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Head Injuries

Prevention, Diagnosis and Treatment of Head InjuriesDescription
Traumatic brain injury (TBI) occurs from a direct blow or acceleration/deceleration forces exerted on the brain. Approximately 2.5 million people in the United States sustain some form of TBI annually ranging from mild TBI with only minor symptoms to major TBI leading to significant morbidity. Common causes of TBI include falls, unintentional blunt trauma and motor vehicle accidents. While the vast majority of head injuries are minor with relatively few long-term consequences, severe injury can develop from seemingly minor accidents. As the mechanical forces involved in TBI increase so does the severity. The diagnosis is based off the mechanism of injury as well as the symptoms (see below). The terms head injury, TBI and concussion are used interchangeably with similar meaning and outcome.

Symptoms/Diagnosis
Some people may not have any symptoms after a mild blow to the head; however, even mild trauma may lead to additional symptoms, including headache, nausea/vomiting, scalp swelling, dizziness, confusion, fatigue, mood changes, seizures, loss of consciousness, or fluid draining from ears or nose. Symptoms of mild injuries are typically limited to headache, nausea, brief dizziness and fatigue. Signs of serious injury include vomiting, progression of headache, loss of consciousness, seizure, trouble walking or talking, numbness, amnesia, bruising around eyes and ears, unequal pupils, and blood or clear fluid draining from the ear or nose. Not all head injuries require imaging of the head (CT scan or MRI), but if a patient exhibits any of the signs of a serious injury listed above they require emergent evaluation at a hospital.

Treatment
Minor head injury symptoms can be treated with acetaminophen or ibuprofen, but patients with minor head injuries should still be observed for 24 hours to watch for signs of more serious injury. During that period of observation any person who suffers what appears to be a mild or moderate concussion must remove him or herself from any activities that could lead to repeat injury as consecutive head injuries can be devastating. Curtailed activities include basic head rest for 24-48 hours with only minimal exertion as necessary for boating operations. Head rest generally involves minimizing exertion, avoiding significant computer screen and/or cognitive activities. Most symptoms will resolve in 7-10 days after which a gradual resumption of activities is allowed. Any persistent or recurrent signs of serious injury listed above require urgent evaluation at the nearest medical facility.

Prevention
Prevention of head injuries is focused on general safety and commonsense measures such a wearing of seat belts or use of helmets when indicated. Shoring up all heavy objects and shelving units to prevent items from falling during boating operations is essential. Avoid drinking and boating. The driver of the boat should be experienced and educated in maritime safety.

Impact on Boating
Mild head injuries may briefly impair ability to do daily activities on a boat, but severe head injuries require evacuation to nearest hospital.Dr. Dave Lambert, MD FACEP
Mark Binkley, MD Fellow in Hyperbaric and Undersea Medicine
University of Pennsylvania


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