Treatment varies according to the severity of the injury, type and location of injury, and development of secondary complications. For mild head injury, no specific treatment may be needed other than observation for complications, although an initial medical evaluation should still be done. Over-the-counter analgesics may be used for headache. Aspirin is usually discouraged because prolonged use increases the risk of bleeding.
For moderate to severe head injury, where the victim is comatose or if symptoms are severe, urgent treatment is required. Take the following first aid treatment steps:
1. Call the local emergency number (such as 911) before you begin treating someone with a severe head injury.
2. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
3. If the victim's breathing and heart rate are satisfactory but he or she is unconscious, treat him or her as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the victim's head, keeping the head in line with the spine and preventing movement. Wait for medical help.
4. Unless there has been a skull fracture, attempt to stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the victim's head. If blood soaks through the cloth, don't remove it, just place another cloth over the first one.
5. If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing and get medical help immediately.
6. If a victim is vomiting, remember you must always suspect a spinal injury and roll the head, neck, and body as one unit to prevent choking. (Children often vomit once after a head injury. But even if the child does not vomit again and is not behaving differently, contact a doctor.)
7. Apply ice packs to swollen areas.
For patients with mild or moderate head injury and no loss of consciousness, a full medical evaluation should still be sought. If the patient is not hospitalized, you will receive instructions to observe the victim for any signs of a serious head injury over the next 24 hours. These instructions may include waking the patient every 2 to 3 hours during the night to check for alertness; you may be told to ask the victim specific questions, such as "What is your address?"
If the patient becomes unusually drowsy, develops a severe headache or stiff neck, vomits more than once, or behaves abnormally, get medical help immediately.
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