Treat a Concussion

When a blow to the head shakes the brain within the space between the brain and the skull, the resulting shaking is known as concussion.[1] A concussion is the most common type of head injury. A concussion can result from a car crash, a sports injury, a fall, or a violent shake to the head or upper body.[2] While most concussions are a temporary disturbance that don't leave lasting damage, it can lead to associated serious problems if not treated promptly and effectively.[3]

Steps

Determining If a Person Has a Concussion

  1. Assess the victim. Examine the wound and look carefully at the victim. Check to see if the victim has a bleeding head wound. Concussions might not bleed on the surface, but under the scalp, creating a "goose egg" or a hematoma (a large bruise).[4]
    • Visible external injuries are not always a good way to tell if someone has a concussion since some very minor scalp wounds bleed profusely, while some less visible impact injuries can cause major brain impairment.
    • Physical symptoms to look for include signs of basilar skull fracture, Battle’s sign (a swollen bruised area that appears several days after a skull fracture because blood has leaked into the area behind the ear), raccoon eyes, and rhinorrhea (leakage of cerebrospinal fluid).[5][6]
  2. Check for physical symptoms. Mild and severe concussions can result in many physical symptoms. Look for any of the following symptoms:
    • Loss of consciousness.
    • Severe headache.
    • Light sensitivity.
    • Double or blurred vision.
    • Seeing "stars", spots or other visual anomalies.
    • Loss of coordination and balance.
    • Vertigo.
    • Numbness, tingling, or weakness in legs and arms.
    • Nausea and vomiting.[7]
    • Amnesia.
    • Obvious confusion.
    • Loss of consciousness.
  3. Check for cognitive symptoms. Since a concussion is an ailment of the brain, concussions often disrupt brain function. These disruptions include:
    • Unusual irritability or excitability.
    • Disinterest or difficulties with concentration, logic, and memory.
    • Mood swings or outbursts of inappropriate emotions and tearfulness.
    • Drowsiness or lethargy.
  4. Assess consciousness. When checking for a concussion, it is important to know whether or not the victim is conscious and know his or her level of cognitive function. To check the consciousness of the victim, try the AVPU code:[8]
    • A - Is the victim alert? - Does the victim watch you with their eyes? Does he answer your questions? Does he respond to normal environmental stimuli?
    • V - Does the victim respond to voice? - Does the victim respond when spoken to, even if the response is small and not completely alert? Does he need to be yelled at to respond? A victim can respond to verbal commands and not be alert. A response of "Huh?" when you speak to them means they are verbally responsive, yet not alert.
    • P - Does the victim respond to pain or touch? - Pinch skin to see if there is movement or if the victim opens his eyes. Another technique is to pinch or poke the nail bed. Be careful when doing this; you do not want to cause unnecessary harm to the victim. You are simply trying to get a physical response from him.[9]
    • U - Is the victim unresponsive to anything attempted?
  5. Watch the victim afterwards. Most concussion symptoms appear within minutes of the injury. Others appear hours later. Some symptoms can change days later. Keep a watch on the victim and call a doctor if symptoms worsen or change.[10]

Treating a Mild Concussion

  1. Apply ice. To reduce swelling with a minor injury, apply an Make an Ice Pack Quickly to the affected area. Apply ice every two to four hours, for 20-30 minute increments.[11]
    • Do not apply ice directly to the skin. Wrap it in a cloth or plastic. If ice is not available, use a bag of frozen vegetables.
    • Do not apply pressure to any head trauma wound as this could push bone splinters into the brain.
  2. Take over the counter pain medicine. To treat head pain at home, take acetaminophen (Tylenol). Do not take ibuprofen or aspirin because that could make bruising or bleeding worse.[12]
  3. Keep focused. If the victim is conscious, ask questions continually. This serves two purposes: to assess the degree of the victim's impairment, and to keep the victim awake. Continuing to ask questions can alert you to changes in the victim's cognitive state if the victim fails to answer a question they could answer before. If the cognitive state changes and worsens, seek medical attention. Good questions include:
    • What is today's date?
    • Where are you?
    • What happened to you?
    • What is your name?
    • Are you feeling alright?
    • Can you repeat the following words after me...?
  4. Stay with the victim. For the first twenty-four hours, stay with the victim. Do not leave them alone. Monitor their physical and cognitive function for any changes. If the victim wishes to sleep, wake the victim every quarter hour for the first 2 hours, then every half hour for the following 2 hours, then hourly.[13]
    • Every time you wake them, do the AVPU consciousness test as outlined above. You want to continuously monitor their cognitive and physical state in case symptoms appear later or worsen.
    • If the victim does not respond to being woken up, treat as an unconscious patient.
  5. Avoid strenuous activity. For days after your concussion, avoid sports and strenuous activity. During this time, avoid stressful situations. Your brain needs to rest and heal.[14] Before taking part in sports, you may want to contact your doctor.
    • Returning to activity too early predisposes you to increased risk for a repeat concussion and long term problems of dementia.
  6. Don't drive. Do not operate a vehicle or ride a bicycle until you feel fully healed. Get someone to drive you to and from the doctor's office or hospital.
  7. Rest. Do not read, watch TV, text, listen to music, play video games, or perform any other mental task. You should rest both physically and mentally.[2]
  8. Eat brain-healthy foods. Food can positively and negatively affect the healing of your brain. Avoid alcohol after a concussion. Also avoid fried foods, sugars, caffeine, artificial colors and flavors. Instead, eat the following foods:
    • Avocados.
    • Blueberries.
    • Coconut oil.
    • Nuts and seeds.
    • Salmon.
    • Butter, cheese, and eggs.
    • Honey.
    • Any of your favorite fruits and vegetables.[15]

