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Recognise suspected: Head injury

Head injuries can be potentially life-threatening. Loss of consciousness often follows a head injury, which could compromise the airway.

There are different types of head injury

 Concussion. Where the brain is shaken and hits against the inside of the skull. This can be caused by a fall or a blow to the head. Concussion may also cause unconsciousness for a short period, but can be followed by an improvement in response and full recovery.

 Compression. Swelling or bleeding in the skull puts pressure on the brain. This can occur from injury, a ruptured blood vessel, a tumour or infection (meningitis). There may be a history of a recent head injury with apparent recovery but then a deterioration in the patient’s level of consciousness (AVPU) can occur.

 head injuries

 Fractured skull. Damage to the skull may cause bleeding within the skull causing compression. The broken bone may damage the brain or ‘brain shaking’ may have occurred causing concussion.


  1. Suspect a neck injury – a casualty suffering a serious head injury could also have a neck injury.
  2. Apply appropriate pressure to any wound to stop bleeding, cover the site to protect from infection.
  3. With any casualty who is unconscious, has a reduced conscious level (AVPU), their conscious level deteriorates or you suspect a fractured skull, ring 999.
  4. Maintain airway and breathing.
  5. If the casualty is conscious help them lie down. Keep the head, neck and body inline in case of neck injury.


Signs and symptoms


  • Level of response (AVPU) worsens as the condition develops.
  • Intense headache.
  • Flushed, dry skin.
  • Deep, noisy, slow breathing.
  • Slow, strong pulse.
  • One or both pupils may dilate as pressure increases.
  • Condition worsens and a seizure may occur.



  • Short term memory loss, confusion, irritability.
  • Mild, general headache.
  • Pale, clammy skin.
  • Shallow/normal breathing.
  • Rapid, weak pulse.
  • Normal pupils, reacting to light.
  • Possible nausea or vomiting.


Fractured skull

  • Bleeding, swelling or bruising to the head.
  • A soft area or depression of the scalp.
  • Bruising around one or both eyes.
  • Bruising or swelling behind the ear.
  • Bleeding or fluid coming from the nose or an ear.
  • Deformity or lack of symmetry to the head.
  • Blood in the white of the eye.


Q and A

When is a head injury deemed serious?

When there is damage to the brain, scalp or the skull. External bleeding may be present.

 Injuries to the head can lead to unconsciousness, which can dangerously compromise the airway. When an injury is sustained to the head there may also have been damage caused to the neck. In addition, permanent damage to the brain can also result from a head injury.

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