Head injuries are potentially serious, but few lead to problem. a concussion or a head injury that has led to a loss of consciousness requires emergency care. if the skull isn't obviously damaged, bleeding inside the skull is the major concern. the accumulation of blood inside the skull may eventually put pressure on the brain and cause damage. fortunately, the valuable contents of the skull are carefully cushioned. careful observation is the most valuable tool for diagnosing serious head injury. usually this can be done as well at home as in the hospital; there is some risk either way, so it is your choice.

The question in the decision chart will help you distinguish between a brain injury, which can be serious, and a head injury, which usually isn't.

Home Treatment
Ice applied to a bruised area may minimize swelling, but "goose eggs" often develop anyway. the size of the bump doesn't indicate the severity of the injury. the initial observation period is crucial. symptoms of bleeding inside the head usually occur within the first 24 to 72 hours. check the patient every 2 hours duringthe first 24 hours, every 4 hours during the second 24, and every 8 hours during the third. look for the following symptoms;

* Loss of Alertness: Increase lethargy, unresponsiveness, and abnormally deep sleep can precede coma.
* Unequal pupil size after injury: about 25% of people have pupils that are slightly unequal all the time.
* Severe vomiting: the vomit may be ejected several feet.

In rare cases, slow bleeding inside the head may form a blood clot that produces chronic headache, persistent vomiting, or personality changes months after the injury. this is called a subdural hematoma.

Minor Injury
A typical minor head injury generally occurs when a child falls and hangs his or her head. a bump begins to develop. the child remains conscious, although initially stunned. for a few minutes, the child is inconsolable and may even vomit once or twice during the first couple of hours. the child is back to normal except for the tender "goose egg."

Severe Injury
In a more severe head injury, symptoms usually take longer to develop. two or more of the danger signs are often present at the same time. the individual remains lethargic and isn't easily aroused. a pupil may enlarge. vomiting is usually forceful, repeated, and progressive worse. if in doubt, call your doctor. because most of the accidents occur in the evening hours, the injury person will generally be asleep several hours after the accident. you can look in on the person periodically to check pulse, pupils, and arousability if you are concerned. with minor head bumps and no signs of brain injury, nighttime checking is usually not necessary.

Head Injuries

Have any of the following occured?
1. unconsciousness
2. patient cannot remember injury
3. seizure

* if yes, see a doctor
* if no, use home treatment

Are any of the following present?
1. visual problems
2. bleeding from eyes, ears or mouth
3. fluid draining from nose
4. irregular breathing or heartbeat
5. child under 2 years old

* if yes, see a doctor
* if no,  use home treatment

Smashing fingers in car doors or deck drawers, or with hammers or baseball, is all too common. if the injury involves only the end segment of the finger (the terminal phalanx) and doesn't involve a significant cut, the help of the doctor is seldom needed. blood under the fingernail (sunbungual hematoma) is a painful problem that you can treat.

Joint Fractures
Fractures of the bone in the end segment of the fingers aren't treated unless they involve the joint. many doctors feel that it is unwise to splint the finger even if there is a fracture of the joint. although the splint will decrease pain. it may also increase the stiffness of the joint after healing. however, if the fracture isn't splinted, the pain may persist longer, and may end up with a stiff joint anyway. discuss the advantages and disadvantages of splinting with your doctor.

Dislocated Nails
Fingernails are often dislocated in these injuries. it isn't necessary to have the entire fingernail removed. the nail that is detached should be clipped off to avoid catching it on other objects. nails will take from four to six weeks to grow back

Home Treatment
If the injuries doesn't involve other parts of the finger and if the finger can be moved easily, apply an ice pack for swelling and use acetaminophen, aspirin, ibuprofen, or naproxen for pain. 

Blood Under a Nail
Pain caused by a large amount of blood under the fingernail can often be relieved simply. the home remedy sounds terrible but it is very simple and can sometimes save the nail.

1. Bend open an ordinary paper clip and hold it with a pair of pliers.
2. Heat one end with a flame from a butane lighter or gas stove, steadying the hand holding the pliers with the opposite hand.
3. when the tip is very hot, touch it to the nail; it will melt its way through the fingernail., leaving a clean, small, painless hole. there is no need to press down hard. take your time, lifting the paper clip to see if you are through the nail; usually the blood will spurt a little when you are through. reheat the papaer clip if necessary.

The blood trapped beneath the nail can now escape through the small hole. and the pain will be relieved as the pressure is released. if the hole closes and the blood reaccumulates, the procedure can be repeated using the same hole once again.

