Accidents and injuries
Serious injuries can occur as a result of incidents such as car accidents, falls from high places, industrial and farming accidents, or assaults. Major physical trauma is the term used to describe serious or complex injuries caused by an external force for example, during an accident or an assault.
The impact on the injured person, their family and friends, and the community is enormous. The treatment of major trauma is specialised and requires the care of a team of trauma professionals.
Initial hospital treatment
If you have a major trauma, initial hospital treatment may include:
Emergency department for assessment and immediate stabilisation of your injuries.
Radiology for x-rays to determine the extent of your injuries. These tests may be repeated during your hospital stay to determine how well your injuries are healing.
Operating theatre for surgery on any life-threatening injuries. This may be followed by other operations, particularly if you have multiple injuries.
Intensive care unit if necessary, you may need life support or may just need to be closely monitored.
Trauma or general ward until your injuries are stable enough for you to go home, or go to another hospital or rehabilitation centre for further treatment.
Other hospital departments you (and your family or support people) will have contact with numerous medical, nursing and allied health staff during your stay in hospital.
What to expect
Depending on individual factors, such as the type and severity of your major trauma, you can expect:
Pain any injury is painful, but pain is experienced differently by different people. Although pain and discomfort are common in major trauma, they can be well controlled. It is important that you report your pain to staff so that it can be managed correctly. Pain management is a priority in trauma care. Hospital staff and pain teams will monitor your pain continuously and give you the appropriate pain relief medication.
Surgery some injuries are managed without surgery, while others may require multiple operations over a considerable length of time. The treating doctor or surgeon will talk with you and your family about the planned treatment during your stay in hospital. You may need to return to the operating room a number of times, especially for repair of injuries involving broken bones or large cuts.
Movement major trauma affects your ability to move and do many things for yourself. Some people need help with feeding, washing and going to the toilet. Hospital staffs are used to helping with these things and do so every day, so there is no need to be embarrassed. A physiotherapist may visit you during your hospital stay to help with normal daily activities and exercises.
Wounds, swelling and scars when your body is injured, it undergoes a healing process. Swelling is a normal part of this process. The swelling can be severe in the first couple of days, particularly if your face is injured. It is important to know that this swelling does go down in time. Scars are inevitable when your skin has been cut. They may be quite visible for the first couple of weeks, but will eventually settle down and fade.
The impact on family and friends
Major trauma is sudden and unexpected. This is difficult for the injured person and their family or friends to deal with. Suggestions include:
Be aware that this is an extremely stressful time for you and your family or friends.
Be active in finding support and ways to cope with this stress.
Make sure that there are plenty of opportunities for communication within the family.
Ask the hospital staff what to expect during the recovery period.
Realize that healing after a major trauma is a slow process and may take months.
Keep a journal this helps many people who experience major trauma. Some also like to take photographs.
Hospital staff can help you and your family or support people through this tough time.
Head injuries - first aid
The brain is a soft and delicate organ. A hard blow to the head can injure the brain or spinal cord even when there are no visible signs of trauma to the scalp or face. Thats why all head injuries are considered serious and you should consult with your doctor or nearest hospital emergency department.
This article offers first aid suggestions, but is not a substitute for professional medical care.
Two types of head injury
Head injuries are classified as:
Open with bleeding wounds to the face or head
Closed no visible signs of injury to the face or head.
Closed head injuries explained
The soft, jelly-like brain is protected by the skull. The brain doesnt fill the skull entirely it floats in a clear, nourishing liquid called cerebrospinal fluid. This fluid acts as a shock absorber, but its protective value is limited.
For example, the kinetic energy of a small knock to the head or face can be absorbed by the cerebrospinal fluid, but a hard impact can smash the brain against the inside of the skull. This can bruise the brain or tear blood vessels. If blood and blood serum start to escape, the swelling is contained within the skull. Intracranial pressure (pressure inside the skull) can cause permanent damage by literally crushing the brain.
Symptoms of serious head injury
Remember that blood is not a reliable indicator of the seriousness of the head injury. Apart from wounds, other symptoms of serious head injury can include:
Altered consciousness for example, the person may lose consciousness or may be conscious but confused or drowsy.
Skull deformities compressions or deformities are signs of fractures.
Clear fluid from the ears or nose a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.
Black eyes and bruised skin behind the ears this indicates that the force of the blow was sufficient to rupture blood vessels around the eyes and ears.
Vision changes the pupils of the eyes may be dilated to different sizes in a person with a serious head injury. The person may complain of double or blurred vision.
Nausea and vomiting these are common side effects of serious head injury.
First aid for serious head injury
In cases where there is a serious head injury, always call an ambulance.
If the injured person is conscious, encourage them to minimise any movement of their head or neck. Control any significant blood loss from any head wounds. Reassure the person and try to keep them calm.
If unconscious, the person should not be moved unless they are in immediate danger. Any unnecessary movement may cause greater complications to the head injury itself, the spine or other associated injuries.
Your role is to protect the injured person from any potential dangers at the scene. You should also monitor their airway and breathing until the arrival of an ambulance.
If the persons breathing becomes impaired due to a problem with their airway, you may need to very carefully tilt their head back (and support it) until normal breathing returns.
If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be required.
First aid for concussion
Concussion is a brief period of unconsciousness (less than five minutes) after sustaining a blow to the head. First aid suggestions include:
Lie the person down, with their shoulders and head slightly raised.
