An open head injury is when there is a wound (eg. from a sharp object or bullet) that penetrates through the skull. A closed head injury is one in which any wound does not penetrate the skull, and there may be no obvious injury at all.
Closed head injuries can occur from violent shaking of a child or in an accident when the head is protected by a helmet but is violently agitated. The brain can move within the hard case of the skull and during a violent move may hit and rebound from the bone of the skull to cause bleeding, bruising and swelling of the brain.
The brain is housed, very compactly, in the rigid skull, and cannot tolerate any increase in pressure. If pressure increases due to bleeding or swelling from fluid then pressure is exerted on the base of the brain, which contains the vital centres controlling such functions as breathing and heart action.
Any patient who sustains a head injury, even if it appears to be mild, should be checked by a doctor. If after being checked he or she shows no serious signs of damage, they can go home and expect that recovery will follow within 24 hours. However, rarely, complications may follow at any time over the next few days.
Someone should keep the patient under close observation over the next 24 hours at least, and take them to a doctor immediately if any of the features below are noticed. The problems may occur gradually and certain warning signs will develop that indicate the pressure will have to be relieved by surgery.
- Unconsciousness or undue drowsiness.
- Confused irrational or delirious behaviour.
- Headache that continues.
- Bleeding from an ear.
- Repeated vomiting.
- Fits or spasms.
- Blurred or double vision.
Other points to consider:-
- Diet – Food and drink should be consumed in moderation for 24 hours.
- Alcohol – Nil for 24 hours.
- Drugs – No medication unless instructed by doctor. Paracetamol is allowed.
- Rest – No physical exercise for 24 hours. Use a flat pillow. Do not drive a vehicle.