Smashing melons: a guide to head injuries

iStock_000008037242_SmallSummer is in full force now. And with summer comes trauma. Just ask any ER doc: people start crashing into and falling off things they wouldn’t otherwise starting with the first warm day of the year. With all these collisions, head injuries abound, as do all the misinformation that has been passed on from generation to generation. Before any more melons are bashed, let’s smash some myths and clarify some truths.

Myth 1: if someone has a head injury, you can’t let him sleep afterwards. False. It’s perfectly fine to sleep after a good whack to the noggin. But, someone has to check on the injured person, preferably waking him up every 2 hours or so. The reason? Sleep and coma look the same, until you try to wake the person. Sleep is fine. Coma is, well, you know. As long as the person wakes up and knows what’s going on, home neuro check is done.

Myth 2: If an injured head isn’t swelling on the outside, it must be swelling on the inside. False. Whoever started that rumor must have owned stock in CT scans. There is no correlation between lack of external swelling and serious head injury. On the other hand, a ton of swelling might mean there is a fracture, which can signify a more serious injury below. I have never been worried because a patient did not have swelling to the scalp.

Myth 3: A head injury where a person was knocked out (unconscious) should have a CT scan. Maybe. But maybe not. While I think it’s prudent for a person with a head injury who gets knocked out be seen by a doctor for an evaluation, he may not need a scan of the brain. Don’t get me wrong: prolonged loss of consciousness, change in behavior, repeated episodes of vomiting, a large area of swelling (hematoma) that could cover up a fracture, or a new weakness on one side of the body are all reasons to get a CT scan. Elderly patients and people taking blood thinners or who have abnormal blood clotting (like hemophilia) are at higher risk than the average Joe. These patients are more likely to need imaging of their heads.

So, a person wrecks his bike, hits his head, is unconscious for a couple of seconds, has no neck pain, and is fairly quickly back to normal. He may need to be evaluated by a doctor, but may not need to have any imaging of his brain. That same person not acting right 30 minutes later with repeated vomiting probably just earned a CT scan.

A couple of other things. Riding a bike or skateboard? Wear a helmet. It’s the one part of your body we’re not great at fixing. Also, if there is a head injury, make certain the cervical (neck) spine, located in the midline back of the neck, is not painful. The head and the cervical spine are often injured together.

In conclusion, most people who hit their heads are fine. Perhaps by knowing exactly what to look for, and learning what wives tales not to believe, you can know what to watch for, which might save you a trip to the hospital (and the accompanying bill)for a clearly minor injury.

What experiences have you had with emergency department visits for minor head injuries?