March 2015
Head Injuries YOU ARE AT RISK
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violent shaking as typically occurs in abuse scenarios.
id you know that head injury is one of the most common causes of death in transport-related incidents? It is also a common cause of death among pedestrians who are knocked by vehicles. ER24 attends to patients who sustain head injuries during collisions on a daily basis. With March 20 being World Head Injury Awareness Day, ER24 is urging people to use safety belts, refrain from speeding and driving recklessly, to use child car seats and be alert while on the road. This will assist in limiting the likelihood and impact of head injuries. Speaking about all road users, Dr Vernon Wessels, from ER24, said, “As with most injuries, prevention is better than cure. The best way to reduce head injuries is to try and avoid the impact in the first place. “Where potential impact is unavoidable, wear the appropriate headgear. Use the appropriate restraint in vehicles. Using a car seat for children that is correctly fitted protects them from injury. It also protects other occupants from being hit by an unrestrained child in the event of a
Contusion
collision.” People must seek medical attention if a head injury leads to loss of consciousness or coordination, visual disturbances and loss in memory no matter how short the effects may have been. “Life-threatening brain injuries can initially present very subtle and a medical assessment will determine if further tests or admission for observation are required. Bleeding and swelling of the brain is potentially treatable with good outcomes if done before serious complications occur. “The most catastrophic event is a missed bleed inside the skull cavity that can cause severe disability or death. There are however subtle effects that can present at a later stage such as personality changes, co-ordination problems, speech difficulty and memory and concentration problems,” said Dr Wessels.
Children
Dr Wessels said in a perfect world, any head injury should be assessed
by a health professional, however we also need to be realistic. “Children will sustain minor head injuries mainly due to the relatively large size of the head during early childhood and immature motor skills. “However, there are certain signs that can be used to determine when a medical consultation is appropriate. These include any loss of consciousness no matter how brief, convulsions after the injury, vomiting, a headache that worsens or does not improve with rest or oral paracetamol and any visual disturbances or behaviour that is not typical for the child. If there is any doubt, rather consult a doctor,” said Dr Wessels.
Understanding head injuries
Dr Wessels said head injuries could range from simple lacerations to devastating bleeding inside the skull cavity that causes pressure on the brain. This pressure can cause death if the patient is not urgently treated. “Although injuries involving the skull cavity are usually the most catastrophic, external head injuries can also cause permanent damage or death especially if the airway or major blood vessels are affected,” he said. Types of head injuries include concussion, contusion and skull fractures.
Concussion
A concussion is the most common type of head injury. A concussion results
when the brain undergoes impact that shakes the brain tissue but does not cause bleeding or visible damage to the cells. “A patient may lose consciousness for a short while and is often confused, disorientated or has poor co-ordination. However, the effects return to near normal fairly quickly. “Some functions like short-term memory may take much longer to recover and headaches and dizzy spells can last for months after a concussion episode. By repeating questionnaire tests over a period of time, doctors are able to track the recovery process. Although the brain cells do not appear abnormal (a CAT Scan will be normal), the functioning of the cells are affected and a repeat impact could have a more serious result,” said Dr Wessels. Usually, a concussion is sustained through impact to the head, however indirect force can also cause this. A sad example of bleeding that can occur in the brain of a child is through
Do’s & Don’ts
If severe head trauma occurs
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Don’t drive home from the hospital after you have been discharged. Ask someone to give you a lift home. Rest quietly for the day. Arrange for someone to stay with you for the next 24 hours, in case you need help. Only use medication prescribed by your doctor and do not exceed the dosage. Contact ER24 on 084 124 should you require any medical advice. Published by ER24 Communications
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Keep the person still until medical help arrives. Avoid moving the person unless absolutely necessary. Stop any bleeding by applying firm pressure to the wound with gauze or a clean cloth. Don’t apply direct pressure to the wound if you suspect a fracture to the skull. Watch for changes in breathing and alertness. If no breathing or pulse, begin with CPR. Call ER24 on 084 124. media@er24.co.za
With contusion, the brain tissue is bruised by the impact and this can cause swelling. As the brain is inside a bony cavity that cannot expand, pressure will build up due to the swelling. This prevents adequate blood supply to the brain, which suppresses it’s functioning and can cause permanent damage to the cells and potentially lead to death. The same result occurs when there is a bleed inside the skull cavity.
Skull fracture
With a skull fracture there is a risk of bony fragments causing direct damage to the underlying brain tissue. In addition, skull fractures are often associated with a wound of the overlying skin that then causes a pathway for germs to travel from outside into the skull cavity and cause infection of the brain (encephalitis) or the membranes covering the brain (meningitis). This infection can be life threatening or cause permanent disability.