Head injuries

Head injuries

Introduction

So I was watching my grandsons under 11s footy match a few weeks ago and couldn’t help overhearing a conversation between a couple of elderly gentlemen, also watching the game. Their conversation highlighted some of the effects of head injuries. It went something like this:

Gent one. ” Remember the good old days when we played footy? The coach never worried if we got concussions or head injuries, he would just send us back in.”

Pause

Gent two. “No.”

It made me smile. I could relate. As a youngster, and even into my twenties playing sport, there was a very casual approach to head injuries. ” You’ll be ok” was the general panacea for all knocks to the Uncle Ned. ” In ya go”! No thought at all for any long-term damage to anyone’s brain.

Memory loss, long-term brain damage, major trauma in the short term, or even – worst case scenario – death could be the end result of what appears to be a minor head injury.

Never considered.

Then I thought about how the attitude to head injury has changed. How there is a greater understanding now of the impact a head injury can have on a person.

Now in sports, players who suffer a head injury, no matter how minor, are removed from the game, assessed, rested, reassessed and either sent back on or sent to hospital for even more assessment and tests.

And rightly so.

Damage to the brain can result from even minor head trauma as this causes the brain to move inside the head and collide into the skull.

When the head hits something with a hard enough impact, the brain can twist and strike the skull.

A bit about the BRAIN

The brain is a soft and delicate organ, approximately 75% water that can generate more electrical impulses in one day than all the telephones on the planet.

One hundred billion neurons processing information, 161,000 blood vessels to keep them all functioning, generating enough electricity to power a light bulb.

It is a miracle of natural computing power and an absolutely vital element for your quality of life.

That’s all very interesting, but as this blog is about head injuries and not the brain, the important bit for us is “soft and delicate”.

Although your soft and delicate brain is protected by your skull, which is very strong, a hard blow to the head can cause a brain injury. There may even be no visible signs of trauma to the scalp or face.

And, as the brain itself does not feel pain because it has no pain receptors you will have no warning – pain – if any damage has occurred.

Indications that something is seriously wrong may come later.

Head Injuries

Head injuries may be caused by a number of mechanisms including, falls, assaults, motor vehicle crashes, sporting injuries and, less commonly, penetrating injuries.

It is important to note that a head injury does not always result in a loss of consciousness or memory.

Even if there is a suspected head injury it should be treated with the utmost care.

A final assessment of the injury should still be done by a health care professional.

Be aware that if the head is injured, the neck and spine may be injured too.

There are two types of head injury

  • Open – with bleeding wounds to the face or head
  • Closed – no visible signs of injury to the face or head

 

Head Injuries – signs and symptoms

Head Injuries signs and symptoms.

Blood is not a reliable indicator of the seriousness of a head injury. This is because minor cuts on the head often bleed heavily as the face and scalp have many blood vessels close to the surface of the skin.

Although this amount of bleeding may be alarming, many times the injury is not severe.

 Apart from wounds, other symptoms of serious head injuries can include:

  • Altered consciousness – for example, loss of consciousness for even a short period then regains consciousness but is confused and or drowsy. Their condition improves for a while, deteriorating again later. They may even experience a small seizure or persistent headache.
  • Skull deformities – signs of Fracture are indications there may be compressions or deformities. A serious head injury.
  • Clear fluid from the ears or nose – a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.
  • Black eyes and bruised skin behind the ears – this indicates that the blow was of sufficient force to rupture blood vessels around the eyes and ears.
  • Vision changes – dilated (enlarged) pupils or different pupil sizes often indicate serious head injuries. The casualty may also complain of double or blurred vision.
  • Nausea and vomiting – these are common side effects of serious head injuries and should always be considered important if they persist.


Remember, a victim may have a brain injury without any external signs of injury to the head or face. Serious problems may not be obvious for several hours, or even days, after the initial injury.

Management of head injuries

Follow the initial action plan DRSABCD with a focus on assessing and managing the airway and breathing.

For a conscious casualty

  • Encourage the injured person to minimise any movement of their head or neck and control any significant blood loss from head wounds with direct pressure and a dressing.
  • Reassure the casualty and monitor their condition.
  • Call 000 if the casualty lost consciousness, suffered altered consciousness even for a short time, or any of the above symptoms indicating head injuries are present.
  • If 000 called do not give the casualty any food or drink.

