Traumatic Brain Injuries
Injuries are part and parcel of a long-term survival scenario. Many realize that good boots, gloves, and even protective eyewear will prevent many of these injuries, but few will take action to protect against head injuries.
Most head injuries cause superficial damage and are not life-threatening. Indeed, most amount to only a laceration of the scalp, a black eye, or a painful bump. These wounds, however, can hide damage inside the cranium, the part of the skull that contains the brain.
Injuries that affect the brain are called traumatic brain injuries (TBIs). It’s important for the medic to recognize when trauma to the skull has caused damage that is more than superficial.
Concussions – The Most Common TBI
Concussions are the most common type of TBI. A concussion is associated with a variety of symptoms that are often immediately apparent. The presentation of a concussion will vary from one individual to the next.
Although you might expect a loss of consciousness, the victim often remains completely alert. As you might imagine, pain at the site of injury or headache is the most commonly seen symptom.
Others include:
- Dizziness
- Confusion
- Nausea
- Loss of motor coordination
- Blurred or double vision
- Slurred speech
- Ringing in the ear (also called “tinnitus”)
- Difficulty concentrating
A person with trauma to the head may be knocked unconsciousness for a period of time. In most cases, they will “wake up” in less than 2 minutes, but you can notice them to be “foggy” and behave inappropriately (put me in, coach!). They may not remember the events that led to the injury. This patient will merit close observation for the next 48 hours.
Examine the victim for evidence of superficial injuries and determine that they has normal motor function. This includes making sure they can move all their extremities with full range and strength. Even so, rest is prescribed for the remainder of the day. When your patient goes to bed, it will be appropriate to awaken them every two or three hours to make sure that they are easily aroused. In most cases, a concussion causes no permanent damage unless there are multiple episodes of head trauma over time, as in the case of, say, boxers.
It should be noted that a physical strike to the head is not necessary to suffer a concussion. A particularly jarring football tackle or the violent shaking of an infant can cause a concussion or worse traumatic brain injury. This is because the brain “bounces” against the walls of the cranium. When injury occurs at the site of a blow to the head, it’s called a “coup” injury. Just as often, it can occur on the opposite site of the head, known as a “contrecoup” injury.
In many cases, evidence of direct trauma to the skull is visible. An “open” head injury means that the skull has been penetrated with possible exposure of the brain tissue. If the skull is not fractured, it is referred to as a “closed” injury. An indentation of the skull is clear evidence of a fracture and the outlook may be grim, due to the likelihood of bleeding or swelling in the brain. A closed injury may still become life-threatening for the same reasons.
The brain requires blood and oxygen to function normally. An injury which causes bleeding or swelling inside the skull will increase the intracranial pressure. This causes the heart to work harder to get blood and oxygen into the brain. Blood accumulation (known as a hematoma”) could occur within the brain tissue itself, or between the layers of tissue covering the brain.
Without adequate circulation, brain function ceases. Pressure that is high enough could actually cause a portion of the brain to push downward through the base of the skull. This is known as a “brain herniation” and, without modern medical care, will almost invariably lead to death
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