DEALING WITH A HEAD INJURY: SELF-HELP
The prevention of head injury and brain haemorrhage is simple, but often neglected. If you are given head protection in your job, or for driving a motorcycle or pushbike, then me it – it’s not macho to do without.
Motorbike helmets are deceptive – they are very effective in reducing head injury, but they rapidly lose their strength if previously dropped or banged, even if tin’ blow wasn’t particularly hard.
Helmets don’t respond well to being painted, either. The solvent in some paints dissolves the plastic of the helmet, weakening it considerably.
Increasingly, cyclists are being recommended to wear helmets; the neurosurgical units are spearheading campaigns to encourage their use.
Repeated violent head movements can result in torn nerve fibres, small bleeds in the brain, and in some cases more serious bleeds from ruptured blood vessels. ‘Headbanging’, a dance popular more in the Seventies and Eighties, in which the head is repeatedly jerked violently up and down, can cause severe brain damage and even death as a result of rupturing blood vessels inside the head.
The second dangerous activity is boxing. You can suffer brain damage even when wearing headguards. Although a headguard may protect against direct blows to the face, there is virtually no protection against the twisting force of a sideways blow to the chin, and it is these twisting, rotating forces on the brain that probably do the greatest damage in producing a punch-drunk fighter.
Contrary to the impression given in the movies, keeping the patient awake after a head injury doesn’t help. In any case, the stress of the circumstances surrounding the head injury usually makes him want to sleep – especially if the patient is a child.
Self-help after a head injury is largely a matter of common sense. If you’ve been knocked out, or show any of the symptoms described above, then you will need to get to hospital as soon as possible. On the other hand, if the injury is minor, you haven’t been knocked out, and you haven’t got any of the other symptoms, then a couple of paracetamol (or in adults, aspirin, if you’re able to take it) may be all that you need to get rid of the headache. If you’ve jarred your neck as well as banging your head, then an anti-inflammatory drug such as ibuprofen can often be more effective than simple analgesics. (This is available over the counter as Nurofen; don’t take it if you have stomach ulcers.)
If there is a lot of spasm in the neck muscles then a cold compress and massage may be helpful. However, don’t apply heat to the site of a recent soft-tissue injury; it will make the swelling worse. Instead, cold compresses will reduce the swelling, the inflammation, and the pain. Warmth is for a few days later, after the initial injury has started to settle down.
One very important word of warning: where there has been a head injury, there may also be a neck injury. If the patient is complaining of severe neck pain, or if you think the neck may have been damaged, then do not move them. If the neck has been broken, moving the head or body may rupture the delicate spinal cord inside the neck. There have been instances where patients have been damaged more by the actions of their first-aid ‘helpers’ than they were by the original injury. There is one horrific case of a motorcyclist who came off his machine and was found lying on the ground with his neck broken but his spinal cord intact. Somebody took his helmet off, and in doing so bent his neck, and severed his spinal cord, paralysing him permanently. So, if there is a neck injury of any severity (which usually means the patient is in severe pain, and perhaps unable to move without experiencing agonising pain), or else is unconscious, then do not move them. Wait for the ambulance to arrive: ambulancemen and paramedics have specialised equipment to allow them to move patients without causing further movement to the head and neck.
*60\20\2*