Control any bleeding.
Check for signs of serious head injury.
If the injury occurred during sport, dont allow the person to play on under any circumstances, even if they insist they feel fine.
Always seek medical attention following concussion, even if the person only lost consciousness for a few seconds.
Be alert for any danger signs over the next one or two days for example, persistent vomiting, loss of coordination or bad headaches. Seek medical attention immediately.
Spinal injuries symptoms
A person who has sustained a head injury may have also injured their spine. In elderly people, the force required to cause neck injuries is much less than in younger people.
It is important to keep the persons head in line with their neck. Avoid twisting their head or allowing their head to roll to the side. If you can, roll a t-shirt, towel or similar soft item and place it around their neck to keep their head straight. Dont try to move them unless there is dire need.
Signs and symptoms of spinal injuries could include:
Their body is lying in an awkward, unnatural position.
Their skin is clammy and cool.
If conscious, they may report unusual tingling sensations in their limbs or an absence of any sensation including pain.
They cant move their limbs.
Toddlers and head injuries
Toddlers fall over all the time. Suggestions for parents include:
A fall from the childs own height usually isnt enough to cause a serious head injury.
The size of a bump on the head has no connection with the severity of injury.
Minor head injuries, like a bump on the head, can be treated with cuddles and an age-appropriate dose of childrens pain-killing syrup.
Seek medical attention immediately if the child shows any signs of serious head injury, particularly if they are unusually drowsy or vomiting, if you think the fall was heavy enough to have caused harm or if the child appeared to be unconscious did not immediately cry after the fall. Examples of a heavy fall would be falling down some stairs or rolling from a normal height change table to a hard floor. If in doubt, see your doctor anyway.
Things to remember
The presence or absence of blood isnt a reliable indicator of the seriousness of the head injury.
Symptoms of serious head injury can include leaking clear fluid from the nose or ears, altered consciousness or a period of unconsciousness, skull deformities, vision changes, bruised eyes and ears, nausea and vomiting.
A person who has sustained a head injury may also have injured their spine.
Head injury - home care tips
The hard skull and facial bones protect the brain, which is a soft organ. If these bones are injured then the brain becomes more vulnerable. When someone has a knock to the head, the brain moves about and can hit the skull and facial bones. This type of injury may cause the brain to swell and even bleed.
The most common type of head injury is concussion. Concussion may or may not be associated with loss of consciousness (blackout). The loss of consciousness is often brief and is normally followed by a rapid and complete recovery. Always seek medical attention for a head injury.
Medical care
While in the emergency department at hospital, you can expect:
Observation
Mild painkillers for any headache
To have nothing to eat or drink until further advised
Antinausea tablets for any nausea or vomiting
An x-ray of the neck, if you have any neck pain
A CT scan, if needed
For a mild head injury, to be discharged home with family or friends. Ask for a certificate for work, if needed.
Taking care of yourself at home
Be guided by your doctor, but self-care suggestions include:
Dont drive home from the hospital. Ask someone to give you a lift or catch a taxi.
Rest quietly for the day.
Use icepacks over any swollen or painful area.
Take simple painkillers such as paracetamol for any headache. Check the packet for the right dose.
Arrange for someone to stay with you for the next 24 hours in case you need help.
Dont eat or drink for the first six to 12 hours, unless advised otherwise by the doctor.
Once you can eat again, have small amounts of light food and drink in moderation.
Avoid alcohol for at least 24 hours.
Dont take sedatives or other drugs unless instructed by your doctor.
Children are allowed to sleep, but should be woken every four hours to check their condition and gauge their reaction to familiar things.
What to expect
There is no specific treatment for mild head injury other than plenty of rest and not overdoing things. General recovery issues to keep in mind include:
It is common to not be able to remember the events surrounding the head injury.
It is normal to feel more tired than usual.
It can take some time for the brain to recover from a head injury. During this time, headaches, dizziness and mild cognitive (thought) problems are common.
Cognitive problems can include mood changes and difficulties with concentrating, remembering things and performing complex tasks.
Most people make a full recovery and the symptoms only last a few days.
Some people have ongoing symptoms. If this is the case, visit your local doctor.
When to seek urgent medical care
Seek urgent medical care if you have any of the following:
Severe headaches
Vomited more than twice
Memory problems
Blackouts
A seizure (fit or spasm of arms, legs or face)
Difficulty staying awake
Blood or clear fluid coming from the ears or nose
Neck stiffness
Numbness, tingling, pins and needles, or weakness in the arms or legs
Confusion, slurred speech or unusual behaviour
Blurred or double vision
Dizziness
Any other concerns.
Going back to normal activities
It is best to wait until you are feeling better. Dont go to work or school until you have fully recovered. The length of time to wait varies, as it depends on the type of work or study that you do and how severe the head injury was. Ask your doctor for advice.
Dont return to sport until all symptoms have gone and you are feeling better. This is because reaction times and thinking will often be slower, so you are at risk of further injury. If you have another head injury before you have fully recovered, this may be even worse than the first head injury.
Things to remember
Always seek medical attention for a head injury.
There is no specific treatment for mild head injury other than plenty of rest and not overdoing things.
It can take some time for the brain to recover from a head injury and, during this time, headaches, dizziness and mild cognitive (thought) problems are common.
Dont go to work or school, or resume sporting activity, until you have fully recovered.
Source: Trauma Services in Victoria, Australia
