The first thing you need to assess with a head injury is whether the person is conscious or not. If they are unconscious you can't ask them questions about what happened and if their neck hurts. The neck is a major concern. If it is fractured and the neck moves fragments into the spine it can sever the spinal cord causing permanent paralysis. The neck must be stabilized until a collar can be applied. Normally the patient would go to the hospital and receive x-rays. 

If the patient is conscious but has a laceration, put pressure on it to stop the bleeding. It's going to bleed A LOT. It can be stitched up. Limit the patient's movement to limit brain swelling. Wake up the patient every hour for six hours and then every four after that. Check for changes in mental status. Use a flashlight to check for eye dilation. One pupil may get very large, indicating that the nerve has popped off the brain stem. If there is a change in mental status you will need to find a doctor. If you suspect extreme blood pooling is happening in the brain a doctor may want to drill a hole in the skull to remove pressure. Do not give this patient Aspirin or Advil! Tylenol is okay.

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In the long term if you've been waking them all night the next day they will be very groggy. If in two to three days things aren't back to normal, this can indicate a traumatic brain injury.  PTSD or similar psychological changes may take place. If the patients had a lot of concussions over a long period of time, problems can arise as well. 

There are some special items you may want to pack in your go bag:

• A c-collar

• Flashlight

• Tylenol

• Sutures but if you don't have them, superglue or a stapler

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You can suture this injury but stitching was only designed to decrease scar formation and help the wound heal quicker. Nature will leave it open and heal itself from the bottom up. If you develop a scab leave it alone, unless you can see puss underneath. If you are concerned about redness surrounding the injury mark it with a pen to track it's growth. As long as it does not grow, you are okay. If the wound edges can be brought together with no tension, you can superglue skin to skin over the laceration. Do not get superglue in the wound. The body can't heal with plastic in the way.

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