LESSON 10
PERFORM FIRST AID FOR AN OPEN HEAD WOUND
(TASK 081-831-1033)
TASK:
Identify the procedures for administering first aid to a casualty with an open or closed head wound.
CONDITIONS:
Given multiple-choice examination items pertaining to head wounds.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldiers Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers.
NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.
A head injury may be the only injury (such as a single blow to the head) or it may be combined with other injuries (such as head and body injuries caused by an explosion).
A head injury may consist of a cut or bruise of the scalp, a concussion, a fracture of the skull with injury to the brain, or a combination of these injuries.
10-2. IDENTIFY SIGNS AND SYMPTOMS OF OPEN AND CLOSED HEAD INJURIES
Head injuries can be either open (skin broken) or closed (skin not broken). Either type of injury can be severe and life-threatening. Bleeding from the scalp, visible skull fracture, and visible brain tissue are signs of an open head injury. The following signs and symptoms are also indications of a head injury, even if no open wound is present.
Deformity of the head.
Clear or bloody fluid leaking from the nose or ears.
"Black eyes."
Loss of consciousness (either current or recent unconsciousness).
Headache.
Vision problems.
Difficulty in breathing.
Convulsions.
Twitching.
Bruising behind one or both ears.
Staggering or dizziness.
Slurred speech.
Paralysis.
Nausea or vomiting.
Drowsiness.
Mental confusion.
10-3. DETERMINE LEVEL OF CONCIOUSNESS
10-4. POSITION A CASUALTY WITH A HEAD INJURY
A casualty with signs and symptoms of head injury other than minor wounds is presumed to have a severe head injury. When possible, avoid moving the casualty since he may also have a fractured neck. If you suspect that the casualty has a fractured neck, tell the casualty not to move and immobilize his head using the procedures given in lesson 12.
| WARNING | |
| If you need to turn a casualty onto his side and you suspect that he may have a spinal injury, do not move the casualty by yourself. Have one person roll the casualty gently onto his side while another person provides support for the casualty's head and neck. | |
FIGURE 10-1. CASUALTY POSITIONED ON HIS SIDE
If the casualty is choking, nauseous, vomiting, or bleeding from his mouth, position the casualty on his side in order to promote drainage and to maintain an open airway. Place the casualty on the side opposite that of the wound (wound away from the ground).
If the casualty is having convulsions (involuntary muscle movements such as uncontrolled jerking or shaking), ease him to the ground and gently support his head and neck. Do not try to forcefully hold his arms and legs if they are jerking. Trying to "pin down" jerking limbs will probably cause additional injury. A casualty with convulsions presents a two-fold task in that you must treat his injuries and you must also keep him from accidentally hurting himself.
If the casualty is conscious, does not have a severe head or spinal injury, and other injuries do not prohibit his sitting up, have the casualty sit up. The casualty should have a tree, wall, or other stable object to lean against if possible.
If the casualty is conscious, does not have a severe head or spinal injury, is not accumulating drainage in his throat, and is not able to sit up, elevate his head slightly.
Remove the casualty's helmet if he is still wearing it.
If the casualty is wearing a mask and hood and the "all clear" (safe from chemical agents) signal has been given, remove the casualty's mask and hood.
| WARNING | |
| If the casualty is wearing a mask and hood and the "all clear" signal has not been given, do not remove the casualty's mask and hood or attempt to dress the wound. If the mask or hood has been breached, repair the breach with tape or wet cloth stuffing if possible. | |
10-6. APPLY A DRESSING TO A WOUND ON THE HEAD
Obtain the casualty's field dressing. If the casualty's field dressing is lost or has already been used, improvise a dressing and bandages from the cleanest materials available.
Remove the dressing from the wrappers.
Grasp a tail in each hand and hold the dressing directly over the wound with the white side of the dressing toward the wound.
Pull the dressing open and place the white side of the dressing directly over the wound.
| WARNING | |
| Do not attempt to clean the wound
or attempt to push any brain matter back into the head.
If an object is protruding from the wound, do not attempt to remove the object. Improvise bulky dressings from the cleanest material available and build up the area around the object to support and stabilize the object. Secure the dressing with improvised bandages. |
|
Secure the dressing with the attached bandages using the appropriate procedures given in the following paragraphs.
| CAUTION: Apply the dressing and bandage so as to not interfere with the casualty's vision or hearing unless the eye or ear is injured. Avoid putting pressure on the wound. The dressing should be adequate to control the bleeding. Do not apply a pressure dressing to a head wound. |
10-7. SECURE A DRESSING TO THE FOREHEAD
Place one hand on the dressing to keep it from slipping. (You may have the casualty hold the dressing in place if he is able.)