Unconscious Casualty

  • Call 000.
  • The casualty should not be moved unless they are in immediate danger. Be aware that any movement may cause greater complications to their head injury as well as their spine.
  • If they are lying on their back, you will need to place them in the recovery position.
  • If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be needed.

Once again follow the initial action plan DRSABCD with a focus on assessing and managing the airway and breathing, whilst caring for the neck until expert help arrives.

Remember, if they have a serious head injury, the neck may be injured too.

After any head injury, advise your casualty to seek professional medical advice as soon as possible.

Concussion

As far as head injuries go, concussion is the most common place. But what is concussion?

According to the university of Qld. –

“Concussion is the most common and mild form of traumatic brain injury. Within the skull, the brain floats in a protective suspension of cerebrospinal fluid. Concussion occurs when either a direct impact or whiplash effect – either through a blow to the skull or the body — causes the brain to move inside the head and collide into the skull. As a result, neurons are damaged and the brain may bruise at the site of impact. You don’t have to lose consciousness to have a concussion, and the force required for it to occur is small.”

Concussion is quite a common sporting injury, predominately contact sports, such as Australian rules football, rugby league and rugby. The AFL website has a great blog on concussion in AFL and some very useful tools.

Other activities such as horse riding, cycling and skiing, with a high risk of falls, are also common causes of concussion.

Traumatic Brain Injury (TBI)

A Traumatic Brain Injury ( TBI ) is an injury to the brain caused by an external force and is classified according to its severity: mild, moderate or severe.

Signs and symptoms of TBI

Traumatic Brain Injury
Signs and Symptoms

Mild to moderate:
 Headaches, dizziness and fatigue, sleep disturbances, 
memory or concentration problems and  blurred vision.

A person may not display all of these at all times.

Moderate to severe:
 Slurred speech, profound confusion, seizures, persistent headaches, loss of consciousness.

According to the same University of Qld. study, a staggering 89% of concussions will not be assessed by a medical professional, and 70 to 90% of concussions are TBIs! (Here is the link to the study: https://qbi.uq.edu.au/concussion/what-is-concussion )

The message here is clear – ANY head injury must be taken seriously and professional medical attention should be sought.

Recovery from concussion

Generally, most people recover fully within 2 weeks, however, children usually take longer to recover.

For some people, symptoms can continue for longer, especially if they have had a head injury before.

A small number of people have longer-term complications such as ‘persistent post-concussive syndrome’ when concussion symptoms continue for longer than 3 months after the event.

Of course, see your doctor if you are concerned about ongoing symptoms after a concussion.

I found lots of great stuff while researching this blog so watch this space for some more on head and brain trauma.

So, for this blog on head injuries, I’ll give the last word to my old friend Publilius

“Even when the wound is healed, the scar remains.” Gives me goosebumps….

Well, that’s that. Until next time….. stay safe

Adrian

What is RICER – First Aid for Soft Tissue Injuries

An image showing a sprained ankle with the title 'RICER: First aid for sprains and strains'
A poster outlining first aid measures for sprains and strains, defining what sprains and strains are, and describing the RICER action plan (Rest, ice, compression, elevate, refer) and HARM (do not: heat, alcohol, running, massage)

Understanding Soft Tissue Injuries

Sprains occur when a ligament supporting a joint is overstretched or torn. Sprains commonly happen in the ankle, knee, or wrist. Strains occur when a tendon or muscle is overstretched or torn. They are often the result of repetitive movements.

Soft tissue injuries refer to damage to muscles, ligaments, or tendons, often resulting from trauma or overuse. These injuries can cause pain, swelling, bruising, and limited mobility, varying in severity from mild to severe. Common types include:

  • Sprains: Injuries to ligaments, typically caused by stretching or tearing due to sudden twists or impacts, commonly affecting ankles and wrists.
  • Strains: Injuries to muscles or tendons, often resulting from overstretching or repetitive movement, frequently seen in the back or hamstrings.
  • Contusions (Bruises): Caused by a direct blow to soft tissue, leading to bleeding under the skin.

