ER or Not: ConcussionsSep 24, 2013
Whether it's from an accidental fall or a head-cracking tackle on the sports field, concussions can be a common result. Learn about the symptoms of a concussion from ER doctor Troy Madsen, MD, and when you should visit the emergency room.
Dr. Troy Madsen: What's a concussion and how do you know if you or your young athlete has one. Plus today on ER or Not how bad does a headache have to be to go to the ER? I'm Dr. Troy Madsen Emergency Physician at the University of Utah Hospital that's today on The Scope right after Health Headlines.
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Scot: Here are your Health Headlines. I'm Scot Singpiel. The FDA today approved [beep]. In other health news [beep]. Does life make it impossible for you to get a workout in three or more times a week? Well good news because a recent study says how many times you exercise isn't as important as getting 150 minutes of exercise every week. People that only worked out once for 150 minutes were just as healthy as those that worked out more frequently according to a study published in the Journal of Applied Psychology, Nutrition, and Metabolism. So even if it's just all day on Saturday to get in that 150 minutes get in any way you can.
Dr. Troy Madsen: I'm a binge exerciser myself so.
Scot: Weekend warrior?
Dr. Troy Madsen: Yeah exactly. So if I can just take three hours go out hike, whatever, happy to hear that. Speaking of weekend warriors I was a warrior in the ER this weekend. Not my favorite thing to do as a weekend warrior, but one of the patients I've been... you know one of the patients I've seen recently in the ER is a young girl who's a cheerleader and her worst nightmare happened. She was being lifted by one of the male cheerleaders, he dropped her from above his head she fell down hit herself right on the head. She was unconscious, knocked out. I mean you can just imagine the drama at this scene with 15 high school cheerleaders around this girl who had just got knocked out.
So that's what we're talking about today; concussions. So what happens in the brain with a concussion? So every one of us has fluid around our brain and as we're moving our heads around that fluid just kind of keeps everything so it's not hitting the sides of your head or hitting the skull. It's kind of like the cushion of the brain, but what happens in a concussion is that that fluid just doesn't do its job. You get hit so hard that the brain is shaking around, it's hitting into the skull, and from that you get potentially damage to the brain. It shakes things around, it causes an impact on the electrical activity, and that's what makes you lose consciousness.
In this girls situation obviously she had hit her head, she had gotten knocked out, when I saw her she looked great. You know she was talking to me; she was alert, appropriate, a little bit slow on some of her responses, but again all things we often see with a concussion. So the big question in my mind as an ER doctor when I see someone like this I want to say, "Okay was this just a concussion or when she hit her head and it rattled around in her skull did something worse happen?" And so there I'm concerned about bleeding in the brain.
So the number one thing I look for as an emergency physician is do I need to get a CT scan of the brain. Fortunately for her the CT scan was negative. So at that point you're kind of left with well you know what do we do, and at this point it's kind of a long process of getting back to normal often times. People can have chronic issues with concussions where it can cause chronic headaches, nausea, vomiting, confusion, things that can kind of come and go. We've seen a lot in the news recently about football players, and a lot of the repeated head injuries some of the chronic issues with that where it may even cause personality changes, difficulty with memory, even in some cases in some football players possibly contributing to suicide. So it's some really horrible potentially devastating things from you know what at first may even seem maybe even kind of a minor injury or maybe not too serious.
What do you do if you have a head injury then? Well first of all if you've lost consciousness that's a concerning thing that should bring you to the ER. Other things I always look for are confusion, nausea, vomiting, any dizziness, difficulty walking, and certainly any neurologic symptoms like trouble speaking, or numbness, or tingling in your arms or legs. So those are all symptoms of a concussion, and all things that should bring you to the ER to get evaluated further.
So let's imagine you're a parent or a bystander of this situation where the cheerleader fell and hit her head. She's lying on the ground unconscious what do you do? Number one most people are going to wake up fairly quickly from a concussion, or from a head injury. Certainly if she's not responding call 911 get help there immediately, but if she does respond, and she's alert, she's talking to you, you know make sure her spine's okay. Make sure she's not having a lot of tenderness on her spine, and at that situation get her to the Emergency Department to get evaluated.
So our take home points from today are if you hit your head, if you have a head injury, keep an eye out for those symptoms nausea, vomiting, confusion, any trouble thinking, difficulty speaking, numbness, tingling be sure and get in to see us in the Emergency Department, and once you're there we'll make sure everything's okay in terms of the brain itself, and then get you on the right track to hopefully get you back on your feet and feeling normal after a concussion.
Scot: Is it bad enough to go to the Emergency Room or isn't it? Find out now. This is ER or Not on the scope.
Dr. Troy Madsen: So Scot what's our question for the day for ER or Not?
Scot: All right are you ready?
Dr. Troy Madsen: I think so.
Dr. Troy Madsen: These are always tough questions.
Scot: Rachel from Layton wants to know if you should go to the Emergency Room for a really bad headache. Now she's talking about worse than just everyday headaches, is that a reason to go to the ER? Headaches, ER or not?
Dr. Troy Madsen: This is a great question, and this is one we get all the time in the ER. We see lots of people with headaches, and the question in my mind is always is it serious or not? If you have a headache that is different from headaches you usually have, or it's a very severe headache you should go to the ER, and our number one concern in the ER is bleeding in the brain. Now you may have a brain aneurism, a vessel in your brain that's kind of dilated, or just like ballooned out, and that can rupture, and that's the big thing I worry about.
If you've got a new sudden severe headache some people talk about it as a thunderclap headache, just feels like a thunder just hitting your head. That's where we really get concerned. When you come into the ER in that situation we're typically going to get a CT scan. A scan of your brain to look for any sign of any bleeding. If it's a headache that's different, or much more severe than what you've had before you really need to come in and get checked out.
Next week on The Scope I'll tell you what you can do if you see someone having a seizure, and if putting a spoon in their mouth is a good idea or not. I'm Dr. Troy Madsen, thank you for listening to The Scope.
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