How to Evaluate for Head Injuries During First Aid

Head injury is one of the most common reasons for death in the wilderness. By asking some important questions and conducting a careful examination, a rescuer may be able to assess whether an injured person might have suffered injuries to the head.

Instructions

Difficulty: Easy

Things You’ll Need:

• Rubber Or Latex Gloves
• Surgical Masks
• Powerful Flashlight
• Pens
• White Paper

Setup

1. Put on rubber gloves and a surgical mask before touching the injured person.

The Exam

2. Ask the injured person if he or she has a headache, is experiencing difficulties with vision, is feeling a lack of balance or is nauseated. If the answer to any of these questions is "yes," suspect a head injury.
3. Feel the injured person's skull and face, and note bruising, lacerations, bleeding, blood or fluids in the nose or ears, depressions of the skull, or damage to the eyes. If any of these are found, suspect a head injury. See "How to Conduct a Secondary Survey of the Head."
4. Look at the injured person's skull and face for any bruising or discoloration, especially behind the ears or around the eyes. If any bruising is seen, suspect a head injury.
5. Take the injured person's pulse and respiratory rate. (See "How to Take a Pulse" and "How to Take a Respiratory Rate.") If the pulse is slow or bounding, or if the respiratory rate is irregular, suspect a head injury.
6. Shine a flashlight or headlamp into the injured person's eyes and observe how the pupils respond to the light. If the pupils are unequal in size or react slowly to the light by barely contracting, suspect a head injury.

Record Results

7. Write down your observations, and hand these over when care is transferred to a medical professional.

Tips & Warnings

• Infectious diseases such as HIV and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing gloves and a surgical mask. Wear goggles or glasses to protect against spurting blood or fluids.
• Pupils which are equal in size but react slowly may indicate a deprivation of oxygen to the brain.
• Pupils which are as small as pinpoints and equal in size may indicate drug intoxication.
• Pupils which are unequal in size and degree of reaction to light may indicate damage on the side of the pupil which is larger and less reactive to light.
• When a head injury is suspected, a spinal injury must be suspected as well, because similar mechanisms can produce both kinds of injuries. Immobilize the injured person until both of these injuries are ruled out. Seek professional medical assistance immediately. See "How to Rule out a Spinal Cord Injury," "How to Logroll an Injured Person," and "How to Manage a Spinal Injury."
• If you suspect a head injury, treat for head injury and immediately evacuate. Seek professional medical care immediately. (See "How to Treat a Head Injury.")
• If symptoms persist or if you have specific medical conditions or concerns, we recommend you contact a physician. This information is not intended as a substitute for professional medical advice or treatment.