Typical causes of soft tissue injuries include sports activities, physical exertion, slips or falls, and sudden impacts. Overtraining, poor technique, or insufficient warm-ups in physical activities also contribute significantly.

Common Joint Injuries: Dislocations, Fractures and breaks, Sprains and strains of the tendons and ligaments around the joint, Tendonitis or other overuse injuries, Osteoporosis

Factors increasing the risk of these injuries include poor physical fitness, inadequate equipment or footwear, age-related changes like reduced flexibility, and previous injuries. Occupational hazards, such as repetitive movements or lifting heavy loads, can also heighten vulnerability. Understanding these risks and taking preventative measures is essential for reducing the likelihood of soft tissue injuries.

Signs and Symptoms of Sprains and Strains

Signs of sprains: Pain, swelling, bruising. Sings of strains: Sudden pain in the affected area, loss of power in the affected limb, The muscle is tender to the touch

Signs and Symptoms of Strains:

  • Pain
  • Swelling in the affected area
  • Bruising in the affected area

Signs and Symptoms of Sprains:

  • Sudden pain in the affected area
  • Loss of power in the affected limb
  • The muscle in the affected limb is tender to the touch

The RICER Acronym Explained

RICER action plan: Rest, Ice, Compression, Elevate, Refer

Rest

Resting the injured area is crucial to prevent further damage and promote healing. By reducing movement and stress on the affected tissue, rest minimises pain, swelling, and the risk of exacerbating the injury. It allows the body’s natural repair processes to function effectively, reducing inflammation and preventing complications. Overusing an injured area can delay recovery and worsen the damage. Proper rest, combined with other treatments, ensures a faster and more complete return to normal function.

Ice

To reduce pain and swelling, apply ice to the injured area as soon as possible. Wrap the ice pack or frozen item in a thin cloth to avoid direct contact with the skin, preventing ice burns. Place it on the injury for 15–20 minutes every 1–2 hours during the first 48 hours. Avoid applying ice for too long, as it can damage the skin and underlying tissue. Regular ice application helps minimise inflammation and numbs pain effectively.

Compression

Compression bandages help limit swelling and provide support to an injured area by applying gentle, consistent pressure. Wrap the bandage snugly around the injury, starting away from the heart and working toward it, ensuring it’s firm but not too tight to avoid restricting circulation. Check for signs of reduced blood flow, such as numbness or discoloration, and adjust if needed. Compression helps control swelling, reduces pain, and stabilises the area, promoting faster recovery when combined with rest and elevation.

Elevation

Elevation is essential for reducing swelling and promoting faster recovery. By raising the injured area above heart level, it helps decrease blood flow to the injury, reducing inflammation and fluid buildup. This also alleviates pain and prevents further damage by minimising pressure on the affected tissue. Elevation works best when combined with rest, ice, and compression, as it enhances overall healing and prevents complications. Keeping the injury elevated as much as possible, especially in the initial stages, ensures optimal results.

Referral

Seeking professional medical advice is crucial for accurately diagnosing and treating an injury. A healthcare professional can assess the severity of the injury, identify underlying issues, and recommend appropriate treatment, such as physical therapy or medication. Delaying medical attention can lead to complications or prolonged recovery. Referral to a professional ensures the injury is managed effectively, reducing the risk of long-term damage and supporting a safe return to normal activities. Always consult a doctor if symptoms persist or worsen.

RICER: Rest - Encourage the casualty to stop any activity and make them comfortable
Ice - Apply an ice pack wrapped in cloth to the injured area
Compression - Apply an elastic bandage over the injured area
Elevate - Elevate the injured area above their heart height
Refer - Refer them to a medical professional to have the area looked at

How to Use the RICER Method Step-by-Step

Immediate Actions Post-Injury

Follow the RICER method immediately after a soft tissue injury to promote recovery:

  1. Rest: Stop any activity to protect the injury and prevent further harm.
  2. Ice: Place a wrapped ice pack on the area for 15–20 minutes every 1–2 hours to reduce swelling and pain.
  3. Compression: Wrap the injury with a compression bandage to limit swelling and provide support.
  4. Elevation: Raise the injured area above heart level to reduce swelling and improve blood flow.
  5. Referral: Consult a healthcare professional for a proper diagnosis and treatment plan.

