or a blow to the head. Concussion may also cause unconsciousness for a short period, but can be followed by an improvement in response and full recovery.

Compression. Swelling or bleeding in the skull puts pressure on the brain. This can occur from injury, a ruptured blood vessel, a tumour or infection (meningitis). There may be a history of a recent head injury with apparent recovery but then a deterioration in the patient’s level of consciousness (AVPU) can occur.

Fractured skull. Damage to the skull may cause bleeding within the skull causing compression. The broken bone may damage the brain or ‘brain shaking’ may have occurred causing concussion.

Treatment

Suspect a neck injury – a baby or child suffering a serious head injury could also have a neck injury.

Apply appropriate pressure to any wound to stop bleeding, cover the site to protect from infection.

With any baby or child who is unconscious, has a reduced conscious level (AVPU), their conscious level deteriorates or you suspect a fractured skull, ring 999.

Maintain airway and breathing.

If the baby or child is conscious, help them lie down. Keep the head, neck and body inline in case of neck injury.

Signs and symptoms

Compression

Level of response (AVPU) worsens as the condition develops.
Intense headache.
Flushed, dry skin.
Deep, noisy, slow breathing.
Slow, strong pulse.
One or both pupils may dilate as pressure increases.
Condition worsens and a seizure may occur.

Concussion

Short term memory loss, confusion, irritability.
Mild, general headache.
Pale, clammy skin.
Shallow/normal breathing.
Rapid, weak pulse.
Normal pupils, reacting to light.
Possible nausea or vomiting.

Fractured skull

Bleeding, swelling or bruising to the head.
A soft area or depression of the scalp.
Bruising around one or both eyes.
Bruising or swelling behind the ear.
Bleeding or fluid coming from the nose or an ear.
Deformity or lack of symmetry to the head.
Blood in the white of the eye.

When is a head injury deemed serious?

When there is damage to the brain, scalp or the skull. External bleeding may be present. Injuries to the head can lead to unconsciousness, which can dangerously compromise the airway. When an injury is sustained to the head there may also have been damage caused to the neck. In addition, permanent damage to the brain can also result from a head injury.

How to recognise and manage a suspected spinal injury.

Spinal injuries can involve many parts of the back and or neck (the weakest part). Trauma can include injury to bones (vertebrae), muscles, ligaments, or the spinal cord, which is the most serious area to damage.

Treating a spinal injury:

Conscious Casualty

Reassurance and tell the baby or child not to move to prevent any further injury.

Maintain the position of the baby or child as you found them.

Using your hands, hold their head still, keeping it in line with the upper body.

dial 999.

Unconscious Casualty

Maintain an open airway.

Using your hands, hold their head still keeping it in line with the upper body.

If you feel the baby or child will vomit, or you have to leave to dial 999, place them in the recovery position.

Keep the baby or child warm and still, constantly monitoring airway and breathing until the arrival of the paramedics.

Signs and symptoms

Mechanism of injury
Pain or tenderness in the neck or back at or near the site of injury.
Loss of control over limbs, movement restricted.
Loss of feeling, sensation in limbs.
Pins and needles or burning in the limbs.
Loss of bladder and/or bowel control.

What is the mechanism of injury?

How and what has happened to the baby or child involved in trauma. We are looking for any abnormal forces which may have been exerted on the back or neck. Such examples can be seen below:
Blow to the head, neck or back.
Falling from a height.
Awkward fall whilst doing gymnastics or trampolining.
Diving into a shallow pool and hitting the bottom.
Thrown from a horse.
Heavy object falling across the back.
Multiple injuries.
Thrown from a motor bike.
High speed RTC (Road Traffic Collision).

How do I manage the airway with spinal injuries?

Delicately open the airway (chin lift)
Log roll
Recovery position

How to Manage Head Injuries, Including Concussion

Learn the basics of supporting little ones with serious injuries through Unii's Paediatric First Aid Journey.