Trampolines, Teeth and Cuts With a Concussion!

I received a Rescue Fan’s email today that described what sounds like an accident on a trampoline.  Their friend hit their mouth on their head and now they sound as though they have concussion symptoms with a possible infection on the scalp.  They asked my opinion and the following is my reply.  It’s warm and it’s trampoline weather so if this happens to you or someone you know, I hope it helps!scalpcut

 

I wrote:

Ouch!  So, it sounds like your friend hit their mouth on your head and though it didn’t knock you out, it made you feel dizzy and now is painful/sore and maybe even a small abrasion or cut? If you’re feelings dizzy, nauseated(sick to your stomach) and have a headache, it sounds like you may have a concussion. As long as the symptoms get better with time from the concussion, you’re probably in pretty good shape.  Some people just take tylenol or another over the counter(OTC) pain medication for the headache.  With time and rest, it should get better.  If not, call your doctor.  If you it’s severe or you go unconscious, a family member should call 911.  The pain to the touch, redness, or cut and possibility of something coming from the wound may indicate an infection which could be a problem too.  If you think it’s something that could be getting infected, it sounds like it may have been a laceration.  If so, I’m not sure if needed stitches originally(didn’t sound that way from your story) but it’s probably too late for stitches at this point.  Some people like to put triple antibiotic on their cuts and abrasions to control infection.  If you’re not comfortable with over the counter or it’s really starting to concern you, it may be a good idea to see your doctor.  Have your mom take a look at the wound by separating your hair. Is there a laceration where the skin forms a fish mouth?  Is it oozing any white, or discolored and blood tinges secretion?  If any of these, then it’s probably a  good idea to see a doctor.  If not, and the wound is closed but red and sore, it’s common for people to get triple antibiotic at a drug store or grocery store, keep the wound clean and then put some of the ointment on the abrasion with a Qtip or cotton swab.  Do this until the wound is healed and not painful.  Wash your hands before and after all treatment to help not re-infect or infect the wound.

Remember, when in doubt, call your doctor and follow their advice.  In the meantime, I hope this helps.

What Is Cerebral Venous Sinus Thrombosis?

Hello Rescuers!

I received an email from a RoyOnRescue friend who had suffered a head injury while playing a sport.  After being seen by the doctor he was diagnosed with Cerebral Venous Sinus Thrombosis or (CVST).  He had asked me if I would give my explanation of what it is and if it was something he should be worried about.  His doctor had exCSVTplained it but he was still a bit foggy regarding the diagnosis.  Well, after looking into it from the clinical perspective, I realized that it was a pretty big deal and in some cases may be fatal.  I researched multiple sources to gather credible information and when it all came down to brass tacks, I found that the Wikipedia explanation had done a pretty dog-gone good job of summarizing CSVT.  So, with all credit given to them for most of this article and a link back to their website, here it is.

I have personally responded and treated many different types of head injuries as a paramedic but had not researched this problem to this level.  Then, shortly after receiving this question, I read that  Secretary of State, Hillary Clinton was diagnosed and hospitalized with the very same problem secondary to her head injury!  Ironic.   So, I thought to myself, if two people experienced this problem secondary to a common traumatic head injury(concussion), there may be more with the same question.

Here’s my trimmed-down version of what it is, what it’s symptoms are, how to determine if it is truly CSVT and then what a person may want to do if they think they may be suffering from such a complication.  So let’s dig into some of the questions you may have!  P.S.  You’ll notice there are more links then usual in this article.  The topic is so complex and has so many different facets I thought it wise to allow you to do some of your own information mining and hope the links make it easier.

Q:  What is a cerebral venous sinus thrombosis anyway?

A:  A CVST is the presence of thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. 

Q:  What causes a CVST?

A:  There can be many causes of CVST.  Here is a few I included:

Q:  How might I know if I have a CVST?

A: Headache that may worsen over the period of several days, but may also develop suddenly.  Strangely the headache may be the only symptom of cerebral venous sinus thrombosis.  Stroke, 40% of all patients have seizures, Common symptoms in the elderly with this condition are otherwise unexplained changes in mental status and a depressed level of consciousness.  The pressure around the brain may rise, causing papilledema (swelling of the optic disc) which may be experienced as visual problems.  In severely raised intracranial pressure, the level of consciousness is decreased, the blood pressure rises, the heart rate falls.  This is a common symptom found in closed head injuries which makes sense as the mechanism is very similar.

Q:  How will the doctor know if this is what I have?

A:  The most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram and  visualise the veins around the brain

Q:  How is a CVST treated and cured?

A: Treatment is with anticoagulants (medication that suppresses blood clotting), and rarely thrombolysis (enzymatic destruction of the blood clot). Given that there is usually an underlying cause for the disease, tests may be performed to look for these. The disease may be complicated by raised intracranial pressure, which may warrant surgical intervention such as the placement of a shunt.

AmbulanceQ:  Can this be serious?

A:  Yes.  Like any illness or injury that causes a problem with the circulation of oxygenated blood to our tissues, this type of problem can be very dangerous if left untreated.  It also runs a risk of complication in that it raises the intracranial pressures which can act similar to a closed head injury and this too can cause severe injury or death.  If a person has any of the symptoms listed above, they should be seen as soon as possible to rule out this potentially life threatening disorder.  If a person is reacting with decreased level of consciousness, or any type of life threatening complications, activation of Emergency Medical Services or 911 should be immediate with life saving or time buying intervention given.

 

I hope this helps and keep well!

See Source:

http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosis

http://neurology.jwatch.org/cgi/content/full/2007/515/2

http://www.medscape.com/viewarticle/705510_3

 

 

When Is It Safe To Return To Work or Sport After A Concussion?

Hello Everyone,

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

How to Hit Your Head on Pavement at 17MPH and Survive!

Imagine riding your road bike and as you near a curve in the bike trail hitting speeds of around 17 miles per hour your front tire instantly goes flat.  Now you’re trying to corner on a metal rim sliding across the pavement which has as much traction as an ice skating rink.   This is exactly what happened to Tom Monett, cycling enthusiast, big mountain skier, hiker and mountain climber.  As Tom’s bike slid out from underneath him, he didn’t have enough time to catch himself let alone think about what was about to happen.  As his head hit the pavement, and his ribs began to break, his wisdom to ride with personal protective equipment most likely made the difference between life and death.  Watch this episode of royonrescue to see the full interview and hear his story about surviving a high speed cycling crash.

Concussion

Warning!  Video contains graphic pictures of injuries and accidents.

Video Gallery of Actual Bike Accidents

Concussion vs. Closed Head Injury

Ever see someone hit their head very hard?   Wonder if it’s just a minor “Knock on the Noggin” or could it be a serious head injury?  In this Roy On Rescue Video Blog entry, Roy Shaw, EMT-Paramedic answers those questions with directives on how to assess, stabilize and treat a person for a serious head injury or minor. There’s nothing worse than sitting with a crying child or an injured adult and wonder if we are over reacting by calling 911, or under reacting by not doing more. Watch this video blog for some interesting insights straight from the Paramedics mouth on what to do.

Don’t miss this entry where Roy puts a common sense spin on how to handle the next event where someone hits their head and no one knows if they should go in to the hospital or just sleep off the headache.

Watch the video below if you would like to see a video animation of what happens in the skull when a person hits their head.

A website that shows a video explaining a traumatic closed head injury is located at: http://www.youtube.com/watch?v=AmAML1-F2LE