Lesson 7 APPLY A DRESSING TO AN OPEN HEAD WOUND

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Combat Life Saver
Lesson 7APPLY A DRESSING TO AN OPENHEAD WOUND
Compiled and edited by, 2LT John C. Miller, PA-C
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Lesson 7APPLY A DRESSING TO AN OPENHEAD 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 life-threatening.

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APPLY A DRESSING TO AN OPENHEAD 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.

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IDENTIFY SIGNS AND SYMPTOMS OF OPENAND 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.

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IDENTIFY SIGNS AND SYMPTOMS OF OPENAND 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.

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CHECK A CASUALTY'S LEVEL OFCONSCIOUSNESS

• 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.

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POSITION A CASUALTY WITH A HEADINJURY

• 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.

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POSITION A CASUALTY WITH A HEADINJURY

• 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.

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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.

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APPLY A DRESSING TO A WOUND ON THEFOREHEAD 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.

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APPLY A DRESSING TO A WOUND ON THEFOREHEAD 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.

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APPLY A DRESSING TO A WOUND ON THEFOREHEAD 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.

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APPLY A DRESSING TO THE TOP OF THEHEAD

• 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.

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APPLY A DRESSING TO THE TOP OF THEHEAD

• 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.

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APPLY A DRESSING TO THE TOP OF THEHEAD

• 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).

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APPLY A DRESSING TO THE TOP OF THEHEAD

• 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.

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APPLY A DRESSING TO THE CHEEK OR SIDEOF 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.

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APPLY A DRESSING TO THE CHEEK OR SIDEOF 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).

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APPLY A DRESSING TO THE CHEEK OR SIDEOF 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.

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APPLY A DRESSING TO THE CHEEK OR SIDEOF 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.

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APPLY A DRESSING TO THE CHEEK OR SIDEOF 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.

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Other Head Dressings

• The following dressings are found in FM 21-11

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MONITOR A CASUALTY WITH A HEADINJURY

• 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.

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APPLY A DRESSING TO AN OPENHEAD 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.

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Questions