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Pledge Your Head To Clearer Thinking

Part of the classic 4H Pledge and Motto invokes using the head for clearer thinking – precisely what we’re after here.  Concussions are in the news lately, mostly because it’s the start of the football season, but contact sports are not the only culprits.  Motor vehicle accidents, falls, horseplay and other routine mishaps can all cause brain injuries.  General awareness of the symptoms of possible concussion is on the rise; teachers and coaches are on the lookout for signs of injury among their charges; parents and childcare workers are more tuned in.

Over the past few days, we have looked at concussion risk factors, causes, complications and signs and symptoms.  We have also offered some guidelines and recommendations for when to seek emergency care,  including suggestions from the American Academy of Pediatrics about caring for a child with a suspected brain injury.  Now we look at what to expect from your doctor when you see him or her about an injury and related signs of concussion.

Your doctor will very likely ask the following questions:

  • Do you play contact sports?
  • How did you get this injury?
  • What symptoms did you notice immediately after the injury?
  • Did you lose consciousness after the injury?
  • Do you remember what happened right before and after the injury?
  • Did you have any seizures?
  • Are you sick to your stomach?  Have you experienced any vomiting since the injury?
  • Have you had a headache?  When did it start?
  • Have you noticed any trouble with your physical coordination since the injury?
  • How about problems with concentration or memory since the injury?
  • Have you noticed any sensitivity or problems with your hearing or vision?
  • What about mood changes?  Have you been irritable? Anxious? Depressed?
  • Have you felt lethargic since the injury?  Are you more easily fatigued?
  • Are you having any trouble sleeping or waking from sleep?
  • Have you noticed any changes in your sense of taste?  How about your sense of smell?
  • Do you have any dizziness or vertigo?
  • Are there any other signs or symptoms that worry or concern you?
  • Have you had any previous head injuries?
Rest while waiting for your appointment day.   Proper rest is a challenge, we know, and doesn’t mean simply staying in bed or on the couch.  Resting the brain means minimizing activities that demand focused attention – using the computer, watching television (really!), texting, playing video games and so forth.  You should also avoid sports and physical activities that increase the heart rate, including long walks, or require strong muscle contractions, such as weight-lifting.  Take acetaminophen (such as Tylenol and others) for headache pain or discomfort.  Stay away from aspirin or ibuprofen (Motrin, Advil and others) as there may be a risk of bleeding, something you want to avoid if you suspect concussion.
 
Tests and diagnosis:
If all the usual suspects are there – a blow to the head, upper body or neck followed by headache, dizziness, nausea and/or loss of consciousness – you’ve got yourself a concussion.  Keep in mind that these symptoms and signs may take their time showing up, a few hours, even a few days.  Your doctor may need to order imaging tests to determine the extent and severity of the injury.
Neurological exam
After you have answered the questions (above), your doctor may perform a neurological exam to evaluate the following:
  • Memory
  • Concentration
  • Hearing
  • Vision
  • Strength and sensation
  • Coordination
  • Balance
  • Reflexes
Imaging tests
The standard test to evaluate and assess the brain right after injury is a CT scan (cranial computerized tomography scan).  This involves multiple cross-sectional X-rays which are combined to produce highly detailed, two-dimensional images of the skull and brain.  The process is painless and should take less than ten minutes; during the test, you lie still on a table that slides through a large ring-shaped X-ray machine.
Such imaging is not always necessary following a traumatic brain injury.  You will likely need the scan if you:
  • Fell from a height of more than 3 feet (1 meter)
  • Were hit by a car or ejected from your seat in a motor vehicle accident
  • Are an older adult
  • Are under the influence of drugs or alcohol
  • Are unable to remember the accident for at least 30 minutes after it happened
  • Vomited repeatedly
  • Had a seizure
  • Have persistent short-term memory problems (retaining new information, after you’ve completely regained consciousness)
  • Suffered bruises, cuts or scrapes on your head and neck
  • Are confused or have other neurological symptoms and they are getting worse.
Observation, treatment and drugs
  • You may need to stay overnight in the hospital for observation.  If you can go home, you will need someone to check on you every few hours for at least 24 hours.  You may need to be awakened from time to time to be sure you can be roused to normal consciousness.
  • Rest is the best medicine in many cases.  Children require both physical and mental rest; school workloads should be reduced temporarily, and video games, television, email and the rest are out.
  • Acetaminophen is okay, aspirin and ibuprofen are out.
  • Return to competitive sports and related activities when your doctor okays it – and not before!
Prevention (always better than cure)
  • Buckle up! Wearing your seat belt may prevent serious injury, including head injury, during an accident.
  • Keep your house safe.  See that the house is well lighted and the floors clutter-free.  Falls  around the house are the leading cause of head injury for infants, toddlers and older adults.
  • Wear sensible shoes.  
  • Use caution in and around swimming areas.  Read and follow posted safety rules at pools and water parks.  Never dive into water less than 9 feet deep (that’s 3 meters).  If you don’t know how deep the water is, do not dive.  Period.  
  • Protect children.  Make sure they play sports that are age-appropriate.  Pad sharp edges and countertops.   Install window guards.  Block stairs – both up and down.  
  • Wear protective gear during sports and other recreational activities.  Make sure equipment fits properly, is in good condition and correctly worn.  Practice good sportsmanship.  Wear protective headgear when biking, snowboarding, motorcycling or during any other activity where head injury is a risk.  And don’t just talk the talk, walk the walk – safety practices are never on holiday.  Nor do they apply just to kids.  If you make safety and good sense a normal, integral part of any activity, so will your children.  
Have a lovely, injury-free weekend!
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