I had a person email this question and I thought it may be a good refresher for everyone on a very common accident and injury that effects many different age groups and many different people.

Below is the question and the answer follows below that.

Dear Roy,

I had an injury yesterday playing baseball I ran into another player. I don’t really remember what happened.  I was told I hit my head on his chin and on the way down, my chin hit his knee, and then hit my head on the ground. I was knocked out. When I woke,  I didn’t know what happened and could not move or talk for about a minute.  Then, when I went to get up, my legs collapsed.   So I went to the emergency room for  a CT scan.  No bleeding to the brain,  but had an extreme headache.  Now the next day,  head still hurts and my neck is sore but not as bad. the ER doc said everything looked fine, but could not really say if I have a concussion or not.  He said I have the “symptoms”.  I guess my question is,  when should I go back to work?  The doc only took me off for a day but I am still in pain.

Hello J—-,

Concussions can be very tricky. They may not show up on CT or Xray and you can really feel lousy for a while after the initial accident. If you don’t feel capable of returning to work, it’s always best to allow your body the ample time required to heal prior to putting your body back in a stressful situation. However, that’s the perfect case scenario. It’s pretty common that those of us who work, may have to return to work prior to feeling 100%. If this is the case and you cannot get your doctor to write a letter for additional recovery days for your employer, make sure you watch your signs and symptoms and listen to your body. If you become dizzy, nauseated, develop a headache etc., these can lingering signs of a concussion but may not be serious enough for you to be hospitalized. But if you handle heavy equipment or must be at your best to stay safe, keep others safe, or do the level of job required of you, this should probably be communicated to your professional health care provider and see if an extra bit of recovery time could be allowed.

It’s never any fun getting a “Konk On The Melon” and even less fun dealing with the lingering side effects while duty is calling the patient back to work.

Keep an eye on your symptoms and as most any health care provider would tell you, if your symptoms worsen, you become more painful and not less painful over time, if you have numbness, tingling, have a seizure, headache increases, get more dizzy not less dizzy or have a decreased level of consciousness, 911 should be called and you should be seen in the Emergency Room.

Other wise, if the symptoms don’t get worse but get better though are still lingering a few days, it may be within normal recovery expectations and you simply need to take it easy and allow yourself to recover.  If you are ever in doubt, don’t hesitate to contact your medical professional and let them know what your symptoms are and see if they want to reassess the situation.

I found a well laid out guideline for definitions and signs and symptoms from a website and I’ll pass the information on to you along with the link for credit to the referenced website.
www.centerforbrainhealth.net

Sports Concussion

It’s more than just a bump on the head

MYTHS about sports concussion…

1. Concussion is a minor brain injury with no long-term effects

2. If you weren’t knocked out, then you didn’t have a concussion

3. Having multiple concussions is common in sports and no cause for concern

4. Symptoms of a sports concussion will always clear up, usually in a few days

5. If there’s no visible injury, everything’s okay

6. You should play through the pain—get back in the game!

FACTS about sports concussion…

1. Twenty percent of all concussions are sports-related

2. A concussion doesn’t always knock you out

3. Having one concussion increases your chances of having another

4. Symptoms of a concussion can last hours, days, weeks, months, or indefinitely

5. Concussion can cause disability affecting school, work, and social life

6. Returning to contact or collision sports before you have completely recovered from a concussion may lead to more serious injury and can increase your chances of long-term problems

What is a concussion?

Concussion is a mild traumatic brain injury that occurs when a blow or jolt to the head disrupts the normal functioning of the brain. Some athletes lose consciousness after a concussion but others are just dazed or confused. Concussion is usually caused by a blow to the head, but can also occur due to whiplash.

How can you tell when an athlete or person gets a concussion?

Sometimes, but not always, the athlete will be knocked out. In cases where there is no obvious loss of consciousness, the athlete may appear to be confused or disoriented (such as running in the wrong direction), and may not remember things that happened before or after the concussion, such as what period it is or the score of the game. Often, the athlete will describe some symptoms of a concussion, such as headache, dizziness, nausea, or blurred vision. It is also common for athletes to describe feeling “fuzzy” or “foggy” after concussion, and to have problems with balance or coordination. For this reason, and also because symptoms can sometimes worsen rather than improve, careful observation of the athlete after concussion is especially important.

What is post-concussion syndrome?

Post-concussion syndrome is a term that describes the physical, cognitive, and emotional symptoms that are caused by concussion and which can last for a varying amount of time after injury. Some symptoms show up right away, but others may not appear or be noticed until the next day or even later. Likewise, some symptoms might resolve fairly quickly, but others—especially fatigue—can persist much longer. The number and severity of symptoms, the speed of recovery, and the impact of symptoms on day-to-day functioning will be different for each athlete.