Wrap one tail horizontally around the casualty's head and bring it back across the dressing. Angle the bandage so that it will cover the top or bottom edge of the dressing.
FIGURE 10-2. WRAPPING TAIL HORIZONTALLY AROUND HEAD
Wrap the second tail around the casualty's head in the opposite direction.
Bring it back across the dressing angled so that it will cover the other edge of the dressing (either top or bottom).
Continue to wrap the bandage around the head again until it meets the first tail.
Tie the tails in a nonslip knot on the side of the head.
| CAUTION: The bandages should be tight enough so the dressing will not slip but not tight enough to place undue pressure on the wound. |
FIGURE 10-3. TYING TAILS ON THE SIDE OF THE HEAD
Tuck in any excess tails. Tucking in excess material will keep the ends of the tail from possibly catching on an object or accidentally hitting the casualty in the eye.
(NOTE: The same general procedures are also used to secure the bandage to a wound to the back of the head.)
10-8. SECURE A DRESSING TO THE TOP OF THE HEAD
Place one hand on top of the dressing to hold it in place.
Grasp the near tail with the other hand.
FIGURE 10-4. BRINGING TAIL UNDER CHIN
| CAUTION: When passing a tail under the chin, make sure that the tail remains wide and close to the front of the chin. This will keep the bandage from choking the casualty. |
Remove your hand from the dressing and grasp the other (free) tail.
Bring that tail down the opposite side of the face in front of the ear, under the chin, and up until it meets the first tail (about a three-fourths circle).
Cross the tails so that each makes a 90° turn. The cross should be made slightly above and in front of the ear (Figure 10-5).
Bring one tail across the casualty's forehead in front of the opposite ear (about a half circle). The tail should be above the casualty's eyebrows.
Bring the other tail back above the ear, low behind the head at the base of the skull, and up to a point above and in front of the opposite ear (about a half circle) where it meets the other tail. (Bringing the tail across at the base of the skull helps to keep the bandage from slipping.)
FIGURE 10-5. CROSSING THE TAILS
FIGURE 10-6. TYING TAILS (INJURY TO TOP OF HEAD)
Tie the tails in a nonslip knot in front of and above the ear.
Tuck in the excess material from the tails.
10-9. SECURE A DRESSING TO THE CHEEK
Place one hand on top of the dressing to hold it in place. If the casualty is able, you can have the casualty hold the dressing in place while you secure it.
Bring the top (uppermost) tail over the top of the head, down in front of the ear, under the chin, up the side of the face, and over the dressing to a point just above the ear (a full circle). Do not cover the ear if it can be avoided. Covering the ear will decrease the casualty's ability to hear.
Bring the other (bottom) tail down, under the chin, up the side of the face, in front of the ear, and over the top of the head until it meets the first tail (almost a full circle).
FIGURE 10-7. BRINGING SECOND TAIL AROUND TO MEET FIRST TAIL
Cross the two tails. The tails are crossed just above the ear on the injured side of the face.
FIGURE 10-8. CROSSING THE TAILS
Bring one tail across the forehead (above the eyebrows) to a point just in front of the opposite ear (the ear on the uninjured side of the face).
Bring the other tail above the ear, low behind the back of the head at the base of the skull, and above the other ear until it meets the first tail.
Tie the tails in a nonslip knot just above and in front of the ear on the uninjured side of the head.
Tuck in the ends of the tails.
FIGURE 10-9. TAILS TIED IN NONSLIP KNOT AND ENDS TUCKED
(NOTE: A dressing applied to an open wound on the side of the casualty's head is secured using the same general procedures.)
10-10. MONITOR A CASUALTY WITH A HEAD INJURY
A casualty with a serious head wound (brain tissue visible, fractured skull, deformity of the head, or fluid leaking from an ear) or who does not regain consciousness should be examined by medical personnel and evacuated as soon as possible.
Any person with a head injury should be evaluated by medical personnel (medic, physician assistant, etc.) even if evacuation is not needed.
If you remain with the casualty, check his level of consciousness every 15 minutes. Have him tell you his name, where he is, and the date. If the casualty falls asleep, wake the casualty to check his level of consciousness. Note any changes from earlier observations.
Do not give the casualty anything to eat or drink. Eating or drinking may cause him to vomit.