Use RICER during the first 48 hours for the best results.

Duration and Frequency of Each Step

To maximise the benefits of the RICER method, follow these guidelines:

  1. Rest: Avoid using the injured area for 48 hours to prevent further damage.
  2. Ice: Apply a wrapped ice pack for 15–20 minutes every 1–2 hours during the first 48 hours. Avoid direct contact with skin.
  3. Compression: Use a compression bandage continuously, ensuring it’s snug but not too tight. Adjust as needed.
  4. Elevation: Keep the injured area elevated as much as possible, ideally above heart level, especially during rest.
  5. Referral: Seek professional advice promptly if symptoms persist or worsen.

Adhering to these timeframes aids in effective recovery.

Benefits of the RICER Method

Accelerated Healing

The RICER method minimises tissue damage and accelerates recovery by addressing key aspects of the injury. Rest prevents further strain, allowing the body to focus on repair. Ice reduces pain and swelling by constricting blood vessels and numbing the area. Compression limits fluid buildup and stabilises the injury, preventing excessive swelling. Elevation decreases blood flow to the area, reducing inflammation and promoting drainage. Referral ensures proper diagnosis and treatment, addressing complications early. Together, these steps protect the injured tissue, control inflammation, and create an optimal environment for healing, significantly shortening recovery time.

Pain and Swelling Reduction

The RICER method is highly effective in managing pain and swelling after soft tissue injuries. Ice provides immediate relief by numbing the area and constricting blood vessels, which reduces blood flow and swelling. Compression applies consistent pressure, preventing excessive fluid buildup that contributes to inflammation. Elevation further decreases swelling by promoting the drainage of excess fluids away from the injury. These steps work together to minimise discomfort and control the body’s inflammatory response. By addressing pain and swelling early, RICER promotes faster recovery and prevents further damage, making it a trusted approach for injury management.

Common Mistakes to Avoid When Using RICER

Frequent mistakes during RICER application can delay recovery or worsen the injury. Applying ice directly to the skin can cause frostbite or skin damage; always wrap the ice in a cloth before use. Tight compression bandages may restrict blood flow and cause further harm; ensure the bandage is snug but not overly tight. Failing to elevate the injury adequately can lead to prolonged swelling; keep the area above heart level whenever possible. Delaying medical advice risks improper diagnosis and treatment; seek professional help if symptoms persist or worsen. Following correct practices ensures safe and effective recovery.

When to Seek Professional Medical Attention

Certain signs after an injury require prompt medical attention. Severe pain that doesn’t improve with rest or basic first aid suggests a more serious issue. The inability to bear weight or use the injured area indicates potential fractures or severe soft tissue damage. Visible deformity or abnormal positioning of a limb may point to dislocations or broken bones. Significant swelling or bruising that worsens despite applying RICER should also be evaluated. Numbness or tingling may indicate nerve involvement. If these signs occur, seek professional evaluation immediately to ensure proper diagnosis and treatment, preventing complications and ensuring a safe recovery.

What you should not do – HARM

HARM: Heat - DON’T apply heat to the injury, Alcohol - DON’T consume alcohol, Running - DON’T run or do any activity that might affect the injury, Massage - DON’T massage the injury

When treating using RICER you should also do no HARM, meaning:

  • HEAT: NO application of heat to the injury
  • ALCOHOL: NO alcohol consumption
  • RUNNING: NO activity that might affect the injury
  • MASSAGE: NO massaging the injury

This method should be used within the first 48–72 hours (depending on severity) after the injury to s

Join a Lifesaving First Aid Course Today & Empower Yourself with Essential First Aid Skills

Don’t wait for an emergency to realise the importance of being prepared. Equip yourself with the knowledge and confidence to respond effectively by joining a Lifesaving First Aid course. Whether it’s for work, home, or recreation, our courses are designed to empower you with practical, lifesaving skills.

Book your spot now and take the first step towards making a difference when it matters most!