Head injuries are potentially dangerous because brain damage may result. Indications of brain damage include unconsciousness, headache, convulsions, vacant or dazed expression, drowsiness, vomiting for no apparent reason, and loss of memory of the injury. There may be unequal pupil size and paralysis. 

      Bleeding from the ear without any obvious cause may indicate a fractured skull. Blood trickling from the nose together with other head injuries may indicate a fractured skull and should be treated as such. If the victim has a fractured or dislocated jaw, there will be difficulty in talking and increased salivation. The teeth may seem to be out of alignment. Do not try and set a dislocated jaw. Even if you attempt first-aid steps, summon emergency medical assistance immediately.

   That raises this often perplexing question: "When should a head injury involve a trip to the emergency room?" 

Steps to take: For anything other than the most superficial injury, at least call the doctor, observe the victim carefully and report all symptoms.  Such symptoms include:  sleeping more than usual, or becomes difficult to wake up, clear fluid or blood coming from the nose, ears or mouth. 

    Additional symptoms to report include:  nausea, vomiting, dizziness,  headache, vacant or dazed expression, loss of consciousness, seizures, lethargy, irritability, swelling, bruising, bleeding and memory loss may be  signs of a serious problem.  Most such symptoms surface within 36 hours. 

     Ask the doctor what to do if the victim's symptoms change, and, ask where the doctor can be reached during the next 36 hours. 

        The emergency number "911" should be called and the victim should be kept warm if he or she: 

     Immediately: Dial "911" on your telephone or tell someone to dial "911."  This is a standard emergency telephone number across the country. It connects you with a central police and fire rescue service. If "911" does not operate in your area, know your local ambulance service phone number. Keep it posted on each phone. 

     State clearly that this is a medical emergency. Tell the person what is wrong with the person. Example: "My baby is unconscious." Tell the person your exact address. Example: 506 S. 6th Street, 2nd floor rear Have someone wait for the rescue vehicle to direct them to the person, if possible. At night, turn on your lights. Start emergency care if your know what to do. 

 What not to do... Do not panic or delay calling for help.  Do not move the person unless there is further danger.  Do not attempt to drive yourself to the hospital  - emergency vehicles can get to you faster and often have the equipment to start treatment immediately.  Do not hang up until told to do so by 911 personnel. 

The Dangers of Concussion
    " ...during the minutes to few days after concussion injury, brain cells that are not irreversibly destroyed remain alive but exist in a vulnerable state. This concept of injury-induced vulnerability has been put forth to describe the fact that patients suffering from head injury are extremely vulnerable to the consequences of even minor changes in cerebral blood flow and/or increases in intracranial pressure and apnea....

     "Experimental studies have identified metabolic dysfunction as the key  post concussion physiologic event that produces and maintains this state of vulnerability. This period of enhanced vulnerability is characterized by both an increase in the demand for glucose (fuel) and an inexplicable reduction in cerebral blood flow (fuel delivery). 58 The result is an inability of the neurovascular system to respond to increasing demands for energy to reestablish its normal chemical and ionic environments. This is dangerous because these altered environments can kill brain cells." -- also see our Concussion in Sports page

Pediatric Emergency Medicine Journal - Jay D. Fisher MD FAAP, Editor Pediatric Emergency Services, University Medical Center, Las Vegas, NV