What to do immediately after a concussion

Acute concussion care

Concussion is most commonly spoken about as a sports related injury.  We commonly see concussion in such sports as, hockey, football, cheerleading, soccer and horseback riding.  The reality is that these injuries can happen at any time, and not just during sports.

A concussion can occur slipping on an icy surface, falling in the playground or at work, hitting your head off of a low ceiling, or as a result of a car accident.

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Regardless of the situation that led to the concussion, you should be aware of what steps to take immediately after sustaining a concussion.

Following a concussion, the first 24 to 48 hours are very important. Why? Because in some cases, there is potential for a more serious injury that may require immediate medical attention. This could include a brain bleed or swelling in the brain.

While it’s believed to be safe to take a nap or sleep after a concussion, the concussed person should be closely watched by an adult for at least 3 hours following the injury. The goal is to monitor for any signs of worsening condition. This could mean a more serious injury to the brain.

According to several studies, the rate of an abnormal CT scan in the emergency department following a concussion – which are potentially dangerous or life threatening – is up to 7% or less than 1 in 10 cases [1,2,3]. Of those cases, fewer than 2% require surgery [1,4]. In summary, the rates of these more severe complications are low, but they can happen.

Concussion Red Flags

Please take any and all precautions when a concussed person experiences certain symptoms after the injury. These Red Flags are signs of potentially more serious or life-threatening conditions.

Get medical attention at the nearest emergency department if you experience any of the following:

  • Bad headache that gets worse
  • Very drowsy or tired, or can’t be woken up
  • Vomiting
  • Can’t remember things that just happened
  • Can’t remember things 30 minutes before OR 30 minutes after injury
  • Can’t recognize people or places
  • Repeating the same things or questions over and over
  • Seizure
  • Blood coming from the ears, nose mouth or eyes
  • Bruising behind the ears, black eyes or very tender points on the face
  • Slurring words
  • Unsteadiness or severe balance problems
  • Weakness in the arms of legs

 

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The way that the injury happened may also play a factor.

For example, if you were in a car accident, hit by a car or fell down stairs, you should go to the emergency department as soon as possible. If you were using alcohol, cannabis or other illicit drugs at the time of injury you should also go to the emergency department to rule out more sinister complications.

A proper evaluation after the injury as well as evidence-informed advice about proper concussion management can have a big impact on your recovery.

The first 48 hours after concussion: What you can and can’t do

Rest: Do not go to sleep for at least 3 hours after the concussion. Make sure you have a responsible adult around to watch you for any signs of your condition getting worse.

If you’re the one watching the injured person, continue to talk to them. Are they slurring their words? Are they coherent? Do they know where they are? Are they repeating things? If you answer yes to any of these, take them to the emergency department.

Regular check-ins: This one is for the person monitoring the concussed person. Stand them up every 20 minutes, and have them close their eyes with their feet together. Are they wobbly? Are they swaying back and forth or side to side? If their balance is getting worse, take them to the emergency department.

Overnight check-ins: After 3 hours have passed, they can take a nap or go to sleep. While it’s not mandatory, we recommend that an adult checks on the injured person every 2 hours throughout the first night.

You don’t need to wake them up, but make sure they’re still breathing and seem okay. If there are any signs of their condition getting worse, take them to the emergency department right away.

Medication: Do not take any pain medication before talking to your doctor. Medications can “mask” the signs of a worsening condition and some can also increase the possibility of a brain bleed.

Make an appointment: You should get a full evaluation by an experienced healthcare practitioner that has specific training in concussion.  This appointment should be made within 2 days of the injury. Ideally, this would happen on the day of injury, or next day after injury. The faster you can get assessed by a healthcare provider with training or expertise in concussion management, the faster you can get on the path to recovery.

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Follow the guidance of your healthcare provider, early treatment and rehabilitation can help you get back to doing the things you love.

Complete Concussion Management is a network of clinics and trained practitioners that provide evidence-informed concussion care for all those impacted by concussion.

Concussion treatment and baselines testing can easily be booked online via ODECA online booking system.

Looking for more resources on concussion and how to implement concussion policy in your sport? Visit Complete Concussion Management

 

References/Disclaimer

[1] Easter, J. S., et al. (2015). Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult with Minor Head Trauma? Jama, 314(24), 2672–10. http://doi.org/10.1001/jama.2015.16316.

[2] Klassen, T.P., et al. (2000) Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Academic Emergency Medicine, 7(7),739-44.

[3] Davis, R.L., et al. (1994) Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Annals of Emergency Medicine, 24(4),640-5.

[4] Meehan, W. P., III, & Mannix, R. (2010). Pediatric Concussions in United States Emergency Departments in the Years 2002 to 2006. The Journal of Pediatrics, 157(6), 889–893. http://doi.org/10.1016/j.jpeds.2010.06.040.

Disclaimer

This information is designed to provide education and awareness. This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should always consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.

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