First Aid/Head & Facial Injuries

First Aid

Introduction — Issues in Providing Care — Primary Assessment & Basic Life Support — Secondary Assessment — Circulatory Emergencies

Respiratory Emergencies — Soft Tissue Injuries — Bone & Joint Injuries — Environmental Illness & Injury

Medical Conditions & Poisoning — Advanced Topics — Appendices — Meta content

Head Injuries

Head wounds must be treated with particular care, since there is always the possibility of brain damage. The general treatment for head wounds is the same as that for other flesh wounds. However, certain special precautions must be observed if you are giving first aid to a person who has suffered a head wound. Victims with a head injury causing decreased level of consciousness (no matter how brief) require assessment by a physician. Victims with a head injury also require assessment for a potential spinal injury. Any mechanism of injury that can cause a head injury can also cause a spinal injury. Also it is important to note that injuries to the head involve more blood than lacerations to other parts of the body.

Concussion

Mild head injury that causes a brief "short-circuit" of the brain.
Essentially, the brain has been rattled within the skull.
No damage or injury to brain tissue.

Recognition

Possibly unconscious for a short period of time.
Dazed and confused for several minutes.
Vomiting
Visual disturbances (seeing stars)
Amnesia (memory loss)
Pupils unequal in size or unresponsive to light.
Head pain
Anxiety & agitation

Compression

Pressure on the brain caused by a build-up of fluids or a depressed skull fracture.
The brain has been bruised.
Damage to brain tissue is likely.
Symptoms are progressive, and will usually get worse over time.

Recognition

Possibly unconscious for a short period of time.
Dazed and confused for several minutes.
Vomiting
Visual disturbances (seeing stars)
Amnesia (memory loss)
Pupils unequal in size or unreactive to light.
Head pain
Anxiety & agitation
Symptoms usually worsen over time.

Treatment

EMS
Immobilize spine if required.
Treat for any bleeding, bruising or swelling (if you suspect a skull fracture, do not apply pressure – instead, use a thick dressing with as little pressure as possible).

Notes for head injuries

If the level of consciousness is altered, call EMS.
Do not use direct pressure to control bleeding if the skull is depressed or obviously fractured, as this would cause further injury by compressing the brain.

Injuries involving the eye

Wounds that involve the eyelids or the soft tissue around the eye must be handled carefully to avoid further damage. If the injury does not involve the eyeball, apply a sterile compress and hold it in place with a firm bandage. If the eyeball appears to be injured, use a loose bandage. (Remember that you must NEVER attempt to remove any object that is embedded in the eyeball or that has penetrated it; just apply a dry, sterile compress to cover both eyes, and hold the compress in place with a loose bandage). Any person who has suffered a facial wound that involves the eye, the eyelids, or the tissues around the eye must receive medical attention as soon as possible. Be sure to keep the victim lying down. Use a stretcher for transport.

Many eye wounds contain foreign objects. Dirt, coal, cinders, eyelashes, bits of metal, and a variety of other objects may become lodged in the eye. Since even a small piece of dirt is intensely irritating to the eye, the removal of such objects is important. However, the eye is easily damaged. Impairment of vision (or even total loss of vision) can result from fumbling, inexpert attempts to remove foreign objects from the eye. The following precautions must be observed:

DO NOT allow the victim to rub the eye.
DO NOT press against the eye or manipulate it in any way that might cause the object to become embedded in the tissues of the eye. Be very gentle; roughness is almost sure to cause injury to the eye.
DO NOT use such things as knives, toothpicks, matchsticks, or wires to remove the object.
DO NOT UNDER ANY CIRCUMSTANCES ATTEMPT TO REMOVE AN OBJECT THAT IS EMBEDDED IN THE EYEBALL OR THAT HAS PENETRATED THE EYE! If you see a splinter or other object sticking out from the eyeball, leave it alone! Only specially trained medical personnel can hope to save the victim’s sight if an object has actually penetrated the eyeball. However if you have two rolls of gauze, apply one to each side of the impaled object and then cover it with a plastic cup and then secure the cup to the victim with tape.

Small objects that are lodged on the surface of the eye or on the membrane lining the eyelids can usually be removed by the following procedures:

Try to wash the eye gently with lukewarm, sterile water. A sterile medicine dropper or a sterile syringe can be used for this purpose. Have the victim lie down, with the head turned slightly to one side. Hold the eyelids apart. Direct the flow of water to the inside corner of the eye, and let it run down to the outside corner. Do not let the water fall directly onto the eyeball.
Gently pull the lower lid down, and instruct the victim to look up. If you can see the object, try to remove it with the corner of a clean handkerchief or with a small moist cotton swab. You can make the swab by twisting cotton around a wooden applicator, not too tightly, and moistening it with sterile water.

CAUTION: Never use dry cotton anywhere near the eye. It will stick to the eyeball or to the inside of the lids, and you will have the problem of removing it as well as the original object.

If you cannot see the object when the lower lid is pulled down, turn the upper lid back over a smooth wooden applicator. Tell the victim to look down. Place the applicator lengthwise across the center of the upper lid. Grasp the lashes of the upper lid gently but firmly. Press gently with the applicator. Pull up on the eyelashes, turning the lid back over the applicator. If you can see the object, try to remove it with a moist cotton swab or with the corner of a clean handkerchief.
If the foreign object cannot be removed by any of the above methods, DO NOT MAKE ANY FURTHER ATTEMPTS TO REMOVE IT. Instead, place a small, thick gauze dressing over both eyes and hold it in place with a loose bandage. This limits movement of the injured eye.
Get medical help for the victim at the earliest opportunity.

Bone & Joint Injuries

Musculoskeletal Injuries — Immobilization — Head & Facial Injuries — Suspected Spinal Injury