ER patient complains of a headache after an accident

I was working as a nurse practitioner in the emergency room fast tract.  A patient was triaged to me with the chief complaint of headache. The man came in and calmly sat down on the stretcher.  I asked him how he was feeling and he said, “I'm afraid.” That seemed like a strange answer, so I asked him what was scaring him.  He stated, “I thought I felt my scalp fly.” 

For a moment I was contemplating if something was really wrong with him, so I asked the patient what he meant.  He told me, “I was working on my car in my garage and I went to grab a tool outside. When I was coming back in the garage door was coming down, and I looked up quickly. I felt like my hair had come off of my head, so I threw my hoodie up over my head, ran inside and looked in the mirror. My hair was on top of my head, but I could have sworn it was off. I rushed here because I have no intention of poking around up there.” 

I asked him if he had a headache because that was his chief complaint, and he stated, “Yes, the door must have hit me in the head.” His hair was dirty and looked matted up with grime. We laid him on the stretcher and another nurse began to rinse his hair. She quickly called me back in to the room. Sure enough, the garage door had pulled his scalp away about five inches across the top of his head, sparing his hairline by about an inch. 

The grime was a mixture of dirt from the door and dried blood. When the patient pressed down on his scalp after putting on his hoodie, the action stopped the bleeding.  Bone was exposed, and after the CT scan it took about two hours to suture his scalp back on. The man was grateful he did not have to see the “flap” that he thought he saw.  This is a story we talk about a lot in the ER.  So if your patient says he thinks he has been scalped, make sure you check his head ­– interesting things can happen.

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