Assessing a Bang to the Head in the Outdoors
Your friend has taken a tumble and banged their head. Is it serious or not? How do we know? The simple answer is it is difficult to diagnose a serious head injury.
Of course what we would like to do is see inside the skull to find out what has happened to the brain, has it been damaged? In the outdoors we cant do this so we need to reply on other signs and symptoms to recognise a head injury.
Head injuries can arise directly from bangs to the head leading to an impact site on the skull, or be indirectly caused by movement of the brain within the skull.
Traumatic brain injury may be categorised as primary (damage occurring at the time of impact) or secondary (injury as a result of changes minutes to days following primary injury). Interestingly 70% of admissions to hospital with a primary diagnosis of head injury are male.
In the outdoors a fall from a mountain bike, a crag, snow slope can all lead to head injuries. Below we have listed some of the factors that would a cause for concern for someone who has banged their head. How do we assessing a bang to the head? What are we looking for?
• History or witnessing of an impact
• Change in personality of the casualty, perhaps irritability
• Suspicion of a skull fracture
• A change from normal alertness in the casualty
• Persistent headache since the incident
• Nausea or vomiting since the incident
• Memory loss about the incident or before the incident
• Unusually sleepy
• Any seizure since the accident
• Clear fluid from the ears or nose
• Black eye with no associated damage around the eyes
• Bleeding from one or more ears, new deafness in one or more ears
• Bruising behind one or more ears
• Blurred vision or double vision
How long would it be before we any of these signs and symptoms?
This is difficult to know, it could be we see signs quite quickly if it is a major injury, but if the injury is small then it could be up to a few days before we see anything. The best way to spot any of these changes is to monitor the casualty closely. If we have any suspicions then the casualty should be taken to hospital as soon as possible.
Remember: wearing a helmet when on your mountain bike, skis or horse will help protect the skull from damage but brain and skull injuries can still occur underneath a helmet. Therefore monitoring your casualty is your best defence against serious head injuries and their consequences.
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