Responding to Head Injuries

Part one of a three part series.

It seems that after the tragic deaths of both Natasha Richardson and Billy Mays, head injuries have been getting a lot of play time in the media. Richardson died of an epidural bleed after a helmetless fall on skis. Mays was found to have an enlarged heart, but the minor head injury he received the night before his death launched speculation that he had died from intracranial bleeding as well.

Both of these incidents bring to light an important element of head injury response and evaluation. Patients with critical, life threatening brain injuries don’t always present as sick. Often they report feeling just fine. The emergency responder needs to approach head injuries with a high index of suspicion.

Today were going to begin a three part series on head injuries. In part one we’ll take a look at the different ways the skull and brain get injured. In part two we’ll talk about how the brain bleeds and how that can change the patients presentation. In part three we’ll look at treatment considerations for the head injured patient.

Let’s do a quick review of what’s inside your head:

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Learning DCAPBTLS (A word of advice)

I first heard the BCAPBTLS acronym sometime around 1998 while helping a group of EMT’s practice their skills. I hadn’t been involved in EMT education for several years and I had missed the whole inception of the DCAPBTLS acronym. Dutifully, each aspiring EMT moved from the head to the neck, shoulders, chest and abdomen. Each student verbalized their assessments as they went along and sounded off the acronym in turn.

“I’m exposing the chest and looking for DCAPBTLS.” “I’m checking the abdomen for DCAPBTLS.” On and on it went until I finally interjected, “What is this word you all keep using?”

“What word?”

“That word. The Dee Cap something.”

“Oh yeah.” They chimed in and began explaining the purpose of the DCAPBTLS acronym. If I remember correctly, there may also have been a “TIC” component added on to the end as well. If there was, the TIC part has been lost to education history. The students explained that DCAPBTLS was an acronym that was designed to help them remember the various abnormalities that they were looking for during the assessment. Then the funny part happened.

Collectively the students tried to recall all the elements of the acronym. “Deformity, contusions … uh … abrasions.” The room fell silent. “Uh … the T is tenderness.”

“Don’t forget bruising.” Another student chimed in. “Oh, yeah. Bruising.”

By the time the students collectively produced all eight elements of the acronym, several things were clear. The eight elements of DCAPBTLS was not one of them. Before we get in to that, let’s set the record strait. DCAPBTLS stands for:

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