Head Injuries and Illnesses

Head injuries are a common cause of hospitalisation, especially in children. In adults, these can occur from motor vehicle accidents, a fall or assault, an occupational accident, sports injury etc.

• If the casualty becomes unconscious, DRS ABCD should be followed, and bleeding from the skull should be controlled
• If bleeding occurs from the ear the casualty should be placed in the recovery position with the affected side down, to allow blood to drain out of the skull
• All casualties who have suffered a head injury (including a minor head injury) should be referred onto further medical aid to fully assess and monitor the casualty

What to look out for

• Any loss of consciousness
• Signs of injury or face such as bleeding or bruises
• Any change – such as becoming groggy or drowsy
• Blurred or double vision
• Headache
• Dizziness or vertigo
• Confusion or memory loss
• Seizures
• Nausea and/or vomiting
• Bleeding from the ears, nose or mouth

Management

• The casualty should be closely monitored. Call an ambulance immediately if the casualty becomes unconscious or consciousness is altered at any time
• Follow DRS ABCD, and ensure that the airway is clear while protecting the neck
• Any bleeding from the head should be controlled, being careful not to place pressure onto the skull if a fracture is suspected
• If the skull feels ‘spongy’ DO NOT place any direct pressure, but rather use pads and indirect pressure to control bleeding

Spinal Injuries

The SPINAL COLUMN consists of a series of interconnected bones, called vertebrae, which enclose the SPINAL CORD, an integral part of the central nervous system

The spinal column is divided into:

• the cervical spine (neck), 7 vertebrae
• the thoracic spine (chest), 12 vertebrae
• the lumbar spine (back), 5 vertebrae
• fused vertebrae of the sacrum
• a small vertebra called the coccyx

Spinal injuries should be suspected after any serious trauma, such as vehicle accidents, a fall from a height greater than 1.5m, assault, a workplace accident (such as falling from a ladder) or sports injury (such as falling from a horse, or heavy rugby tackle).

Signs and Symptoms:

• Such as pins and needles or numbness in the upper or lower limbs may indicate the spinal cord is already damaged
• Weakness or inability to move limbs
• Pain around the neck or spine
• Headache, dizziness, altered conscious state
• Nausea
• Breathing difficulties
• Shock
• Loss of bladder or bowel control
• If you notice any of the above, an ambulance should be contacted immediately

The priorities of management of a suspected spinal injury are:

1. Calling for an ambulance
2. Management of airway, breathing and circulation
   -If unconscious, follow DRS ABCD. Management of the casualty’s airways takes precedence over any suspected spinal injury
   -Remember, DRS ABCD and CPR should not be avoided when a spinal injury is suspected
   -An unconscious breathing casualty should be carefully placed into the recovery position
3. Spinal Care
   -If conscious but complaining of pain, weakness or altered sensation in the neck and/or limbs, instruct the casualty to remain as still as possible
   -Avoid moving the casualty unless necessary (if they are in immediate danger or become unconscious)
   -If movement is necessary, take additional steps to immobilise the neck and spine to avoid movement in any direction such as manually holding the head or neck

Altered Conscious States / The Brain

There are a large number of conditions that can lead to acute disruption of a casualty’s cognitive function. These can include a direct blow to the head, drug or alcohol abuse, and low blood sugar caused by diabetes.

The Human Brain

The human brain is a uniquely complex and powerful organ. At any one time, the brain is registering sensations such as eyesight, hearing and smell, computing and filtering data and sending appropriate responses.

In basic terms, the brain can be divided into 4 main parts:

• Cerebrum
• Diencephalon
• Cerebellum
• Brain Stem

The Cerebrum is the largest part of the human brain and is associated with higher functions such as conscious thought, intellect and action. It is divided typically into 4 sections called lobes.

• Frontal Lobe: Reasoning, problem-solving, emotions and movement
• Parietal Lobe: Movement, recognition,
• Occipital Lobe: Visual Processing
• Temporal Lobes: Auditory, memory and speech

The Cerebellum or literally ‘little brain’ is predominantly responsible for the coordination of movement, balance and posture.

The Brain Stem is responsible for vital life functions such as heartbeat, breathing, blood pressure etc.

Levels of Alertness

Another way to assess the extent of injury to the brain is to ask questions about the following:

• TIME (Does the casualty know what the time is? What the date is? What year is it?
• PERSON (Does the casualty remember their own name?)
• PLACE (Does the casualty know where they are?)
• EVENT (Does the casualty know how they got here? What they are doing here?)

