What do you do for a closed head injury?

Hockenberry B, Pusateri M, McGrew C. Sports-related head injuries. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2022. Philadelphia, PA: Elsevier; 2022:790-794.

Hudgins E, Grady S. Initial resuscitation, prehospital care, and emergency room care in traumatic brain injury. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 348.

Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.


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An EDH is often caused by a skull fracture during childhood or adolescence. The membrane covering the brain is not as closely attached to the skull as it is in older people and children younger than 2 years. Therefore, this type of bleeding is more common in young people.

An EDH can also occur due to rupture of a blood vessel, usually an artery. The blood vessel then bleeds into the space between the dura and the skull.

The affected vessels are often torn by skull fractures. The fractures are most often the result of a severe head injury, such as those caused by motorcycle, bicycle, skateboard, snow boarding, or automobile accidents.

Rapid bleeding causes a collection of blood (hematoma) that presses on the brain. The pressure inside the head (intracranial pressure, ICP) increases quickly. This pressure may result in more brain injury.


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Anderson JA, Hogg KE, Weitz JI. Hypercoagulable states. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 140.

Cross SS. Ischaemia, infarction and shock . In: Cross SS, ed. Underwood's Pathology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 7.

Schafer AI. Approach to the patient with bleeding and thrombosis: hypercoagulable states. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 162.


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Aufderheide TP. Peripheral arteriovascular disease. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 73.

Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69(11):1465-1508. PMID: 27851991 pubmed.ncbi.nlm.nih.gov/27851991/.

Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 45.

Kabrhel C. Pulmonary embolism and deep vein thrombosis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 74.

Zettervall SL, Schemerhorm ML. Acute mesenteric arterial disease: Epidemiology, pathophysiology, clinical evaluation, and management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 133.


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Updated by: Anna C. Edens Hurst, MD, MS, Associate Professor in Medical Genetics, The University of Alabama at Birmingham, Birmingham, AL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


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Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Bury J. Responses to cellular injury. In: Cross SS, ed. Underwood's Pathology: A Clinical Approach. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 5.

Scully R, Shah SK. Gangrene of the foot. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1047-1054.


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Updated by: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


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Bluth MH, Pincus MR, Abraham NZ. Toxicology and therapeutic drug monitoring. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 24.

Christiani DC. Physical and chemical injuries of the lung. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 88.

Nelson LS, Hoffman RS. Inhaled toxins. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 153.


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Philpot RM, Kalivas PW. Illicit psychoactive compounds and substance use disorder. In: Wecker L, Taylor DA, Theobald RJ, eds. Brody's Human Pharmacology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 24.

Thomas SHL. Poisoning. In: Ralston SH, Penman ID, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 23rd ed. Philadelphia, PA: Elsevier; 2018:chap 7.

Wang GS, Buchanan JA. Hydrocarbons. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 152.


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Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84(16):1705-1713. PMID: 25901057 pubmed.ncbi.nlm.nih.gov/25901057/.

Maciel CB, Elie-Turrene M-C. Seizure. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 92.

Mikati MA, Tchapyjnikov D. Seizures in childhood. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 611.

Templer JW, Schuele SU. Diagnosis and classification of seizures and epilepsy. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 80.


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Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Mental status. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Siedel's Guide to Physical Examination. 10th ed. St Louis, MO: Elsevier; 2023:chap 7.

Maciel CB, Elie-Turenne M-C. Seizures. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 14.

Mendez MF, Yerstein O. Delirium. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022: chap 4.


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Markell M, Siddiqi HA. Vitamins and trace elements. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Mason JB, Booth SL. Vitamins, trace minerals, and other micronutrients. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 205. 


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A simple rash is called dermatitis, meaning inflammation of the skin. Contact dermatitis is caused by things your skin touches, such as:

  • Chemicals in elastic, latex, and rubber products
  • Cosmetics, soaps, and detergents
  • Dyes and other chemicals in clothing
  • Poison ivy, oak, or sumac
What do you do for a closed head injury?

Seborrheic dermatitis is a rash that appears in patches of redness and scaling around the eyebrows, eyelids, mouth, nose, trunk, and behind the ears. If it happens on your scalp, it is called dandruff in adults and cradle cap in infants.

Age, stress, fatigue, weather extremes, oily skin, infrequent shampooing, and alcohol-based lotions aggravate this harmless but bothersome condition.

Other common causes of a rash include:

  • Eczema (atopic dermatitis) -- Tends to happen in people with allergies or asthma. The rash is generally red, itchy, and scaly.
  • Psoriasis -- Tends to occur as red, scaly, patches over joints and along the scalp. It is sometimes itchy. Fingernails may also be affected.
  • Impetigo -- Common in children, this infection is from bacteria that live in the top layers of the skin. It appears as red sores that turn into blisters, ooze, then for a honey colored crust over.
  • Shingles -- A painful blistered skin condition caused by the same virus as chickenpox. The virus can lie dormant in your body for many years and re-emerge as shingles. It usually affects only one side of the body.
  • Childhood illnesses such as chickenpox, measles, roseola, rubella, hand-foot-mouth disease, fifth disease, and scarlet fever.
  • Medicines and insect bites or stings.

Many medical conditions can cause a rash as well. These include:


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Leggett JE. Approach to fever or suspected infection in the normal host. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 264.

Nield LS, Kamat D. Fever. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 201.


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Earwood JS, Rogers TS, Rathjen NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27. PMID: 29365233 pubmed.ncbi.nlm.nih.gov/29365233/.

Haddad J, Dodhia SN. General considerations in evaluation of the ear. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 654.

Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.

Player B. Earache. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 5.


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Chole RA, Sharon JD. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 140.

Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.

Pham LL, Bourayou R, Maghraoui-Slim V, Kone-Paut I. Otitis, sinusitis and related conditions. In: Cohen J, Powderly WG, Opal SM, eds. Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 26.