Introduction to Head Injuries
Lorna Bagshaw is a Consultant in Paediatric Emergency Medicine at Sandwell and West Birmingham Hospitals. She has written this guide to help you through the next topic, head injuries. This is a common problem in the children’s emergency department and indeed across emergency departments. For all those non-medics out there, parts of this topic are quite technical. You may find it easier to first download the Parent Information Leaflet attached to the bottom of this page. This is written in plain English and avoids technical jargon.
There are approximately 1.4 million attendances at the A&E with head injuries in the UK, and of those 50% will be children. It is the commonest cause of death and disability in people under 40. However, the incidence of death from head injuries is quite low at 0.2%. Initially we are going to talk about what happens in a head injury and a the principles of primary and secondary injury.
Usually when a head injury occurs, the primary injury is something which has happened and has happened at the point of injury and there is little which we could do to prevent or alter the course of that. However, when we talk about secondary injuries, we are talking about the result of that injury so either in expanding bleed or swelling within the brain. The fact that this is occurring within a fixed space, the box of the skull, can result in problems with blood flow to the brain and perfusion to the brain. We will look at this in a bit more detail later.
The primary injury has occurred and nothing we can do can alter that. However, we can try to address the secondary injuries, which may be e.g. the result of expanding bleed or of brain swelling, in order to prevent additional injury to the brain. An increasing intracerebral pressure is an important sign to recognise, as early intervention prevents additional injury to the brain and can prevent the more serious brain damage and death from head injuries.
Here is a useful link to view information about GCS.
The 999 call
“Please help! My little boy has fallen off his scooter! He’s not moving and he’s bleeding from his head! Please come quickly! He was knocked out and I think he was unconscious for about 5 minutes?!”
Control: “OK, how old is he?”
Parent: “He’s five. He wasn’t wearing his helmet and he fell off when he hit the kerb!”
Control: “Is he conscious now?”
Parent: “He is really drowsy and has been sick. He is being sick again now! Please hurry!”
What things do you need to consider before you arrive at the scene?
Think of 5 things which you believe are important to consider. Discuss how you are going to prepare for them below.