1. When in Doubt, Call for Help
It can be difficult to assess the severity of a closed head injury because there's not always bleeding, unlike an open head injury, which occurs when an object penetrates the skull. If you suspect the head injury could be severe, call 911 immediately. Signs of a serious head injury include loss of consciousness, convulsions, shallow breathing, swelling or facial bruising, fluid draining from the mouth, nose or ears, pupil changes, irritability, restlessness, clumsiness, vomiting, slurred speech, blurred vision and loss of senses. A severe headache, stiff neck and worsening symptoms could also indicate the injury is serious.
2. Stabilize the Injured
While you wait for help, check the injured person's breathing and circulation. If the person's not breathing, make sure nothing is blocking the airway and begin rescue breathing and CPR. You can check circulation by applying gentle pressure with two of your fingers on the person's arm or leg. When you take your fingers away, the skin should be momentarily white, then begin to pink up. If the person's breathing is normal but she is unconscious, place your hands on both sides of the neck and keep the head in line with the spine, preventing movement in case of a spinal injury. If an injured person has vomited, roll the person onto her side, making sure the head, neck and spine all roll together. It's normal for a child with a non-serious closed head injury to vomit once, but you should still consult a doctor.
3. Ice and Press
If a non-serious closed head injury is swelling, hold an ice pack to the swollen area for 15 to 20 minutes for the three to four hours following the injury. Place a towel in between the ice pack and the skin. If the head is bleeding and you're sure it's just a surface cut, hold a clean towel to the cut, applying firm pressure to stop the bleeding. Never apply pressure to a cut if you suspect the skull might be fractured. If you suspect a skull fracture, gently hold sterile gauze over the cut. If the injury is serious and you're waiting for medical help, don't take away the towel or gauze when it's soaked. Hold another towel or more gauze on top of the first one.
4. Take No Action
If the injury is a mild bump on the head, you just need to keep a close eye on the person for the 24 hours following the injury to make sure symptoms don't develop. Wake the person every three to four hours and ask basic questions. If the person can't answer questions such as "What is your name?" or "How old or you?", go to the emergency room. An anti-inflammatory can be taken for a mild headache, but aspirin should be avoided because it can increase bleeding.
