Now that school is back in session, our children are busy with sports. Many of these sports involve contact of some sort. In the United States, a Brain injury occurs every 15 seconds. Most of these children are brought to the ER for an “evaluation” or told to “go get a CAT Scan”. Who should go to the ER? Who should get a CAT Scan?
What exactly should a parent do? These aren’t always easy questions to answer, and when they are, I sometimes find parents aren’t convinced about what should be done. So let’s start at the beginning.
If someone injures their head by a fall or collision but did not lose consciousness and is acting normally, all that is needed is some local wound care. For a small scratch or bump, clean the area with soap and water, apply antibiotic ointment, apply cold compresses, and taking pain medication like acetaminophen (Tylenol) or ibuprofen (Motrin) is all that is needed.
Some signs to look for after a head injury that may indicate it is more serious and should be checked by a physician include a loss of consciousness, confusion, amnesia, severe headache, vomiting, or any other unusual complaints.
After careful evaluation, a physician may decide that the only thing a patient and his family will need is reassurance and instructions on what to look for. Not everyone will need an X-ray or CAT Scan. If the physician decides to do a test, it will be a CAT scan. Skull x-rays do not give us the information we need and an MRI is not as good in the case of acute head trauma.
A concussion can be defined as any hit in the head that is severe enough to cause some momentary loss of consciousness. I like to explain to people that a concussion is a “bruise of the Brain”. Like any bruise, there is a varying degree of injury that can take place. Imagine getting hit in your arm and not seeing any injury. Or having a large, swollen, black and blue area without a broken bone. Both injuries would be called a bruise. There is a system for stating the severity of a concussion. We call them grades I, II, and III, and they are based on the severity of injury and the length of time symptoms last. Those symptoms include loss of consciousness, confusion, amnesia, and headache.
The biggest questions most parents and kids have is when the can go back to their activity. The grade or severity of the concussion determines this.
Grade I- momentary confusion (“seeing stars”) but no loss of consciousness. Symptoms last less than 15 minutes. May return to activity in 15 minutes if no problems.
Grade II- brief confusion but no loss of consciousness. Symptoms last longer than 15 minutes. May return to activity that has chance of head trauma in one week.
Grade III- loss of consciousness. Need to see MD if more than brief and if any Symptoms. Re-evaluation in one week for return to activity.
What about letting the person go to sleep after being hit in the head?
A myth in the sense that letting the person go to sleep is not what really counts, but being unable to wake the person up is. Let me explain. A person may go to sleep after a head injury, but should be checked at intervals to see if they are okay. And not only should they be checked to see if they can wake up, but if they are acting normal.
Can you take medication after getting hit in the head or will it mask an injury?
If you get hit in the head you can take medication for it ! People are frequently coming into the Emergency Department after having sustained a head injury complaining of a headache and have not taken anything for it. It
Contributed by Bruce Bonanno, MD