Dude, are you alright? Part 2

In response to two recent occasions in which friends made full use of their helmets, I thought I'd elaborate on the nature of head injuries. This is a continuation of Dude, are you alright? Luckily, as serious as brain injuries are, the response to them is easy in a backcountry setting. The only variant is how fast you need to get someone to medical help. Of course it is only easy because you only have a few options to choose from, but actually dealing with a head trauma is a different story. I'm lucky to say I never have myself!

Head Bonk:
A head bonk without concussion will cause any number of non-alarming symptoms from headache, ringing in the ears, blurred vision and mental cloudiness. Pupils will remain responsive to light. Remember to ride slow as you will be fuzzy for a few minutes.
Concussion:
This is a brain rattle severe enough to piss off the lining of the brain. The brain itself cannot sense pain, but those fragile linings do in a big way! The signs of a concussion include the above symptoms in addition to nausea, disorientation and dilated pupils. I usually check anyone's pupils in a crash. Under direct flashlight, or direct sunlight normal pupils should constrict to about 1-3mm in diameter. Dilated pupils in a head injury will stay dilated to a size greater than 4mm. The degree of a concussion needs to be assessed by a doctor as there are some risks associated.

Subdural Hematoma:
This is the next up in severe head injuries, and involves a slow bleed in the outer lining of the brain. This blood pools into a ball ("hemat" = blood, "oma"=tumor/mass) and progressively puts pressure on the brain. This is a medical emergency, and can be assessed by the follwing symptoms. People with these injuries will become very disoriented, irritable, nauseous and clumsy in their walking and talking. If severe enough, the eyes in addition to pupillary dilation can become deviated.

Subarachnoid Hemorrhage:
In most cases you REALLY have to knock your head hard to get one of these. But consider this! A person had a recent surgery, or something requiring them to be on blood thinners (Heparin, warfarin/coumadin or high dose aspirin, ibuprofen.) Now their blood clotting mechanism is compromised, and they don't require much impact to cause intracranial bleeding. So don't think this can't happen out on the trails!! This is characterized by a headache that is almost intollerable. Blood is a major irritant in the body when outside of the vessels, so when it contacts the linings of the brain it causes excruciating pain. I don't even think you need to know much more since if you see someone like this, you'll know it ain't good. But, they will be very disoriented, clumsy or numb in their extremities and nauseous, and may even vomit repeatedly. Check for pupils being reactive to light equally on both sides. If not, problem confirmed. Diagram of unequal pupils

Remember this with regard to head injuries: It may very well be bad enough to happen. So if your riding partner shows any of the signs of something serious, time for you to take it serious!

Now let's have a little chat about helmets!! I'll save you all the specifics save for just 3.
1. They NEED to cover your forehead. Otherwise, a helmet is more or less useless.

2. They are single impact only. Meaning one good bonk warrents replacing that helmet!

3. Bike helmets are not DOT approved. Deptartment of Transportation (DOT) approval recognizes a helmet as strong enough to handle highway and concrete impacts. Since a lot of riders now ride at near highway speeds on hear concrete hardness ground this is a consideration. This also includes full face downhill helmets unless there is a DOT or SNELL approaval in the inside.

Ride safe!