All casualties who seem to have suffered a head injury (even a minor head injury) should be assessed by a health care professional before continuing with sport or other activity.

Drugs, Alcohol Poisoning and Illicit Drug Use

Alcohol presents a very common cause of altered mental status and can be very serious and even life-threatening if not properly managed.

In short, someone under the influence has a decreased ability to:

• Recognise danger and react appropriately
• Control their emotions or violent tendencies and feel physical pain
• Rationally consider a situation and choose a logical course of action
• Evaluate decisions and consequences of the decisions they make

Alcohol

• Alcohol is among the most commonly misused addictive substances
• Binge drinking is a pattern of alcohol consumption that involves drinking a lot in a short period of time
• A hangover is the result of alcohol poisoning
• It takes time for the liver to detox alcohol
• A person who has been drinking at night may still be affected by alcohol when they arrive at work the next morning
• Note that cold showers, exercise and black coffee DO NOT help a person to recover quickly
• If not promptly & correctly treated, an overdose on alcohol can have severe consequences for a person

Alcohol

Alcohol is typically a depressant and impairs judgment, vision, speech, coordination, reflexes, balance and cognitive function.

Signs and Symptoms of Alcohol Poisoning:

• Slurred speech
• Headache
• Sensitivity to light
• Sensitivity to sound
• Dehydration
• Increased heart rate and blood pressure
• Nausea and vomiting
• Mental confusion, or unresponsiveness
• Aggression or lack of restraint

Drugs

Some common types of drugs:

Marijuana

This is one of the most frequently used illicit drugs in society and has similar effects as stimulants, depressants and hallucinogens.

Cocaine

This is a very strong stimulant to the central nervous system and is very addictive. It can be taken via injection, smoking or snorting.

Ecstasy

This is taken as a capsule or tablet. This affects the serotonin system which plays a large role in regulating mood, sleep, aggression and sensitivity to pain, and as such can affect all of these

LSD

This is a synthetic hallucinogen that is found in tablet, capsule or liquid form (added to paper, sugar cubes etc.)

General signs and symptoms of substance misuse include:

•  Increase in pulse
• Increased respiration
• Raised temperature
• Odd behaviour
• Sweating
• Irritability
• Nausea and vomiting

What are the signs of drug addiction?

There are many types of drugs that people can become addicted to, so there are many different signs to be aware of. If you are concerned that you might be developing an addiction, here are some general signs to look out for.

People with a drug addiction may:

Avoid people who do not take drugs

• Avoid places where it is not possible to take drugs
• Feel distressed and lonely if they do not take the drug regularly
• Rely on drugs to cope with emotional problems
• Be dishonest with friends and family to hide their drug use
• Have financial problems and debts
• Sell or steal things to pay for drugs
• Take dangerous risks, such as driving under the influence of drugs
• Self-blame and have low self-esteem, especially after trying unsuccessfully to quit
• Get into legal trouble.

Health signs

Drugs can cause a range of problems for physical and mental health, even after the acute effects of taking the drug have worn off. These include:

• Depression
• Anxiety
• Having unusual ideas (e.g. paranoia, delusions)
• Hallucinations
• Attention problems
• Memory loss
• Weight loss
• Sexual dysfunction (e.g. impotence)

Signs of substance abuse

Most people enjoy a drink now and again. But when someone loses control of their alcohol or drugs, when the substance starts causing harm like injuries or medical problems, damaging relationships, or causing problems at work, then it can be a sign that the habit is becoming a problem.

People who abuse substances may become dependent. It means they do not feel the effects of the substance anymore, and experience cravings or withdrawal symptoms when stopping.

Common groups of drugs

Drugs can also be grouped by how or where they are commonly used.

Analgesics

Analgesics – or painkillers – relieve the symptoms of pain. Some people take more than the recommended dose to get high, or to self-harm. They can also be overused by people who have chronic pain.

Some are available over the counter, such as:

• Aspirin
• Paracetamol
• Ibuprofen

Others require a prescription from a doctor, such as:

Codeine and paracetamol combination products, Fentanyl, Morphine, Oxycodone, Pethidine

(Following excerpt from ANZCOR Guideline 9.5.2)

Opioids

Opioids are a class of drugs that are generally used as pain-killing medications but are also used for recreational drug use.

Examples include morphine, codeine, oxycodone, hydrocodone, heroin, and fentanyl. Different preparations of opioids can be ingested, injected, transdermal or inhaled.

Opioid overdose is a common and important type of poisoning in the community. Overdose can lead to unconsciousness, slowing or stopping of breathing, and can potentially cause cardiac arrest.

