When You’re Hit Upside the Head: 6 Signs It’s Dangerous | The Survival Doctorby James Hubbard, MD, MPH

I cringe when I see someone on television or in the movies get whacked upside the head with a gun. Of course, most of the time they wake up and go about their business, but that’s not always the case in real life.

First, if you’re knocked out—with anything—you’ve automatically sustained a concussion and should be treated as such. (Though you don’t have to be knocked out to have a concussion.) And if you’ve been hit on the head as hard as many on TV, it’s a good bet you might have a fractured skull as well.

Now, don’t get me wrong, many people with a concussion or even a fractured skull do just fine with a little rest and time. Even so, all should see a doctor. The only question is, if you’re in disaster, or far away on a hike or camping, how long can you wait to see one?

In this post, I’ll give you a few warning signs—six hints that you’d better get to a doctor sooner than later, if that’s at all possible.

6 Red Flags Warning Immediate Help Is Needed
The Survival Doctor’s ABCDEFS of Head Trauma


Blood from an ear
Diffuse (all over) headache
Eyes (pupils)
Fluid from a nostril or ear

With any of the following head trauma symptoms or signs, you should get the injured victim to a medical facility if at all possible, as fast as possible, even if that means calling in air transport.

If any of these signs or symptoms are getting worse, that’s even greater warning that the bleeding or other pressure in the skull is getting worse. The same goes if the person looks initially fine only to start getting the symptoms a few minutes or hours after the trauma.

Immediate, professional help is needed if the person is knocked out and:

1. Doesn’t wake up after a couple of minutes.

2. Doesn’t fully regain his senses within at least 30 minutes. By regaining senses, I mean fully alert and “oriented times four”: to person (who they are, who you are.), to place (where they are), to time (what’s the day of the week? the month?) and to situation (what happened?).

Whether the person is knocked out or not, immediate, professional help is needed after head trauma if:

3. The person has a seizure.

4. There’s not just pain over the area of the injury but a severe, diffuse headache that’s not getting better with time.

5. There’s blood oozing from an ear (and it’s not the result of direct trauma to the ear) or clear fluid coming out of a nostril or ear. This suggests a skull fracture that has injured a blood vessel or the membrane that holds the fluid around the brain.

6. The pupils are unequal or don’t constrict to light equally.

Of course these warning signs are not inclusive. If you’re worried, get help. And if you’re on a hike, at the least, stop where you are. Anyone who has been knocked out or experienced significant head trauma and is nauseated, dizzy, etc., and can’t get immediate medical help should at a minimum rest, have their symptoms monitored, and not risk traveling any further away from help than they already are, in case their symptoms start getting worse.

For more details on symptoms you should monitor and what they indicate about the severity of the head trauma, check out the Glasgow Coma Scale.

What about you? Have you ever had a serious head injury? What were the symptoms?