Guide For Head Injuries

Last week, when Natasha Richardson died so quickly after falling and hitting her head during a ski lesson, I wondered how often that happens to other people. Come to find out, it doesn't happen all that often. But, any head injury should be attended to. Here's a list of things to look for and do.

In most cases, it's pretty clear when someone needs medical attention after a head injury, says Greg Ayotte, a spokesperson for the Brain Injury Association of America and a cognitive rehabilitation therapist. "They're confused, they're agitated, or they might be dizzy or unresponsive," he says.

But then there's what doctors call the "talk and die" scenario, where someone seems fine, only to die hours, or sometimes even days later.

"Talk and die" can happen with several different kinds of brain injuries. In the case of epidural hematomas, the injury Richardson had, blood pools in the area between the lining of the brain and the skull. "Fluid is building up in a contained space, creating pressure. Something's got to give, and that something is the brain," Ayotte says. If you don't get to the hospital to have surgery to drain the fluid, "the deterioration can happen very quickly."

Here, from Ayotte and other experts, is a list of what to do after someone has suffered a head injury.

1. Be vigilant
Keep an eye on someone who has hit his head, even if the person never lost consciousness. "A lot of folks are still under the assumption that as long as you're not knocked out, you're OK, and that's not true," Ayotte says.

2. Look for dizziness, vomiting, headache and confusion
If the injured person has these signs, take him or her to an emergency room, says Dr. Jam Ghajar, clinical professor of neurological surgery at Weill Cornell Medical College in New York, and president of the Brain Trauma Foundation.

3. Look for changes in symptoms and behavior
Any sudden change, such as a headache going from mild to severe in minutes, means the person needs medical attention. For example, Ghajar says, if a person gets suddenly sleepy in the first 12 hours after a hit, it may mean the parts of the brain responsible for staying awake are experiencing pressure from a bleed.

4. Be especially wary if someone a) has been drinking alcohol, b) is on blood thinners, c) is elderly or d) is a young athlete
It's tough to distinguish brain-injured behavior from drunken behavior, so when in doubt, take the person to the hospital, Ghajar says. Also, blood thinners can turn a mild bleed into a major bleed, so be especially vigilant if the injured person is taking blood thinners such as warfarin.
He also warns people to be extra vigilant when an elderly person hits his or her head. The Centers for Disease Control and Prevention has information on traumatic brain injury and senior citizens. The CDC also has information on concussions in young athletes.

5. Go to a certified trauma center if you can
The American College of Surgeons has a list of certified trauma facilities; a hospital that's not a trauma center may not have a neurosurgeon on call. You can also look on this map from the American Trauma Society. Find your state, select trauma centers, update the map, and you can find information about trauma centers in your area.