Concussion Overview by John P. Cunha, DO, FACOEP
The term concussion describes an injury to the brain resulting from an impact to the head. By definition, a concussion is not a life-threatening injury, but it can cause both short-term and long-term problems. A concussion results from a closed-head type of injury and does not include injuries in which there is bleeding under the skull or into the brain. Another type of brain injury must be present if bleeding is visible on a CT scan (CAT scan) of the brain.
A mild concussion may involve no loss of consciousness (feeling “dazed”) or a very brief loss of consciousness (being “knocked out”).
A severe concussion may involve prolonged loss of consciousness with a delayed return to normal.
A concussion can be caused by any significant blunt force trauma to the head such as a fall, a car accident, sports injury, or being struck on the head with an object.
• Loss of consciousness after any trauma to the head
• Nausea or vomiting
• Blurred vision
• Loss of short-term memory (you may not remember the actual injury and the events some time before or after the impact)
• Perseverating (repeating the same thing over and over, despite being told the answer each time, for example, “Was I in an accident?”)
When to Seek Medical Care
Call the doctor about any of the following situations. The doctor will recommend home care, set up an appointment to see the affected individual, or send the the person to a hospital’s emergency department.
• A person struck a hard object with the head (for example: tile floor, ice, bathtub) but did not lose consciousness
• Mild dizziness or nausea after a head injury
• Loss of memory of the event (amnesia) for just a few minutes
• Mild headache with no vision disturbances
Go to an emergency department by ambulance in the following situations. For people with less severe injuries not requiring ambulance transport, a car may be taken to the hospital.
• Severe head trauma, for example, a fall from more than the height of the person or a hard fall onto a hard surface or object with resulting bleeding or laceration.
• Any child that loses consciousness as the result of a head injury.
• Prolonged loss of consciousness (longer than two minutes)
• Any delayed loss of consciousness (for example, the injured person is knocked out only momentarily, then is awake and talking, then loses consciousness again)
• Vomiting more than once
• Confusion that does not go away quickly
• Restlessness or agitation
• Extreme drowsiness, weakness, or inability to walk
• Severe headache
• Loss of memory of the event (amnesia)
• Perseverating (saying the same thing over and over)
• Seizures or convulsions
• Slurred speech
• Someone who takes warfarin (Coumadin) or platelet inhibitors clopidogrel (Plavix) and aspirin and dipyridamole (Aggrenox) for a medical problem and suffers a significant blow to the head.
• If the person fails to regain consciousness after two minutes, or the injury is very severe even if two minutes have not passed, DO NOT move the person. Prevent movement of the neck, which may exacerbate spinal injuries. If the person needs to vomit, carefully roll the person onto his or her side without turning the head. Call 911 immediately for help.
If you are unsure of the severity of the injury, take the person to the emergency department immediately.
Should an injured person be allowed to fall asleep? Many mistakenly believe it is important to keep people, especially children, awake after they have been struck on the head. Children are often more emotionally upset than they are physically injured after a minor fall. They will cry and appear distressed, but as the parent rushes them to the hospital, children may begin to calm down. Because they have expended a lot of physical and emotional energy crying, they will often want to go to asleep.
• You do not need to keep the patient awake. In many cases it may be helpful to the emergency doctor to be able to awaken the person who is now more calm and rested and will behave normally. This gives the doctor a better assessment of the severity of the head injury.
• If, however, a person who was initially normal after a head injury cannot be awakened, or is extremely difficult to awaken, then the person may have a more serious head injury and should be evaluated by a doctor.
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