How to Recognize and Treat a Skull Fracture or Closed Head Injury

Injuries to the head can cause damage to the skull, scalp, or brain. The brain rests inside the skull protected by a cushion of soft tissue called the meninges. There are several different types of head injuries, and it's important to learn the signs.

Paramedic working on man with a head injury
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Skull Fracture

Head injuries typically come from blunt or penetrating trauma the head. The skull does not have to be fractured, but can be. If the skull is soft when touched, or missing, the victim has an open or depressed skull fracture. If skull fracture is suspected, call 911 immediately.

Other signs of a skull fracture include blood or clear fluid draining from the ears or nose, and bruising around both eyes or behind the ears.

Closed Head Injury

A closed head injury is an injury to the brain inside an intact skull. Injury to the brain causes swelling, which quickly increases the pressure within the skull (intracranial pressure). The increased pressure causes more damage to the brain, which causes more swelling, and so on. Common types of closed head injuries include:

  • Concussion: An injury to the head that may cause lack of awareness for a few minutes or hours.
  • Epidural hematoma: A blood clot that forms underneath the skull but on top of the dura, the covering surrounding the brain.
  • Subdural hematoma: A blood clot that forms underneath the skull and the dura but outside the brain.
  • Intracerebral hematoma: A contusion or bruise on the brain.
  • Increased intracranial pressure: A rise in pressure of the cerebrospinal fluid surrounding the brain within the skull.

Closed head injuries range from less severe (concussion) to very severe and possibly death (epidural hematoma). The only way to tell the difference is through a CT scan, which looks at the brain and the skull using x-rays.

Signs and Symptoms

A victim struck with a blunt object should be watched for signs and symptoms of a closed head injury. If a victim of blunt head trauma has any of the following, call 911 immediately:

  • Loss of consciousness at the time of the injury (getting knocked out)
  • Short-term memory loss (victim keeps repeating questions)
  • Unable to wake the victim from sleeping
  • Confusion
  • Vomiting
  • Dizziness


First Aid

In all cases of injury to the head and neck, it's vital not to move the victim's neck. Support the victim's head in the position you found it. Bones of the spine (vertebra) can be injured from movement of the head during trauma. Broken or displaced spinal bones can cut or put pressure on the nerves of the spinal cord, causing temporary or permanent paralysis and loss of feeling.

Vomiting can lead to problems with the victim's airway. If the victim begins vomiting and is unconscious, place the victim in the recovery position to let the emesis (vomit) drain from the victim's mouth.

It is a myth that closed head injury victims should be kept awake. If a victim of trauma to the head does not have any of the signs or symptoms of closed head injury or skull fracture, there is no reason to keep them awake. Once asleep, wake the victim about 30 minutes after falling asleep to make sure they can be aroused. If you are unable to wake a victim of blunt head trauma 30 minutes after falling asleep, call 911 immediately.

12 Sources
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Additional Reading

By Rod Brouhard, EMT-P
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.