2. * 1,000,000+ patients a year in A&E * ~5000 die * Biggest killer for 15-24’s

3. * Falls * Sports injuries * Fights * RTCs * Get info: * When? * How fast? * How high?

4. * Skull fracture * Concussion * Compression * NB may have spinal injury

5. * Shaking of the brain * Temporary loss of function (‘stunned’) * (Usually) no long term damage * Symptoms…?

6. * Headache (mild) * Dizziness * Nausea * Confusion * Loss of memory * Loss of conciousness * Visual disturbances

7. * Bleeding or swelling = increased pressure (BUT no where to go!) * May occur straight after injury * …OR days after! * (so always ask about recent head injuries) * Symptoms?

8. * Deteriorating level of response (AVPU) * Intense headache * Nausea / vomiting * Noisy breathing becoming shallow * Slow, strong pulse * One-sided weakness / paralysis * Drowsiness * Change in personality * Severe amnesia * Posturing * Unequal pupils (NB late sign!) * Seizures * Lucid intervals

9. * Spinal injury v likely (head is heavy) * C3-5 keep the diaphragm alive * Have a feel * Pain or tenderness = immobilise!!

10. * Danger (fights etc) * Response (AVPU) * Airway * C-Spine!! * Recovery position? * Breathing * Circulation * Event history – when depends on seriousness of Pt 999?

11. * Airway is the most important thing * If unconscious, needs to be opened. * Head tilt / chin lift ? * If C-spine is damaged, we can use the jaw thrust * (BUT…what if they vomit?)

12. * Feel the scalp – deformity / swelling / bleeding? * Check for CSF fluid * Take the pulse * SAMPLE (inc. alcohol & drugs) * Level of orientation (place, time, event, person) * (But don’t take the piss) NB – Complicated by alcohol

13. * C-spine? (Jaw thrust?) * Position (sat up? Recov pos?) * HCP? Hospital? 999? * Sort wounds (inspect fist!) * Head injury advice (next slide) * Advise not to drink / get high * Advise not to ‘get back on the pitch’ * Advise they’re watched by a friend (why?) * And more OBS!

14. *  drowsiness * Worsening headache * Confusion & memory loss * Behaviour changes * One-sided weakness * Dizziness * Visual disturbances * Bleeding / CSF * Breathing problems * Vomiting *..Well.. bad stuff. Namely: * NOTE – do they have CAPACITY?? Do they understand what’s going on? Can they remember & repeat the information?

15. * Head injury (with casualty) * Conscious neck injury * Unconscious spinal injury

16. * http://www.nhs.uk/Conditions/Head-injury- minor/Pages/Treatment.aspx http://www.nhs.uk/Conditions/Head-injury- minor/Pages/Treatment.aspx * http://www2.warwick.ac.uk/fac/med/researc h/hsri/emergencycare/prehospitalcare/jrcalcst akeholderwebsite/guidelines/head_trauma_20 06.pdf http://www2.warwick.ac.uk/fac/med/researc h/hsri/emergencycare/prehospitalcare/jrcalcst akeholderwebsite/guidelines/head_trauma_20 06.pdf