Treating a Severe Concussion

  1. Contact a doctor. Any suspected head injury or concussion needs to be evaluated by a medical professional. What may seem like a minor head injury could be a fatal one. If the victim is not regaining consciousness, call for an ambulance. Otherwise, drive the victim to the nearest emergency room or doctor's office.[16]
    • If the patient is unconscious or if you are unsure the extent of the damage, call an ambulance. Driving a head trauma patient requires moving them, which should never done until the head is stabilized. Moving a head trauma patient could lead to death.
    • It may be best to be evaluated in the emergency room if you have a loss of consciousness or severe amnesia. A doctor will order a test called a CT scan to evaluate for swelling or bleeding and diagnose the concussion. Another name for a concussion is mild traumatic brain injury.
  2. Go to the hospital. For severe concussions, you may want to take the victim to the emergency room. If the victim shows any of these symptoms, take them immediately to the ER:
    • Loss of consciousness, even if briefly.
    • Periods of amnesia.
    • Feeling dazed or confused.
    • Severe headache.
    • Repeated vomiting.
    • Seizure.[2]
  3. Stay still and avoid movement. If you think a neck or spine injury may accompany the concussion, avoid moving the victim while waiting on the paramedics. Moving the person may cause further injury.
    • If you must move the person, do so very carefully. Make sure to move the head and the back as little as possible.[17]
  4. Follow up. If your symptoms do not improve within 7-10 days, contact your physician. If at any time your symptoms change or worsen, contact your physician.[12]
  5. Continue treatment. There is very little known about the effects of concussion on the brain and on cognitive function. However, some treatments prescribed by your doctor may improve lingering symptoms.
    • A doctor may perform any number of scans, including an MRI, CT, or EEG.[18] A doctor may also perform a neurological test that evaluates your vision, hearing, reflexes, and coordination. Another test they may perform is a cognitive test, which checks memory, concentration, and recall.[19]

Tips

  • Return to play should not be on the same day of the concussion. The athlete should not return to play until asymptomatic and off medication. A more conservative approach should be taken with children and adolescents.
  • Prevention includes the use of helmets for sports such as football, rugby, baseball, ice hockey, alpine skiing, and snowboarding.

Related Articles

Sources and Citations

  1. ↑ VK, First Aid Manual, p. 180, (2006), ISBN 9-781405-315739
  2. ↑ 2.0 2.1 2.2 http://www.brainline.org/content/2012/06/what-should-you-do-if-you-think-you-have-had-a-concussion.html
  3. ↑ Australian Red Cross, First Aid: Responding to Emergencies, p. 142, (2002), ISBN 0-909896-74-7
  4. ↑ http://www.emedicinehealth.com/concussion/page6_em.htm
  5. ↑ https://medlineplus.gov/ency/imagepages/3067.htm
  6. ↑ http://med.stanford.edu/neurosurgery/patient_care/head_spine.html
  7. ↑ http://www.nytimes.com/health/guides/disease/concussion/overview.html
  8. ↑ DK, First Aid Manual, p. 178, (2006), ISBN 9-781405-315739
  9. ↑ http://www.paramedicine.com/pmc/AVPU.html
  10. ↑ http://my.clevelandclinic.org/services/concussion-center/hic-concussions
  11. ↑ http://www.nhs.uk/Conditions/Concussion/Pages/Treatment.aspx
  12. ↑ 12.0 12.1 http://www.webmd.com/first-aid/concussion-treatment
  13. ↑ New Zealand Mountain Safety Council, Inc, New Zealand Outdoor First Aid, p.49, (2002), ISBN 9-780908-931149
  14. ↑ http://www.healthline.com/health/concussion#Treatments5
  15. ↑ http://healyourconcussion.com/nutrition-for-concussionsmild-brain-injury
  16. ↑ Australian Red Cross, First Aid: Responding to Emergencies, p. 143, ISBN 9-780909-896744
  17. ↑ http://www.healthline.com/health/concussion#Emergency3
  18. ↑ http://www.healthline.com/health/concussion#Diagnosis4
  19. ↑ http://www.mayoclinic.org/diseases-conditions/concussion/basics/tests-diagnosis/con-20019272
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