SEMA: Ten Little Monkeys Jumping on the Bed…

r By Ken Wright

I have to assume these were “free range” monkeys and that “Mama” felt exercising a modicum of parental control would “stifle their special little spirits.” But I digress. We could easily discuss a different head injury for each of these little monkeys, but this time, we’ll only discuss three.

A bump on the head can be a really bad thing, or not. One of the worst things is that you can’t always tell if it’s a bad thing, or not. We’ve all thumped our noggins on something, gotten a “goose egg” and been just fine. However, there are a few signs following head trauma that should not be ignored and call for prompt follow up.

The “knot” we see on the bumped head is a hematoma (a collection of blood in an area – we EMS types get to use all kinds of sophisticated-sounding words for simple stuff). By themselves, these are not serious. It’s a sign of some bleeding between the scalp and the skull. The swelling generally reduces with an ice pack and time. However, in the field, it cannot be determined if that is the extent of the damage.

The three types of head trauma for today include three different kinds bleeding on the interior of the skull: epidural hematoma, subdural hematoma, and basilar fracture (remember sophisticated EMS words)

An epidural hematoma causes bleeding and collection of blood between the skull and a covering over the brain called the dura mater. It classically presents with a loss of consciousness after a blow to the head (often the side) and then a “lucid interval” wherein the person seems to be doing better and may decline medical care or may just want to take a nap (Actress Natasha Richardson). However, continued unseen bleeding and increasing intracranial pressure (ICP) can rapidly progress to serious complications and death.

A subdural hematoma is frequently the result of a fall or injury involving rapid deceleration. As the brain jostles from the force of the rapid stop, it may tear tiny blood vessels under the dura mater (between the dura mater and the brain itself). Because this usually involves smaller blood vessels, the accumulation of blood can be slower and may take significantly longer to present (be recognizable to the naked eye). However, the slower-developing ICP can produce the same complications as the more-rapidly-developing ICP above.

Basilar fracture is a fracture of the bone at the “floor” of the cranium. Think of the cranium (skull) as a kind of bowl that sits atop the face and jaw bones and holds the brain. This would be a break in the bottom of the bowl. This classically presents with bruising behind one or both ears (known as Battle’s sign) within 24-48 hours and/or double black eyes (raccoon eyes). A more immediate indication may be bleeding from the nose or ears with clear fluid (cerebrospinal fluid) mixed with the blood

Do not let those monkeys keep jumping on the bed (and make them wear a bicycle/baseball/motorcycle helmet and seatbelt when they should) and know that, after an injury, the simple remedy of “no more monkeys jumping on the bed” may not be sufficient.

Watch carefully and intentionally for the below signs and seek immediate medical attention if seen:r

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• Loss of consciousness

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• Lethargy (drowsiness, lack of energy, wants to go to sleep or won’t wake up)

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• Vomiting or nausea

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• One pupil larger than the other and/or not changing with more or less light (or both really big with no reaction to light)

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• Confusion regarding people, places, or what happened

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• Restlessness or agitation

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• Convulsions or seizures

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• Slurred speech

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• Weakness, numbness or decreased coordination.

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• Repeated vomiting or nausea.

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• In children who cannot speak, watch for all of the above, but also be concerned if the child cannot be consoled or will not eat or nurse as usual.

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rTake time now to regularly observe what is normal (baseline) for your child, loved one, friend, and people in general so you will notice when something is “off”. If their brain is being impacted by ICP, they will not be able to recognize it themselves.

SEMA is always interested in reaching out to our neighbors to increase community safety. If you might be interested in learning more or have questions, email me at kenwrightsalemems@gmail.com.