Symptoms of overdose

A first aider needs to be aware that there is a wide range of signs and symptoms that can occur when a person overdoses, and that every person responds differently.

Signs and symptoms depend on a variety of factors including:

• Their state of health before taking the substance
• Which substance they took
• The manner they took it
• How much they took and what else was taken with it
• Their age
• Other factors

Management of Acute Alcohol / Drug Poisoning

• If you notice a change in a person’s conscious state, you should not leave them unattended
• If a casualty’s conscious level is dropping, it can continue to drop very quickly as more alcohol is absorbed into the brain
• If the casualty is violent, you can monitor them from a distance
• Display non-judgemental, respectful behaviour towards them, and keep yourself safe
• Be prepared to call an ambulance if the casualty’s condition changes
• Remember: Do not force yourself on the casualty as they may become violent. Use assistance of friends if possible

Note: Always stay calm and don’t make the casualty vomit

If an Intoxicated/Drugged Casualty Becomes Unconscious

• Follow DRS ABCD
• If breathing normally, position the casualty in the recovery position to protect the airways
• If not breathing normally, without delay commence CPR
• Remember: Vomiting is a very likely outcome, and if unattended, this can compromise their airways by causing aspiration or blockage
• Call 000. Emergency medical care is required to prevent further absorption of alcohol and to monitor the casualty until they regain consciousness

Poisoning and Chemical Exposure

A Poison is any substance that causes injury, illness or death. In terms of risk, it is estimated that up to 80% of all poisonings occur at home, particularly in the kitchen or bathroom. Hence the old saying ‘precaution is better than cure is very relevant.

Common Poisons

• Paracetamol is the most common pharmaceutical overdose leading to hospital admission and a common cause of poisoning in children
• Household products including glues, hair spray, aerosol paints, nail polish, petrol
• Household chemicals including dishwasher detergent
• Some varieties of fungi (such as certain mushrooms and toadstools)
• Cyanide

Signs and Symptoms

These can be very variable, as they depend on the nature of the poison and the amount consumed.

• Difficulty breathing, wheezing or shortness of breath
• Burning in the throat and mouth
• Nausea
• Vomiting
• Altered mental state (including hyperactivity, drowsiness, confusion, headache)
• Unconsciousness, or even cardiac arrest

Management

• The first step is to identify the suspected poison and ensure that it is not a danger to yourself or others. Recognise potential risks
• If safe to do so, attempt to separate the casualty from the substance or source
• If the casualty is not responding and is not breathing normally, commence CPR if safe to do so
• If the casualty is unresponsive and breathing normally, position them in the recovery position
• If the poison is swallowed and the casualty is conscious give them a sip of water to wash out their mouth. DO NOT ask them to swallow or attempt to make them vomit
• Once separated from the poison, contact the Poisons Information Centre on 131126. This is a 24-hour national hotline, and operators can instruct you on what to do. They will need to know what type of poison is involved, and approximately how much has been ingested/inhaled
• Decontaminate the skin or eyes if they have been exposed to poison and if it is possible and safe to do so
• Ensure the poison is secured and ambulance personnel are advised of any information on poison

You will need to:

• Identify the poison
• DO NOT give anything by mouth to the casualty unless instructed
• DO NOT attempt to make the casualty vomit unless instructed
• Call the Poisons Information Centre (PIC) and follow their instructions
• You may be advised by PIC to call 000
• While waiting, closely monitor the casualty – do not leave them unattended
• If breathing stops, commence CPR

Chemical Exposure – Capsicum spray (OLEORESIN SPRAY) 

Capsicum spray is an extract of hot peppers consisting of capsaicin and derivatives. It is a lachrymatory agent, meaning that it is designed to irritate the eyes to cause tears and pain. It acts within seconds of being sprayed in a person’s face causing stinging, tearing and blepharospasm (uncontrolled muscle spasm), causing the eyes to shut.

It also has an effect on the respiratory system, causing broncho-constriction and coughing as well as mucous secretion, shortness of breath and laryngeal paralysis (causing inability to speak). The effects can last for up to 30 to 40 minutes.

Treatment:

• Assess airway, breathing and circulation
• Continuously rinse with copious amounts of water or saline until the symptoms subside
• Irrigate eyes with copious amounts of water
• Encourage blinking, this will help flush out the spray from the eyes
• Treat bronchospasm with an asthma inhaler
• If at any stage the casualty becomes unconscious, follow DRS ABCD

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