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Medical Dumps for Writers: Head Injuries

Your character up and bumped their head and now you’re wondering what’s going to happen to them. I’m a Navy veteran with 5+ years of medical experience to include trauma medicine, and today I’ll be talking about head injuries and how to treat them.

A head injury is a very generic term for injuries that occur to the scalp, skull, brain, and underlying tissues. Depending on the severity of the head trauma, your character can develop a traumatic brain injury (TBI).

What are the different types of head injuries?

Concussions are the most common head injury. Patients might black out and not remember the events leading up to, or immediately after the head injury. They might describe “seeing stars”. They might be very confused, disoriented, and sensitive to light. Concussions generally take 2-4 weeks to heal. Continued concussions may result in further damage. Treatment is rest and staying away from electronic screens, typically in the dark.

Skull fractures are breaks in the skull bone. You can have linear, depressed, diastatic, or basilar skull fractures. The most common type of fracture is a linear skull fracture, where there is a break in the bone but the bone did not move. Patients may be observed in the hospital for a few days, but can resume normal activities in a few days. Depressed skull fractures occur when the bone sinks into the skull. It may require surgical intervention. Diastatic skull fractures occur along the suture lines in the skull—these lines fuse together when we become adults, but in children the lines can be widened. Finally, a basilar skull fracture is the most serious, involving a break in the bone at the base of the skull. These patients can have bruising around the eyes, behind their ear, and clear fluid draining from their ear.

Intracranial hematomas are bruises in the brain, or blood clots that form due to traumatic circumstances. An epidural hematoma is generally associated with a skull fracture, with a blood clot forming under the skull but on top of the dura, which is the hard covering of the brain. A subdural hematoma occurs when a bruise forms under the skull and under the dura, but on top of the brain itself. It might also be associated with a skull fracture, but not always. Contusions, or intracerebral hematomas, are bruises in the brain itself, where bleeding and swelling might occur where the head was struck. This might cause a hemorrhage in the brain.

What are the symptoms of a head injury?

Mild symptoms include:

  • raised, swollen area

  • superficial cut in the scalp

  • headache

  • sensitivity to noise/light

  • irritability

  • confusion

  • lightheadedness/dizziness

  • problems with balance

  • nausea

  • problems with memory

  • change in sleep

  • blurred vision

  • tinnitus

  • changes in taste

  • lethargy

Moderate to severe symptoms (require immediate medical attention):

  • loss of consciousness

  • severe headache that doesn’t go away

  • repeated nausea/vomiting

  • short term memory loss

  • slurred speech

  • difficulty walking

  • weakness in one side of the body

  • sweating

  • pale skin

  • seizures

  • behavior changes

  • clear fluid draining from ears or nose

  • one pupil is dilated, the other isn’t

  • deep cut in scalp

  • open wound on head

  • foreign object penetrating from head

  • coma

Now that you’ve got the basics for head injuries, it’s time to go push some characters down the stairs.

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