Head injuries

Head injuries are always spectacular. 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.

Head injuries

General Illness

If any of the following symptoms occur, either alone or with other symptoms, consider contacting your doctor:

• Fever

• Listlessness

• Pale skin

• Dull or sunken eyes

• Dry tongue

• Skin that "tents" (when it is pinched, it remains in the "tent" shape for several seconds)

• Diminished level of consciousness

• Prolonged periods of vomiting

• Prolonged periods of diarrhea

"With temperatures expected to climb into the high...."

Heat Emergencies can be group into three categories:

Heat Cramps

Heat Exhaustion

Heat Stroke

Heat cramps, characterized by muscle spasms, can be induced by profuse sweating and severe exertion in intense heat, sometimes related to salt deficiency, hyperventilation, or overindulgence in alcohol. Heat cramps can result in significant pain but do not present a threat to life. Remove the patient to a cool place and encourage fluid replacement (water, and lots of it.)

Heat Exhaustion is considered a form of "heat illness" that results when the patient is dehydrated. It is characterized by fatigue, lightheadedness, nausea, vomiting, headache, rapid heartbeat and lowered blood pressure. Immediately remove the patient to a cool place and encourage fluid replacement (water, consider putting a few grains of salt in the water, but do so judicially because too much salt can induce vomiting.) and place cool wet cloths on the back of the patient's neck, on the forehead, and if possible on the patient's back. The patient should start to feel some relief after a short period of time.

Heat stroke is an immediate life threatening emergency, considered a severe and even fatal heat illness produced by exposure to high temperature, and commonly associated with exertion. Characterized by elevated body temperature, absence of sweat, hot dry skin, headache, dizziness, confusion or unconsciousness. Immediately cool the patient, by submersion in tepid water (98 degrees.) Do not administer anything by mouth while the patient is confused or unconscious. These three levels of heat illness do not have clear cut lines of definition between them. They occur as a progression from one stage to another, each stage being more serious than the previous one, and each stage, left untreated, can lead to the next.