Is the injury limited to the end section of the finger?
if no, see a doctor
if yes, use home treatment

Is the end of the finger deformed?
if no, use home treatment
if yes, see a doctor

Ingrown nails can be treated at home. cut the nail straight across so that it's corner can grow outside the skin. let the nail grow free by firmly pushing the skin back from the corner with a Q-tip twice a day. keep the area clean. for hangnails, keep them clean. don't chew on them. 

Ligaments are tissues that connect the bones of a joint to provide stability during the joint's action. when the ankle is twisted severely, either the ligament or the bone must give way. if the ligaments give way, they may be stretched (strained), partially torn (sprained), or completely torn (torn ligaments). if the ligaments don't give way, one of the bones around the ankle will break (fracture).

Strains, sprains, and even some minor fractures of the ankle will heal well with the home treatment. some torn ligaments do without a great deal of medical care; operations to repair them are rare. for practical purposes, the immediate attention of the doctor is necessary only when the injury has been severe enough to cause obvious fracture to the bones around the ankle or to cause a completely from ligament. this is indicated by a deformed joint with abnormal motion.

Swelling
The typical ankle sprain swells either around the bony bump at the outside of the ankle or about two inches (5cm) in front of and below it. the amount of swelling doesn't differentiate among sprains, tears, and fractures.

A swollen ankle that isn't deformed doesn't need prolonged rest, casting, or x-rays. home treatment should be started promptly. detection of any damage to the ligaments may be difficult immediately after the injury if much swelling is present. because it is easier to do an adequate examination of the foot after the swelling has gone down and because no damage is done by resting a mild fracture or torn ligament, there is no need to rush to the doctor.

Pain
Pain tells you what to do and not to do. if it hurts, don't do it. if pain prevents any standing on the ankle after 24 hours, see a doctor. if little progress is being made so that pain makes weight- bearing difficult at 72 hours, see the doctor.

Home Treatment:
RIP is the key word:
1. rest
2. ice
3. protection
Rest the ankle and keep it elevated. apply ice in a towel to the injured area and leave it there for at least 30 minutes, if there's any evidence of swelling after the first 30 minutes, then apply ice for 30 minutes on and 15 minutes off through the next few hours. if the ankle stops being painful while elevated, you may cautiously try to put weight on the leg. if the ankle is still painful when bearing weight, you should avoid putting weight on that leg for the first 24 hours. heat may be applied, but only after 24 hours. an elastic bandage can help but won't prevent re-injury if you resume full activity. don't stretch the bandage so that it's very tight and interface with blood circulation. you generally shouldn't try taping on children; if it's done incorrectly, it may cut off circulation to the foot. the ankle should feel relatively normal in about ten days. be warned, however, that full healing won't take place for four to six weeks. if strenous activity, such as organized the ankle should be taped by someone experienced in this technique.

Most of cuts (laceration) affect only the skin and the fatty tissue beneath it and heal without permanent damage. however, injury to internal structures such as muscles, tendons, blood vessels, ligaments, or nerves can bring permanent damage. your doctor can now decrease this chance. these are the signs that normally call for a cut to be examined by a doctor:
--Bleeding that you can't control with pressure- this is an emergency
--Numbness or weakness in the limb beyond the wound
--Inability to move fingers or toes. Signs of infection- such as pus oozing from the wound, fever, or extensive redness and swelling- won't appear for at least 24 hours. bacteria need time to grow and multiply. if these signs do appear, you must consult a doctor.

Stitches
The only purpose of stitching (suturing) a wound is to pull the edges together to hasten healing and minimize scarring. stitches injure tissue to some extend, so they aren't recommended if the wound can be held closed without them. stitching should be done within 8 hours of the injury. otherwise, the edges of the wound are less likely to heal together and germs are more likely to be trapped under the skin. stitching is often required in young children who are apt to pull off bandages, or in the areas that are subject to a great deal of motion, such as the fingers or joints.

Difficult Cuts
Unless the cut is very small or shallow, call your doctor about cuts in these areas:
-- on the chest, abdomen, or back
-- on the face- facial wounds can be disfiguring
-- on the palm- hand wounds can be difficult to treat if they become infected

Home Treatment:
Cleanse the wound. soap and water will do, but be vigorous. you may also need 3% hydrogen peroxide or a commercial antiseptic such as merthiolate. you make it sure that there"s no dirt, glass, or other foreign material remains in the wound.
The edges of a clean, minor cut can usually be held together by "butterfly" bandages or, preferably, by "steristrips" - strips of sterile paper tape. apply either of these bandages so that the edges of the wound join without "rolling under".
See a doctor if the edges of the wounds can't be kept together, if signs of infection appear (pus, fever, extensive redness and swelling), or if the cut's isn't healing well within two weeks.