Physical Symptoms…

* headache
* neck pain
* nausea
* lack of energy and constantly feeling physically and mentally tired
* dizziness, light-headedness, and a loss of balance
* blurred or double vision and sensitivity to light
* increased sensitivity to sounds
* ringing in the ears
* loss of sense of taste and smell
* change in sleep pattern especially waking up a lot at night

Social and Emotional Symptoms…

* mood changes including irritability, anxiousness, and tearfulness
* decreased motivation
* easily overwhelmed
* more impulsive and disinhibited
* withdrawn and wanting to avoid social situations

Cognitive Symptoms…

* feeling ‘dazed’ or ‘foggy’
* difficulty concentrating and paying attention
* trouble with learning and memory (especially for recent events)
* problems with word-finding and putting thoughts into words
* easily confused and loses track of things
* slower in thinking, acting, reading, and speaking
* easily distracted
* trouble doing more than one thing at a time
* lack of organization in everyday tasks

How long does it take to get better?

Most people do recover completely from a concussion, usually in a matter of days. However, it can take up to a year or longer for some athletes to recover, and in some cases the symptoms won’t go away. Recovery may be slower in those who have already had one or more concussions, and in those who have a history of learning disability or attention disorder.

When it is safe to return to play after concussion?

There are several guidelines for return to work/play after concussion.  All of these share some common principles:

1. An athlete who has suffered a concussion should be removed from competition immediately and monitored for post-concussion symptoms

2. An athlete should not return to play before he or she is completely symptom-free at rest and after exertion for a specified period of time, which varies based on the athlete’s history and the severity of the concussion.

3. Athletes who have a history of one or more previous concussions should be treated more cautiously (not returned to play as quickly) than those who have suffered their first concussion

4. When in doubt, sit them out!

How can you tell when an athlete is symptom free?

An athlete should only return to competition when it is clear that there are no lingering symptoms of concussion. Unfortunately, because concussion is an invisible injury, and because athletes may minimize or not recognize persistent post-concussion, symptoms, this can be a tricky matter. Also, symptoms may sometimes go away, only to come back after physical or mental exertion.

Most often, return to play decisions are made without the benefit of neuropsychological testing and are based on observation and player report of symptoms. Neuropsychological testing provides the coach or team physician with information that can help to take the guesswork out of concussion management and return-to-play decisions. Using a battery of tests of memory, reaction time & processing speed, we can provide specific information regarding the severity of injury and a standard for evaluating recovery from injury. It is of benefit for athletes to receive baseline assessment prior to or at the beginning of the athletic season to allow for within-subjects analysis of scores following an injury.

I hope this helps J—- and I hope you feel better real soon.

Thanks for the question.

Best Wishes,

Roy, RoyOnRescue.com
royonrescue@gmail.com

G.S.: “In my scenario, the person fell down hit their head twice and then fell onto the floor face down. I am now wondering if we did the right thing. We picked the person up and carried her outside for fresh air where she revived immediately. We  then monitored the person but nothing else seemed to be wrong with her.”

ROR:  It sounds like the story ends well regardless of the treatment given which is always great!  There may be a few things that we cold improve upon for the future. Let’s analyze what happened and what we might be able to do differently next time to protect and help the fall victim even more.

Whenever a person falls, there is a risk for head and neck injury. As stated in your scenario, this particular person did  hit their head… twice.  This would be enough mechanism of injury that instead of moving the person right away, we would want to minimize movement while assessing the person for any signs or symptoms of other injuries.  We can minimize movement by softly but confidently speaking to the patient who is either conscious or unconscious and place one hand carefully on the victims forehead to help remind them and us not to move their head and neck.   Try to find out  if the person is breathing on their own and if their skin color is somewhat normal while they are lying in the position found. If they are breathing and skin color is good, we do not have to move the person before Emergency Medical Services arrive.

If assessing the person’s airway is impossible in this position,(face down) we may need to carefully roll the person over onto their back even if we suspect that there may be a serious neck or back injury.  We do not move spinal chord injury patients unless they need cpr, their airway is compromised or they are in danger due to the environment.

If we determine that we must roll, or move a person with a suspected spinal chord injury, utilize several people if available,  in order to minimization spinal movement.  If you are the only person, then do the job the best way you can and follow the “Life Over Limb” philosophy.  If the person wakes and is not complaining of any pain or numbness and they don’t allow you to minimize movement because they want to get up, they should be allowed to do so.  It is not wise to hold the person down as this can complicate injuries the patient already sustained trying to wrestle.  Keep encouraging the person to stay still until help arrives by the ambulance service. Keep the person in a position of comfort with confident words of encouragement like, you are in good hands, I’m going to take good care of you and help is on the way.  If they still refuse treatment, there is little you can do at that point other than inform  911 of what has happened.

It sounds as though you did the best you could for this person at the time.  Remember,  most people don’t even get involved when someone needs help.  The fact that you did get involved and tried to help makes you a natural rescuer!

I thought a video clip of all different fainting episodes would not only get my point across that falls can cause injuries to the person even if the fainting spell or the reason they fell wasn’t serious. I hope you don’t feel faint watching others faint but if you want to see what happens to people when they fall from standing up, take a look at the clip below.

P.S. One of the most effective rescue moves for a person who is starting to faint, is to simply help them to the floor before they fall!

Best Wishes,

Roy On Rescue