Advice for head injuries and dehydration at endurance rides

by Lyn Taylor

Head injuries

I’m writing this in the hope that this might help some riders understand how dangerous even a small head injury may be and what we all need to know to manage these.

I hope that we all know that if you come across anyone who is unconscious that the first aid treatment is to stabilise their head and neck prior to rolling them into the recovery position. To do this, use your tee shirt or something similar rolled up and place it around their neck to reduce any movement of their head. Keep their airway clear, stay with the person and send someone else to for help.

We also know that the first thing a rider wants to do when they fall off their horse is to check on their mount and then if all is well get back up and finish the ride. Somewhere between strapping and vet-in, they just might think about themselves and take some form of painkiller – unfortunately, often this is in the form of an anti-inflammatory drug such as Ibuprofen or Nurofen.

Head injuries do not necessarily need to show any visible signs on the scalp or face. These are called ‘closed head injuries’. Any hard impact to the head can cause the brain to smash against the insides of the skull. This can bruise or tear the blood vessels in the brain, resulting in the brain swelling and this increased pressure can literally crush the brain. People can be walking around for several days with their brain bleeding and then collapse and die – they are called the ‘walking dead’.

Some of the signs and symptoms of head injuries that require immediate medical attention are: Severe headache, vomiting more than twice, memory problems, blackouts, difficulty staying awake, neck stiffness or neck pain, clear fluid coming from the nose or ears, numbness, tingling or weakness in the arms or legs, confusion, slurred speech or unusual behaviour and dizziness.

The treatment for non-severe head injuries is to use an ice pack to any bumps or bruises and a mild painkiller such as Panadol. DO NOT use anti-inflammatory painkillers as they interfere with blood clotting and may increase the risk of bleeding from any damaged blood vessels. Using them has increased the risk of death from head injuries by about 20% over the last 10 years. Let someone know you fell – better still let one of the ride officials know, even if you do not believe you lost consciousness. If you lost consciousness, even if only for seconds you should seek medical attention and be alert for any danger signs for the next 2 days.

Dehydration of riders

The utmost concern of any rider is state of their horse not themselves. Their horses’ rehydration is taken very seriously but not their own. Just like you preload your horses prior to a ride, so do the same for yourselves and keep up those fluids. Exercising in the cold can impair your ability to recognise sign of fluid loss from sweating and respiration. Choose a drink that is not high in sugars. These can increase dehydration as they reduce absorption in the gut.

Sports drinks so long as they do not contain caffeine or other stimulants are a good way of replacing electrolytes with a carbohydrate boost of about 6-8%. They need to be either Isotonic (similar to our own blood makeup) or Hypotonic (these contain no carbohydrates).

If you need an emergency electrolyte drink, you can make one up by using 5 tablespoons of sugar and 1/3 teaspoon of salt dissolved in 1 litre of water.

Straight water is not always the best as drinking excessively large amounts of water without any salt causes hyponatreamia or water intoxication – this is a potentially fatal condition. Signs are nausea, muscle cramps, disorientation, slurred speech and confusion leading to seizures, coma and then death. The first aid treatment is a salty drink and then seek medical help.

Lyn is a retired Anaesthetic Nurse with over 20 years of working in operating theatres and is now an enthusiastic TPR and helper at many endurance rides with husband Mike. Information provided is from various sources including the Australian Sports Institute. Article courtesy of NSW Endurance Riders Association

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