Combat Life Saver

Lesson 7 APPLY A DRESSING TO AN OPEN HEAD WOUND

Compiled and edited by, 2LT John C. Miller, PA-C

Lesson 7 APPLY A DRESSING TO AN OPEN HEAD WOUND

INTRODUCTION
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, extruding brain matter, or a combination of these injuries. If the skin has been broken, it is called an open head injury. If the skin has not been broken, it is a closed head injury. Both open and closed head injuries can be severe and lifethreatening.

APPLY A DRESSING TO AN OPEN HEAD WOUND TASK Apply a dressing to a casualty with an open head wound. CONDITION Given a simulated casualty with an open head wound and needed supplies. STANDARD Score a GO on the performance checklist.

IDENTIFY SIGNS AND SYMPTOMS OF OPEN AND CLOSED HEAD INJURIES

If the skin is broken, the head injury is "open." If the skin is not broken, the head injury is "closed. A closed head injury may be as dangerous to the casualty as an open head injury. Bleeding from the scalp. Visible skull fracture and/or visible brain tissue. Deformity of the head. Clear or bloody fluid leaking from the nose or ears. "Black eyes" and bleeding in the whites of the eyes. Bruise behind one or both ears. Headache, nausea, or vomiting.

IDENTIFY SIGNS AND SYMPTOMS OF OPEN AND CLOSED HEAD INJURIES

Loss of consciousness, (either current or recent unconsciousness). Vision problems. Staggering or dizziness. Drowsiness. Mental confusion. Slurred speech. Convulsions or twitching. Difficulty in breathing. Paralysis. Size of pupils unequal.

CHECK A CASUALTY'S LEVEL OF CONSCIOUSNESS

Ask the casualty to tell you his name, where he is, the month and year, or other information which cannot be answered by a simple yes or no. Incorrect responses, inability to answer, or changes in responses may indicate a serious head injury.

POSITION A CASUALTY WITH A HEAD INJURY A casualty with a serious head injury could have a fractured neck. Avoid moving the casualty when possible. Position the casualty on his side with the wound away from the ground if the casualty is choking, nauseous, vomiting, or bleeding from his mouth.

POSITION A CASUALTY WITH A HEAD INJURY Have the casualty sit up and lean against a support such as a tree if only minor wounds are present. After the wounds are dressed, he can be positioned on his back with his head elevated slightly. If the casualty is having convulsions, ease him to the ground and gently support his head and neck. Do not try to forcefully hold his arms and legs or put fingers in his mouth.

EXPOSE THE HEAD WOUND

Remove the casualty's helmet if he is still wearing it.

Do not expose or dress the wound in a chemical environment. If the mask or hood has been breached, repair the breach with tape or wet cloth stuffing if possible. Do not attempt to clean the wound or attempt to push any brain matter back into the head.

APPLY A DRESSING TO A WOUND ON THE FOREHEAD OR BACK OF THE HEAD

Remove a field dressing from its wrappers. Grasp a tail in each hand, hold the dressing directly over the wound with the white pad toward the wound, pull the dressing open, and place the pad directly over the wound with the bandages horizontal. Place one hand on the dressing or have the casualty hold it in place. Wrap one tail horizontally around the casualty's head and bring it back across and past the dressing. Angle the bandage so it will cover the top or bottom edge of the dressing.
Do not cover the casualty's eyes or ears with the bandages.

APPLY A DRESSING TO A WOUND ON THE FOREHEAD OR BACK OF THE HEAD

Wrap the second tail around the head in the opposite direction. Bring the tail across the dressing angled so it will cover the other edge (top or bottom) of the dressing. Continue to wrap the bandage around the head again until it meets the first tail.

APPLY A DRESSING TO A WOUND ON THE FOREHEAD OR BACK OF THE HEAD Tie the tails in a nonslip knot on the side of the head. The bandages should keep the dressing from slipping, but not place undue pressure on the wound. Tuck any excess bandaging material (tails) under the bandage.

APPLY A DRESSING TO THE TOP OF THE HEAD

Remove a field dressing from its wrappers. Grasp a tail in each hand, hold the dressing directly over the wound with the white pad toward the wound, pull the dressing open, and place the pad directly over the wound with the bandages toward the ears.

APPLY A DRESSING TO THE TOP OF THE HEAD Place one hand on the dressing and grasp the near tail with the other hand. Bring the tail down in front of the ear, under the chin, up in front of the opposite ear, over the dressing, and to a point just above and in front of the first ear (about a one and one-fourth circle).
Make sure the tail remains wide and close to the chin.

APPLY A DRESSING TO THE TOP OF THE HEAD

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 degree turn. The cross should be made slightly above and in front of the ear. Bring one tail across the casualty's forehead and above the eyebrows until it is in front of the opposite ear (about a half circle).

APPLY A DRESSING TO THE TOP OF THE HEAD

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 where it meets the first tail.
Do not cover the casualty's eyes or ears.

Tie the tails in a nonslip knot in front of and above the ear. Tuck in the excess material from the tails.

APPLY A DRESSING TO THE CHEEK OR SIDE OF THE HEAD

Remove a field dressing from its wrappers. Grasp a tail in each hand, hold the dressing directly over the wound with the white pad toward the wound, pull the dressing open, and place the pad directly over the wound with the bandages vertical. Place one hand on the dressing or have the casualty hold the dressing in place.

APPLY A DRESSING TO THE CHEEK OR SIDE OF THE HEAD Bring the upper 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).

APPLY A DRESSING TO THE CHEEK OR SIDE OF THE HEAD

Bring the other 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).
Make sure both tails remain wide and close to the front of the chin. Do not cover the ears if it can be avoided.

APPLY A DRESSING TO THE CHEEK OR SIDE OF THE HEAD Cross the two tails just above the ear on the injured side of the face. Bring one tail across the forehead (above the eyebrows) to a point just in front of the ear on the uninjured side of the face.
Do not cover the casualty's eyes.

APPLY A DRESSING TO THE CHEEK OR SIDE OF THE HEAD

Bring the other tail above the ear, low behind 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.
If fluid is coming from the casualty's ear, put a field dressing over the ear to protect the ear and absorb the drainage.

Other Head Dressings

The following dressings are found in FM 21-11

MONITOR A CASUALTY WITH A HEAD INJURY

Position the casualty as in Learning Event # 1. The scalp may bleed excessively, requiring pressure to control the bleeding. Evacuate a casualty with a serious head wound, with fluid leaking from an ear, or who does not regain consciousness soon as possible. Check the casualty's level of consciousness every 15 minutes. If he falls asleep, awaken him to check his level of consciousness. Report your observations, including changes, to medical personnel. Do not give the casualty anything to eat or drink.

APPLY A DRESSING TO AN OPEN HEAD WOUND CLOSING

A head wound may be more serious than it first appears. Any soldier with a head wound should be evaluated by medical personnel.

Questions