The scalp is loaded with blood vessels and a relatively small wound to the top of the head will bleed excessively. Closed head injuries (injury to the brain, with no associated skull fracture,) can cause abnormal behavior and/or breathing irregularities. Injuries to the face are considered by most providers as the most difficult to look at, I guess, because it's an area associated with visual and verbal communication and the thought of being unable to communicate some dire need makes us feel uncomfortable in the presence of "all that blood." The head is a very heavy part of the body supported by the weakest part of the spinal column (consider supporting a bowling ball on top of a pencil) and associated neck injury is common.

Therefore, treat any head injury (or suspected head injury, in the case of closed head injury) by first monitoring the patient's breathing. As discussed earlier, breathing can be monitored in several different ways.

To avoid additional injury to the neck, move the patient as little as possible. If the injury to the head is significant enough to convince you that there is neck injury, have someone hold the head so that it does not move from the position in which it was found.

Control bleeding (if any) by applying direct pressure over the site of the wound. Do not, however, apply pressure over the area of a suspected skull fracture. A skull fracture may be indicated by a painful swollen area, a soft spot in the skull, or a section of the skull that moves independently from the rest of the skull. In the event that this bleeding is associated with a fractured skull, apply a bulky dressing (without pressure) over the wound.

If the head injury includes eye injury, cover the uninjured eye as well as the injured eye. Covering the "good eye" will help prevent involuntary movement in the injured eye and minimize the damage, but will also render the patient "blind." Being "blind" is initially very frightening, therefore, stay with the patient after the "onset of their blindness" and maintain physical contact with them even if it is just a hand on their shoulder. Trust me, it will make them feel better.

If the head injury includes an impaled object, remember we do not remove any impaled objects. (Can you imagine if a telephone pole that had impaled the patient's face? Ooooh Boy! “So, just what was going through his mind at the time of the accident?”)

Keep the patient calm, maintain any corrective action that you have initiated and wait for the ambulance.

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