Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Head Injuries

In outdoor activities, particularly sports, it is not uncommon to sustain a head injury. Most of these occur from a blow to the head incurred by a falling object (e.g., rock or tree limb), a collision of some sort (e.g., skiing into a tree), or a fall (during activities such as rock climbing, mountaineering, tumble in the surf, etc.). One area of constant discussion in the medical profession is the determination of which patients with "minor" or "minimal" head injury should undergo computed tomographic (CT) scanning of the brain in order to determine if there is a significant injury to the skull or brain.

What are the definitions of "minimal" and "minor head" injuries? A minimal head injury is generally defined as a situation in which there has not been any loss of consciousness or other neurological problem. A minor head injury may include a concussion, in which there has been brief loss of consciousness, amnesia, or disorientation in a person who is currently awake and talking. Doctors determine neurological status by applying a series of questions and a physical examination to patients to calculate a numeric score for the "Glasgow Coma Scale (GCS)." The highest number that can be achieved, which indicates that no abnormality can be found, is 15.

In a recent evaluation of 4,551 study patients with head injury and GCS score of 15, published in the September 2006 issue of the Annals of Emergency Medicine, Catherine Clement, RN, Ian Stiell MD, and their colleagues found that only 26 of these patients required an acute neurosurgical intervention. Of these 26, 11 required an urgent operation within 7 days of their injury. These patients demonstrated one or more of the following warning signs: vomiting, restlessness, observed decrease in GCS score, severe headache, confusion, and a focal blow to the side of the head. So, if a person appears normal, but has suffered any one of these, he or she is perhaps at a greater risk for having a serious brain injury. They should therefore be watched very closely. If you are far from medical attention, you should make plans for a prompt evacuation.

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photo by Frank Tramontano at
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.