A child has sustained a basilar skull fracture the staff family should watch for
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Bazarian JJ, Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 371. Show
Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34. Roskind CG, Pryor HI, Klein BL. Acute care of multiple trauma. In: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA. Elsevier; 2020:chap 82. Last reviewed on: 11/13/2021 Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Once your condition is stable, you'll have a computerised tomography scan (CT) scan to help determine the severity of your injury. Read more about diagnosing a severe head injury. ObservationIf you need to stay in hospital for observation, the healthcare professionals treating you will regularly check:
These checks will be made every half an hour until it's clear you know who and where you are, you can speak and move as requested, and your eyes are open. After this, checks will be less frequent. If your CT scan results show bleeding or swelling inside your skull, a small device called an intracranial pressure (ICP) monitor may be fitted. A thin wire will be inserted into the space between your skull and the brain, through a small hole drilled into the skull. The wire is attached to an electronic device that will alert hospital staff to any changes in the pressure inside your skull. Cuts and grazesAny external cuts or grazes to your head will be cleaned and treated to prevent further bleeding or infection. If there are foreign bodies in the wound, such as broken glass, they'll need to be removed. Deep or large cuts may need to be closed with stitches until they heal. Local anaesthetic may be used to numb the area around the cut so you don't feel any pain. NeurosurgeryNeurosurgery is any type of surgery used to treat nervous system problems (problems with the brain, spinal cord and nerves). In cases of severe head injury, neurosurgery is usually carried out on the brain. Possible reasons for neurosurgery include:
These problems will be identified during tests and a CT scan. If surgery is needed, a neurosurgeon (an expert in brain and nervous system surgery) may come and speak to you or your family about it. However, as the problems listed above can be serious and may require urgent treatment, there may not be time to discuss surgery before it's carried out. In such cases, your surgeon will take the time to discuss the details of the surgery with both you and your family after the operation. CraniotomyA craniotomy is one of the main types of surgery used to treat severe head injuries. During a craniotomy, a hole is made in the skull so that the surgeon can access your brain. The procedure will be carried out under general anaesthetic, so you'll be unconscious and unable to feel any pain or discomfort. The surgeon will remove any blood clots that may have formed in your brain and repair any damaged blood vessels. Once any bleeding inside your brain has stopped, the removed piece of skull bone will be replaced and reattached using small metal screws. Skull fracturesYour skull may be fractured during a head injury. The CT scan will help determine the extent of the injury. There are different types of skull fractures, including:
Open fractures are often serious because there's a higher risk of bacterial infection if the skin is broken. Depressed fractures can also be very serious because small pieces of bone can press inwards against the brain. Treating skull fracturesMost skull fractures will heal by themselves, particularly if they're simple, linear fractures. The healing process can take many months, although any pain will usually disappear in around 5 to 10 days. If you have an open fracture, antibiotics may be prescribed to prevent an infection developing. If you have a severe or depressed fracture, surgery may be needed to help prevent brain damage. This will usually be carried out under general anaesthetic. During surgery, any pieces of bone that have been pressed inwards can be removed and returned to their correct position. If necessary, metal wire or mesh may be used to reconnect the pieces of your skull. Once the bone is back in place, it should heal naturally. Your surgeon will be able to explain the procedure you're having in more detail. After surgeryDepending on the seriousness of your operation, you may need to recover in an intensive care unit (ICU). This is a small, specialised ward where you'll be constantly monitored. In an ICU, you may be placed on a ventilator, which is an artificial breathing machine that moves oxygen-enriched air in and out of your lungs. Once you're well enough, you'll be moved to a high-dependency unit (HDU) or another ward and your condition will continue to be monitored until you're well enough to leave hospital. Which intervention is a priority when caring for a child who sustained a head injury 12 hours earlier?The first priority in any emergency is always an adequate airway. The nurse is involved in clearing the mouth, inserting an oral airway, assisting with intubation, oxygen therapy and assessing continually the patient's respiratory system.
What to look for after child hits head?Changes to watch for include inconsolable crying or fussiness, vomiting more than once, balancing difficulties when sitting or walking, and being unresponsive. If your child is exhibiting any of these symptoms, or has any significant swelling over the site of the injury, you should take them to the doctor right away.
When should I be worried about my child hitting his head?See a provider within 1 to 2 days of a significant head injury with ongoing symptoms, even if emergency care isn't required. Seek emergency medical attention if your child experiences: Unconsciousness, confusion or disorientation after a head injury.
What first aid should be given to someone who is unconscious following a traumatic head injury?If necessary, begin rescue breathing and CPR. If the person's breathing and heart rate are normal, but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head. Keep the head in line with the spine and prevent movement.
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