Head Injury

This is a condition commonly seen in General Practice which doctors and patients alike find difficulty in dealing with. However, the condition is not difficult to manage providing that certain simple rules are followed. These apply to children and adults likewise.

Complications are not always immediate following head injury so careful observation for at least 24 hours is required by a responsible adult. The patient should be taken to hospital immediately if they:

• Become unconscious
• Become sleepy or drowsy
• Complain of increasingly severe headache
• Complain of blurred or double vision
• If they vomit repeatedly
• Have a fit

Contacting NHS Direct and/or General Practitioners often imposes a dangerous delay with the above symptoms as the patient should be transferred by all means possible as an emergency to the nearest Accident and Emergency Department. These symptoms can be caused by raised intracranial pressure… simple swelling of the brain, or a bleed within the head itself, both requiring immediate treatment.

Following a head injury, simple life style advice is advisable. The patient should rest for at least 48 hours. Light meals are indicated for a day or two. The patient should not drink any form of alcohol, and should not take any potent sedatives such as sleeping pills or tranquilizers. This may mask recurrence of the above symptoms. Mild headache relief can be obtained with paracetamol. Aspirin and anti-inflammatory drugs such as ibuprofen are contraindicated as they can increase the bleeding tendency and can cause further gastric irritation and nausea, thus complicating the picture.

Medical advice should always be sought following a head injury if the patient has had a loss of consciousness however transient that might be.

Simple crack, linear, fractures of the skull without the complications above require a medical opinion, but not as an emergency. Surprisingly large depressed fractures with dents of the skull seen or felt may not cause immediate intracranial damage, but at all times an urgent medical opinion should be sought for these.

Following head injury, both in adults and children, a swelling of the scalp may arise due to bruising tracking beneath the tissues of the scalp. This leads to the typical duck egg sized, painful, non-bruised, tender swelling, haematoma, often seen. Simple observation management of the patient is all that is required. Local ice cold compresses can be applied.

When in doubt obtain an urgent medical opinion at all times.