ER or Not: Line Drive to the HeadJun 11, 2014
You’re playing softball and get a line drive straight to the forehead. You might have a concussion and may need to go to the ER, but don’t know how to tell if you really need emergency help. Emergency room physician Dr. Troy Madsen discusses head injuries and how to know whether you should make a trip to the emergency room.
Interviewer: You're playing softball and you take a line drive to the forehead: E.R. or not? That's next on "The Scope".
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Interviewer: All right. It's time to play the game E.R. or Not, where we decide whether or not something that happened to you is worth going to the emergency room. We're with Dr. Troy Madsen, emergency room physician at University of Utah Hospital. Softball game, you're pitching, you take a line drive to the forehead. E.R. or not?
Dr. Madsen: Yeah, that's a tough one and this is something, a very common injury this time of year as people are out playing softball or various sports. And I remember playing soccer once and just got nailed in the head with the soccer ball, and I had that same thought. I thought, "Do I need to go to the E.R. for this or can I just kind of sleep it off?"
So the big question is, do you have bleeding in your brain? And that's the reason to go to the E.R. because that's an emergent thing. That's where you need to have something done, oftentimes very quickly, surgically oftentimes. Sometimes if it's small we'll observe you, but that's the question you have to ask yourself, "Are my symptoms concerning enough that I need to go to the E.R. and get a CT scan to my head for possible bleeding in my brain?"
Interviewer: That's the important thing.
Dr. Madsen: Yeah.
Interviewer: Bleeding in the brain.
Dr. Madsen: That's the number one risk right then.
Interviewer: How do I know?
Dr. Madsen: The big thing you're going to look for, number one, did you get knocked out? So that's the first red flag. A person who loses consciousness, we often think of those as being higher risk for bleeding in the brain. And then if you get knocked out, what happened after you got knocked out? Are you vomiting? Are you confused? Are you not sure where you are? As you try and think back over what happened prior to the head injury, do you have a tough time remembering the events that happened before it?
Did it make you lose some sort of memory for, say, 30 minutes before then? And just say, "I don't know what happened before then. Other people are telling me I got hit in the head with a softball, but the last thing I remember was driving to the game." Those are all red flags and all reasons to get a CT scan.
And this is all based on a great study that was done in Canada that's been replicated several times where they took these exact patients, said, "Okay. Someone comes in. They got knocked out. What kinds of symptoms raise their risk or make us more concerned about bleeding in the brain?" And they were exactly those things: tough time remembering things, nausea, vomiting, confusion where I'm just not quite sure where I am or what year it is. Those are all reasons to go to the E.R. and get a CT scan.
Interviewer: One of the things that I don't want to do is if somebody does get hit in the head and they don't lose consciousness, are they in the free and clear or could there be issues?
Dr. Madsen: That's a great question too, and it's often times a question we've asked ourselves as emergency physicians. And that's one area where there just aren't a lot of studies. But for me, if a person didn't lose consciousness, but they're having those other symptoms, again, maybe some trouble remembering things, confusion, nausea, vomiting. Those are reasons I would scan someone even if they didn't lose consciousness.
Interviewer: Is a concussion possible as well, or is concussion a different type of a bang to the head?
Dr. Madsen: No, just by definition, any time someone gets hit in the head and they have any symptoms afterwards-any headaches, confusion, and difficulty concentrating-those are all signs of a concussion. And a concussion isn't something where we're going to get a CT scan and diagnose it, but that's again a big issue. If it were me and I got hit in the head, and I had a headache afterwards, some trouble focusing on things, I wouldn't necessarily rush to the E.R. right then, but I would follow-up with my doctor because I have had a concussion.
And those are reasons to have a doctor. They can get you in to even see specialists who can do cognitive testing. So basically testing of your memory ability and your concentration and basically put you through a rehabilitation for your brain where they work with you on these sorts of things because concussions are a very serious thing too that can cause a lot of long-term issues.
Interviewer: A softball to the head though, would that be a one time? Could that cause a major concussion?
Dr. Madsen: It could.
Interviewer: Oh, okay.
Dr. Madsen: A softball to the head absolutely could.
Interviewer: All right.
Dr. Madsen: Yeah, that could, depending how fast it hits you. You could be talking about a pretty serious concussion there.
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