g. Secondary Survey: Head. Check the head for trauma. Examine the patient
in these areas:
(1) Scalp lacerations. One of the most common types of head injuries is a
lacerated scalp. Because of the great number of blood vessels in the scalp, it may
bleed profusely. The most common signs are profuse bleeding and your seeing the
(2) Skull fracture. Look at the patient's skull to see if he has bumps,
defects, bruises, or lacerations. A skull fracture does not necessarily mean injury to the
brain. The three types of skull fracture are simple, depressed, and basilar. In a simple
skull fracture, there is a linear crack in the surface of the skull. As the name suggests, a
segment of the bony skull is depressed in a depressed skull fracture. A basilar skull
fracture is the term for a fracture at the base of the skull.
(3) Concussion. A concussion is usually caused by a direct blow to the
head or from an acceleration/deceleration injury. In this last type of injury, the brain
tissue impacts with the inside of the bony skull. A variety of signs and symptoms
indicate a concussion. Included are:
(a) Nausea and vomiting.
(b) Possible brief loss of sight or "seeing stars."
Possible skull fracture.
(d) Loss of consciousness.
h. Secondary Survey: Eyes. Check the eyes for trauma. Check the eyes for
Normal pupillary responses.
(a) Light shined into the pupils of the eyes causes the pupils to
(b) Shining a light into one pupil causes the other pupil to constrict.
Abnormal pupillary responses.
(a) Pupils of the eyes remain fixed when light is shined into one or